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What is the Treatment for Narcissistic Personality Disorder?

Tricia Christensen
Updated May 17, 2024
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Treatment for narcissistic personality disorder typically entails several years of weekly psychotherapy sessions. Different theoretical approaches may govern how a therapist would conduct such sessions. Some clinicians favor theories established by Heinz Kohut and others lean toward approaches suggested by Otto Kernberg and James Masterson. These experts all employed Object Relations theories in different ways to address narcissism.

The matter is much more complex because narcissists usually don’t recognize their behavior as a disorder and if they enter therapy, it’s generally not to seek treatment for narcissistic personality disorder. Instead, people with this condition usually see a therapist because they’re experiencing problems or disappointments they view as having occurred through no fault of their own. Since the narcissist considers himself perfect, any problem exists outside of him, and therapy is viewed as an external solution that should correct the problem and doesn’t have anything to do with attending to personal issues or committing to transformative change. Helping the client transition to a view where personal behavior and mental status are acknowledged as contributing to disappointments or problems is very challenging.

As mentioned, a clinician could approach this in several ways. A Kohutian giving treatment for narcissistic personality disorder would likely work on developing a strong transferential relationship with the narcissist through use of mirroring techniques from a deeply empathic perspective. Mirroring affirms and makes clients feel valued and appreciated and they may, in turn, develop strong feelings for the therapist and feel safer examining the self.

Mirroring also models a way for the client to gradually turn empathy toward the self. Over time, the client develops compensatory structures that help to reduce the negative behaviors narcissism causes. Toward the end of his career, Kohut concluded that a full analysis such as that undertaken by a true Freudian wasn’t always necessary. Instead, once compensatory structures were established, many patients did well without additional therapy.

Other approaches in the treatment for narcissistic personality disorder are more confrontational. Therapists could directly point out inconsistencies or behavior patterns to the client that suggest problems and they may try to avoid mirroring because they don’t want clients to depend on therapists to fuel their narcissism. The danger of confrontation remains that a person with very strong defenses may merely decide to leave therapy. As long as the problems in life are viewed as external, anyone who appears not to be helping isn’t necessary. Early confrontation may only be appropriate to people who are higher functioning narcissists with some degree of tolerance for critique, and this doesn’t describe all people with the disorder.

No matter what theories of treatment for narcissistic personality disorder are used, therapists can shift their approach or include additional psychological theories that best serve each individual. In the end, therapy aims to help people with this condition recognize it, understand its underlying features, and work on changing behaviors.

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Tricia Christensen
By Tricia Christensen
With a Literature degree from Sonoma State University and years of experience as a WiseGeek contributor, Tricia Christensen is based in Northern California and brings a wealth of knowledge and passion to her writing. Her wide-ranging interests include reading, writing, medicine, art, film, history, politics, ethics, and religion, all of which she incorporates into her informative articles. Tricia is currently working on her first novel.
Discussion Comments
By fify — On Jul 14, 2014

There is no doubt that treating narcissistic personality disorder is a long process, a struggle. But I don't think that it's impossible to overcome this condition. I agree that the person should want to change. And I also think that most narcissists get to this point of wanting to change when they see that no one wants to be around them anymore.

Since the root cause of narcissism is ironically low-self esteem, this is one of the major points that they should work on in therapy. I actually think that as a narcissist becomes more confident, the narcissism will slowly decrease.

Also, many narcissists also suffer from other issues like depression and anxiety and these need to be dealt with too. My aunt had this disorder thirty some years ago. She still has issues now and again, but with consistent therapy, she has improved greatly. She is getting along with everyone now and the family loves being with her.

By SarahGen — On Jul 13, 2014

@donasmrs-- I agree with you. Another issue with NPD treatment is that narcissists don't react well to confrontation. This is one of the methods that doctors will use, but it's difficult to know how a narcissist will react. A narcissist can become very defensive and even abusive if their shortcomings and mistakes are pointed out to them.

By donasmrs — On Jul 13, 2014

I'm not an expert on this topic. But I briefly dated someone with this disorder and consequently read a lot about it. It seems that narcissistic personality disorder is one of the hardest things to treat.

The first step to treatment for any disorder is admitting that there is something wrong. And this is the hardest part for narcissists. Since they are unlikely to ever see fault in themselves, treatment can become impossible. I think when a narcissist admits to being wrong and faulty, there is a great likelihood that he or she will overcome this disorder. But making that happen is not easy. I think the individual needs to come to this realization on their own.

Tricia Christensen
Tricia Christensen
With a Literature degree from Sonoma State University and years of experience as a WiseGeek contributor, Tricia...
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