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.

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

  1. Avatar of Peter Bloch

    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,

  2. Avatar of Channon Thompson
    Channon Thompson

    both of my parents have narcissitic borderline peronalities and im trying to build a better relationship with them by using psychology tricks they dont know im using …they were both very terrible parents…thankfully they broke up before i was ever old enough to remember them being together at all imagine the fights they both seperatley mentally emotionally and sometimes physicaly abused me and my siblings ….my kids will defintley have grandparents of my choosing rather than blood grandparents at times i feel like there is no hope and they will never ever ever change or see where they have messed things up …but ….i guess it takes a lot more patience than i think ….this is the reason im kind of leaning toward being a psychologist or psychotherapist as a carreer Idk if anyone can give me some hope that would be cool ….idk i think im at the breaking point …i havent directlly or inirectly spoken to my mother for years and the only reason i have contact with my father is because im kinda being forced to because due to a lack of any parental support in life ive found myself at rock botom many times since graduating highschool …so i now live with my wonderful grandmother ….and my failure of a father moved back in with her too ……greaaaaaaatttt ………if it was up to me id never speak with him again but trying to make the best of the situation idk …..any tip or pointers on how to deal with enraging ass behavior that arent here would be greatly appreciated

    1. Avatar of Jessica Yang

      Hey, I don’t know if you’ll read this, but here’s my reply anyway.
      I can’t imagine how terrible you’re feeling right now. Having abusive and narcissistic parents is a lot to deal with and I’m really sorry that you still have to live with your father. I grew up in a loving household, with kind parents, and I guess I have no idea what it feels like, having abuse among your first memories, and finding cruelty in the people you’re supposed to rely on, your parents.
      I wish you all the best with trying to build a better relationship with your parents, and dealing with living with your father. I guess, when you’re living with a narcissist, the best thing to do is acknowledge that he’s a narcissist. So when he degrades and insults you, know that what he’s saying isn’t true, but he just wants to say them to prove himself as superior.

      This is a really, really difficult time for you. I wish you all the best with whatever career you want to pursue, as a psychotherapist or anything else. When all this is behind you, your future self will congratulate you on your strength and patience.

      All the best
      Jessica Yang

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