Treating Narcissistic Personality Disorder: 10 Stages You Must Know About

Treating Narcissistic Personality Disorder: 10 Stages You Must Know About

I point out that we update our cell phones, our computers, and our apps, but most of us are still running our life based on inner “software” that was programmed by a very young child. I suggest that they examine how their inner guiding voice talks to them and pay attention to the following things:

  • Do you like the tone of your inner voice?
  • Is it sweet, loving, harsh, or scary?
  • Is it fair?
  • Is it a reliable guide through life?
  • Does it reward you when you do well?
  • Can you please it?
  • Does it punish you with shame or guilt when you need to be reined in?
  • Is the punishment overly harsh?
  • Do you really require such harshness to get the message?


Once they are aware of the tone and content of their inner voice and understand that the way they speak to themselves can be changed, we explore what changes they might like to make.

Making the changes takes awareness and a willingness to challenge and inhibit the inner voice. Sometimes all that is needed is a firm “Stop that!” when the voice is overly harsh. Then clients practice talking to themselves in the new way that they have decided would be preferable. As with changing the coping mechanisms, this can take vigilance and many repetitions.

Note: You can usually tell how harsh someone is with themselves from listening to how harsh they are with other people. Inner harshness is proportionate to outer harshness. Blaming and judging other people is a way to redirect the harsh inner critic outward. This buys them some inner peace at other people’s expense.


Stage 9: Empathy for Other People.

Once they understand their own pain and have their harsh, devaluing inner voice more under control, they can start to look outward at other people. Generally, their first real emotional empathy for other people is evoked by someone who meets the following conditions:

  • They are no threat to the narcissist.
  • The other person reminds them of themselves.
  • This person is being traumatized or was traumatized in a way that is very similar to what the narcissist experienced.

If all goes well, some of these clients will continue to slowly expand their capacity for emotional empathy.


Stage 10: Authenticity.

My consistent and nonjudgmental interest in them and the dropping of their defenses improve our relationship. It can be a reparative emotional experience. They feel trust that they can be authentic with me because I have seen their “bad side” and nothing terrible has happened to either of us.

They take baby steps forward and try and be more authentic with other people. If this goes well, their reliance on their old “false self” defenses diminishes and they become more spontaneous and joyful.

“Narcissistic people are always struggling with the fact that the rest of the world doesn’t revolve around them” – unknown


The above is a highly abbreviated sketch of therapy for narcissistic personality disorder. It is complex, involves many stages, and is likely to take a long time. There is a lot of ground to cover. Sometimes people do not want to do all of this, or cannot do it all. Everyone who keeps plugging away at evolving eventually improves. How much depends on their willingness to keep working on themselves.

Find Elinor’s book on amazon: Borderline, Narcissistic, and Schizoid Adaptations: The Pursuit of Love, Admiration, and Safety.

Elinor’s website is


Here’s an interesting video that you may like:

It is difficult for people with narcissistic personality disorder to accept therapy and they usually don’t cooperate with mental health professionals during the stages of treatment. However, if you are suffering from NPD, you need to learn to work with your therapist and your loved ones if you hope to recover. Narcissism can also lead to depression and anxiety. Hence, it is crucial that you get help to treat this disorder and keep an open mind towards treatment.

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Peter Bloch

Dear Elinor, I was wondering… Read more »

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