Treating Narcissistic Personality Disorder: 10 Stages You Must Know About

Treating Narcissistic Personality Disorder: 10 Stages You Must Know About

Narcissistic personality disorder (NPD) not only affects the life of the sufferer but also impacts the lives of other people around them in unpleasant ways. Narcissistic people often struggle with their careers, relationships, and mental health issues. However, Narcissistic personality disorder can be treated to help the person with NPD live a normal healthy life.

“The greater our own level of narcissism, the more we detest it in others.” – Steve Maraboli


10 Stages in the Treatment of Narcissistic Personality Disorder

Narcissists can slowly change, with appropriate therapy and a lot of effort.

By Dr. Elinor Greenberg

The internet is full of sites by non-mental health professionals that say that narcissistic personality disorder cannot be treated. They also say that narcissists are master manipulators who can fool even experienced psychotherapists and what appears to progress is just a temporary behavior change. Or, else they claim that narcissists twist the truth and somehow manage to convince experienced psychotherapists that they are blameless and the real problem is someone else.

I would like to set the record straight: None of the above is true. There are effective treatments for narcissistic personality disorder. Change is difficult but possible. Everyone has the capacity to grow and evolve and this includes people with NPD.

Note: In this article, I am using the terms “narcissist,” “narcissistic,” and “NPD” as shorthand to describe people who qualify for a diagnosis of narcissistic personality disorder.


So why do so many people believe that NPD cannot be treated by psychotherapy?

There are three basic reasons that we do not hear about the successful treatment of narcissistic personality disorder:

  1. There are very few psychotherapy training institutes that focus on teaching the diagnosis and treatment of NPD. Most psychotherapy training programs are designed to turn out general practitioners, not specialists.
  2. This is a difficult, expensive, and time-consuming specialty to learn properly. At least three years of advanced training are necessary to become competent in this area.
  3. Most narcissists avoid psychotherapy or quit prematurely when they feel threatened or uncomfortable.

In summary: There are not enough psychotherapists available who are properly trained in the diagnosis and treatment of narcissistic personality disorder. Not many people with NPD actually want psychotherapy. And many who do want psychotherapy, do not realize that their underlying problem is narcissism. Their ignorance about the real nature of their issues leads them to choose the wrong type of therapist. This means that the majority of narcissists who enter therapy end up with psychotherapists who may not recognize that they have a narcissistic personality disorder, or if they do, they have no idea how to treat narcissistic issues.

Further adding to the difficulty, most narcissists quit therapy prematurely, even when they have a good therapist. This is usually because they find self-reflection incredibly painful. It involves dropping their defenses and facing their own underlying shame and low self-esteem.

“Narcissus does not fall in love with his reflection because it is beautiful, but because it is his. If it were his beauty that enthralled him, he would be set free in a few years by its fading.” – W.H. Auden


What is the therapy of narcissistic personality disorder actually like?

All psychotherapy takes longer than most clients expect. There is no ten-session cure for complex problems. Full psychotherapy of NPD generally takes at least 5-10 years. It is a long, slow, and complex process. It proceeds in stages. Clients can stop at any point. How far they get in therapy depends on how many stages they complete and how impaired they were, to begin with. High functioning narcissists who are self-reflective and cope with most parts of their life well are likely to do better in therapy than lower functioning narcissists who are unable to keep a job and have no friends.


The 10 Stages of Therapy for Narcissistic Disorders

Here is a very abbreviated look at the process. In reality, it may not be this neat or linear. And, please keep in mind, that different forms of therapy for NPD exist, and each may see the therapy process somewhat differently than I do. I am describing what my experience treating people with NPD for over 40 years has taught me.

Stage 1: Symptom Relief or Appeasement.

Most clients with NPD do not enter therapy in order to reflect or change. They usually come to get relief from unpleasant feelings and symptoms or to please someone important to them. Some leave as soon as they feel better or the person is appeased.

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4 thoughts on “Treating Narcissistic Personality Disorder: 10 Stages You Must Know About”

  1. Dear Elinor,
    I was wondering if there are any studies that support your experience? Ideally ones that are able to demonstrate that people diagnosed as clear and stable examples of NPD (i.e. not situationally or acutely severely narcissistic persons) by other competent professionals have been able to reach a point where (without coaching) they are able to relate as non-personality-disordered persons in a rigorous interview situation? In other words, research evidence that they have healed? And if so, what proportion of people who start this protracted treatment have attained this goal at the end?
    I do not at all reject your experience (most understanding starts with experience before more objective research is undertaken) but I am sure you will agree that there are few established ways of experiencing and relating with the world that ought, in theory, to be more refractory to treatment than NPD.
    With kind regards,

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