Treating Narcissistic Personality Disorder: 10 Stages You Must Know About

Treating Narcissistic Personality Disorder: 10 Stages You Must Know About


Stage 2: Avoid Future Pain.

Some clients with NPD find therapy more interesting than they expected. If they are at all capable of self-reflection, they may continue long enough to understand their triggers and develop a plan that will help them avoid future pain. It is still all about them at this stage without any desire to understand or change their impact on other people. It is about understanding other people’s impact on them.


Stage 3: Identify their Coping Mechanisms.

In this stage, I am helping people understand and identify their primary defense patterns. It may involve looking at their childhood situation and how they learned to cope with it. This is still fairly easy because it can be explored (in many cases) without them feeling judged.

“I thought narcissism was about self-love till someone told me there is a flip side to it… It is unrequited self-love.” – Emily Levine


Stage 4: Create New Coping Mechanisms.

Now that the person knows what they do and why they do it, the old narcissistic strategies do not simply disappear. If you are holding on to the edge of a cliff with both hands, so as not to fall, you do not just let go because your climbing technique is inefficient or painful. So, we start discussing other ways that they can meet their needs that are more constructive. Eventually, they will identify new methods.


Stage 5: Form New Habits.

Most narcissistic coping mechanisms can be viewed as habits that are encoded in the brain through neuronal connections. The basic goal now is two-fold: (1) Inhibit the old, automatic narcissistic habits and (2) Substitute the new, more desirable patterns.

If this is done a few hundred times, the new method eventually gets encoded in the brain. The older narcissistic pattern of neuronal connections weakens through lack of use, and now the new coping mechanisms become the automatic default pattern.

If you would like to know more about what happens at the neuronal level when you try to change a habit, I suggest you check out the work of the Nobel Prize-winning biologist Gerald Edelman (1929-2014), especially his 1987 book: Neural Darwinism.


Stage 6: Impact on Other People.

Most of the time, clients with narcissistic defensive coping patterns cannot seriously consider their impact on other people until they have newer coping patterns in place. They will feel too much shame.

Their success in understanding themselves and forming new habits creates some realistic pride. This gives them less incentive to be grandiose, and more able to tolerate the idea that it might improve their life if they took other people’s needs into consideration. This is not about having more emotional empathy. We are still looking at everything through the lens of how it benefits them.


Stage 7: Focus on Childhood Pain.

At this stage, the clients are calmer and their life is generally calmer. They have learned what type of things trigger them and have developed more productive ways of coping with situations.

Now that some of their defenses against shame are less necessary, painful traumas from the past start to take center stage in the therapy. If this goes well, some healing takes place and in the process, they develop some emotional empathy for themselves as a child.

They also start to develop the capacity to form a stable, realistic, and integrated image of themselves (Whole Object Relations). This allows them to start to see other people in a more integrated way as well—neither all-good or all-bad.

“Narcissus weeps to find that his Image does not return his love.” – Mason Cooley


Stage 8: Update the Inner Voice.

Before they can develop emotional empathy for other people, most people with NPD need to empathize with themselves. Quite early in the therapy—at almost any stage—I start talking about how children automatically internalize their understanding of how their caregivers saw them, their caregivers’ ideas about right and wrong, and also their ideas about what deserves praise and blame.

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Peter Bloch

Dear Elinor, I was wondering… Read more »

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