Can Narcissistic Personality Disorder Be Treated?

It is possible for someone with narcissistic personality to develop new coping skills, improve relationships, and decrease distress levels.

A clear understanding of what personality disorders are is important to realize that it’s not as simple as figuring out “how to stop being a narcissist.”

Some experts describe personality disorders as behavioral adaptions. In other words, people with personality disorders may adapt to challenging situations — like abuse and neglect, for example — by developing certain traits and behaviors to protect themselves.

Some therapy approaches focus on unlearning these behaviors while developing new coping mechanisms. It’s possible to learn new behaviors and patterns of relating to others.

However, to accomplish this, the person needs to first become aware of the role some of their behaviors have in the difficulties they face.

Someone who still hasn’t reached this awareness might have a lower motivation to explore and address their symptoms.

The myth that therapy can’t help people with narcissistic personality largely stems from the fact that many never actually seek such help. They might not be aware they need it.

When people with narcissistic personality seek support from a therapist, they won’t necessarily want help addressing their narcissistic defenses. In fact, they may not even realize they have those defenses.

Often, other factors may provide the motivation to enter therapy, like:

• workplace challenges
• relationship challenges, or an ultimatum from a romantic partner
• problems in family relationships
• symptoms of anxiety or depression
• eating disorders
• substance use

So long as they continue to see therapy as something that offers benefits, they may continue to show up and put in effort — but much the same is true for anyone else.

When it comes to narcissistic personality, progress generally requires support from a skilled therapist who has experience working with personality disorders.

How do therapists treat narcissistic personality?

Regardless of the specific type of therapy someone chooses, therapists will typically help a person accomplish some general goals.

Common main goals of psychotherapy include:

• examining traits and behaviors that negatively affect life
• identifying ways these behaviors cause distress to the person and others
• exploring early experiences that contributed to narcissistic defenses
• developing new coping mechanisms to replace those defenses
• helping the person see themselves and others in more realistic and nuanced ways, rather than wholly good or wholly bad
• identifying and practicing more helpful patterns of behavior
• developing interpersonal skills
• learning to consider the needs and feelings of others

When exploring therapy options, a person can consider one of these:

Gestalt therapy

This approach to treatment largely focuses on present experiences.

Events from childhood or earlier adulthood might be explored. The work, however, will focus on how past emotions and experiences affect the present life.

Gestalt therapists often use specific techniques, including:

• role play
• the “hot seat” technique, or guided re-experiencing of challenging situations
• the “empty chair” technique, or guided exploration of conflicting aspects of personality
• questioning
• repeated or exaggerated movements
• guided imagery

These exercises can help uncover buried emotions and explore ways they affect someone’s emotional and physical reactions and behavior.

Learning to recognize the “how” and “why” behind actions can, in turn, boost self-awareness.

This increased awareness marks an important first step toward learning to accept feelings and take responsibility for one’s own actions. It can also contribute to a complete sense of self.

Schema therapy

This type of therapy combines elements of several other treatment approaches, including:

• emotion-focused therapy
• cognitive behavioral therapy (CBT)
• psychoanalysis
• psychodynamic therapy
• attachment theory

Schema therapists offer guidance with identifying and understanding patterns of behavior that develop in childhood when emotional needs go unfulfilled.

These patterns, called schemas, can persist throughout life, contributing to unhelpful or harmful coping styles. These coping styles can then prompt specific traits and behaviors, including the arrogance, entitlement, and grandiosity that can characterize narcissistic personality.

With a therapist’s support, you can learn to counter and heal unhelpful schemas by:

• experiencing and expressing emotions
• examining schemas in the context of personal relationships
• challenging and reframing thought patterns that cause distress
• finding evidence for and against early schemas
• practicing communication and other skills that promote positive growth

Transference-focused psychotherapy (TFP)

The therapeutic relationship is always important, but a strong therapeutic relationship is even more essential to the success of TFP.

Choosing a therapist you feel comfortable with can lead to better results.

Therapy can begin by establishing a unique contract with the therapist.

This contract helps the client and therapist outline boundaries around specific behaviors that might disrupt therapy progress.

You might, for example, agree to stay at your current job and avoid heavy substance use for the duration of therapy. You’ll also share key goals you’d like to achieve in therapy.

This approach focuses on splitting, a defense mechanism common in narcissistic personality. Splitting means you see people and situations as all good or all bad, rather than a combination.

This distorted thinking can fuel much of the distress someone with narcissistic personality experiences. It’s also why people with narcissistic personality have difficulty recognizing their own shortcomings: If they’re not perfect, they must be wholly inadequate and worthless.

TFP therapists help people build more realistic and integrated images of themselves and others through the use of transference.

In other words, you transfer emotions and thoughts that come up in sessions onto your therapist, who can then help you decipher them and explore more helpful reactions.

