Types Of Therapy For Narcissistic Personality Disorder (NPD) and Narcissists

Can a narcissist change and if so, how?

The most difficult thing about getting a narcissist to change is getting them to see and accept that there is something they need to change. While this is challenging for all people, it is especially difficult for narcissists as they believe they are flawless. People with Narcissistic Personality Disorder (NPD) have an exaggerated sense of self-importance and believe that they are superior. Furthermore, they think that they are entitled to special treatment and they lack empathy. Due to these traits, it is incredibly difficult for a narcissist to see that they have flaws which they need to change so that they do not hurt the people in their life.

Narcissists comprise only 2-16% of all therapy clients.

More importantly, they do not seek to treat their personality disorder but to manage an external problem. This means that they tend to use therapy for work-related issues, trauma, or divorce. While narcissists do not seek to treat their disorder, therapy can treat NPD. However, it means admitting that you are not perfect and that you need help: this is something a narcissist finds impossible to do.

There are different types of approaches in therapy.

1. Individual therapy

This type of therapy consists of the therapist and their patient. In individual therapy, the patient is taught to look inwards and self-examine. This type of therapy tends to be difficult for narcissists as when self-examining, they will find that they are not perfect; this realization can shatter them and leave them with low self-esteem. Subsequently, they will most likely quit therapy and refuse to try it again.

2. Weekly sessions

If the patient has weekly therapy sessions, they will gradually notice how they make progress over time. A narcissist can learn how to manage their abusive tendencies by controlling their rage and anger. Moreover, they can be taught how to feel empathy by learning how to put themselves in the shoes of others.

3. Psychoanalytical therapy: 2-3 sessions weekly

This type of therapy is used to treat severe cases of NPD. Darlene Lancer, JD, LMFT explains that this treatment works using empathic mirroring which results in a “transmuting internalization” whereby the patient attributes the positive and caring attitude of their therapist. Lancer further claims that therapists should take 3 steps to bring the narcissist’s underlying painful affect. A therapist must first identify and acknowledge the patient’s painful affect with empathy and understanding. Then, they must stress the impact this affect has on the patient. Finally, they must “identify and explain the defense or resistance, which can be tied to step 1, by observing how it protects, calms, and soothes the patient from experiencing the painful affect. Care must be taken to avoid a narcissistic injury.”

4. Conjoint therapy

Co-therapy or conjoint therapy consists of the therapist and more than one patient (couples therapy). Conjoint therapy aims to give partners a more realistic and compassionate understanding of one another. The therapist will ask the partners to talk about their needs and what they want from each other. Moreover, they will be asked to share their feelings and how their partner’s behavior affects them. When they do so, the therapist can interrupt and point out unhealthy defenses which the couple employs. More importantly, they can connect the “couple’s pain to their individual past” to promote mutual empathy and compassion.

5. Individual therapy (for the narcissist’s partner)

As previously stated, narcissists are unlikely to attend therapy. Often, it is the narcissist’s partner who seeks help. The therapist will help them find out that their spouse/partner suffers from NPD and that they are not perfect. Thus, the analyst can teach their patient to de-idealize their partner and in turn, build self-esteem and autonomy. With time, the narcissist’s partner will learn how to speak assertively and set boundaries. This kind of therapy has the power to improve the relationship between a narcissist and their partner.

Just like everybody else, narcissists cannot change if they are not willing to seek help. If they do seek help, however, they will succeed in treating their disorder. 

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