Mentalization-based therapy (MBT)

This psychodynamic approach to therapy helps the person develop and practice the ability to mentalize, or:

• understand and reflect on emotional experiences
• identify differences between one’s own emotions and those of others
• understand how thoughts and feelings affect behavior
• use this emotional insight to regulate behavior

Experts believe this skill develops as part of attachment and makes up an important part of personality development.

Traumatic experiences like neglect or abuse can prevent someone from forming secure attachments and learning to mentalize.

A key goal of MBT involves developing a secure therapeutic attachment, so the person feels safe enough to process and explore difficult and unwanted emotions.

Therapists might use transference and other strategies to achieve this goal.

MBT doesn’t just help you learn to understand and reflect on your own feelings. It also opens the door to a deeper insight into how others feel, which can help someone learn to respond more thoughtfully, productively, and with greater empathy.

Dialectical behavior therapy (DBT)

While DBT was developed from principles of CBT specifically to treat borderline personality disorder, it can help address narcissistic defenses, too.

This approach can help someone with narcissistic personality learn to:

• identify and regulate emotions
• tolerate uncomfortable or distressing experiences
• navigate interpersonal relationships more effectively
• boost mindfulness skills to better manage unwanted emotions

DBT usually includes group therapy along with individual therapy.

Group sessions offer the chance to practice communication and other interpersonal skills. These sessions can also help the person build empathy for others.

Metacognitive interpersonal therapy

This approach to therapy aims to address narcissistic defenses in a series of steps. These steps happen in two separate phases.

The first phase, stage setting, involves:

• exploring past experiences and memories in detail
• learning to identify emotions and understand what triggers them
• exploring schemas
• recognizing problematic and unhelpful relationship patterns
• recognizing and challenging perfectionistic tendencies and other traits contributing to emotional distress

The second phase, change promoting, involves:

• learning to identify differences between reality and internal self-concept
• recognizing people and situations as complex and nuanced, rather than wholly good or bad
• strengthening interpersonal skills, like honesty and empathic listening
• expanding awareness of others’ needs and feelings

Supportive psychotherapy

Some therapists may recommend supportive therapy for narcissistic personality.

This approach to treatment can help ease symptoms and distress without necessarily addressing the source of narcissistic defenses.

A therapist may:

• teach skills for managing unwanted emotions
• offer treatment for co-occurring symptoms like anxiety and depression
• help explore and resolve challenges in interpersonal relationships
• teach CBT techniques for challenging and reframing unpleasant thoughts
• help identify the benefits of working toward change

In some cases, a therapist might also recommend including loved ones in therapy.

The opportunity to better understand their thoughts and feelings can help the person with narcissistic personality take steps toward deeper empathy.

No medication can directly address narcissistic traits, but it can still offer some benefits.

People with narcissistic personality often find medication helpful for related symptoms.

Severe mental health symptoms can sometimes curb successful therapy.

If a person feels extremely anxious or lives with symptoms of depression or paranoia, they might have a hard time staying in treatment for narcissistic personality.

Antidepressants or anti-anxiety medications can help ease these symptoms, providing enough relief that therapy feels more manageable than overwhelming.

Sometimes, people with narcissistic personality live with symptoms of other mental health conditions. In these cases, like bipolar disorder, a psychiatrist might also recommend medication to help manage mood episodes.

Two things to keep in mind:

• Medication can help relieve symptoms, but it doesn’t address underlying causes.
• Some medications might cause unwanted side effects. It might be a good idea to discuss these with your healthcare team.

If your loved one has narcissistic personality, you might recognize that living with the condition isn’t easy.

When they choose to seek professional help, you might offer encouragement and praise their efforts. This can have a lot of benefits and can validate their effort to make progress.

At the same time, it’s essential to take care of your own needs, too.

For this, you might want to consider working with a therapist of your own. A therapist can offer guidance with:

• setting healthy boundaries
• recognizing abusive behavior and manipulation
• understanding what type of changes to expect
• establishing your own support system
• cultivating and maintaining a strong sense of self

Setting realistic expectations is also important.

Therapy for narcissistic personality may progress slowly, over a span of years rather than months.

Also, although change is possible, it doesn’t mean your loved one will radically change some of their behaviors or attitudes. It’s a process.

Treatment options exist for people living with narcissistic personality. It might be a long process, but change is possible and distress can be relieved.

A person with narcissistic personality may want to search for a local therapist who specializes in personality disorders.

Online therapy services often don’t treat personality disorders. Many therapists do offer counseling online, however, which can make it easier to find a provider who specializes in narcissistic personality.

Begin with these resources to start the process:

• American Psychiatric Association
• American Psychological Association
• National Alliance on Mental Illness
• National Institute of Mental Health
• U.S. Department of Health & Human Services
• Project Air