The internet is full of websites run by non-mental health professionals who claim that Narcissistic Personality Disorder is incurable. They say that narcissists are skilled manipulators who can fool even experienced therapists and that what appears to be progress is only a temporary behavior change. Or they claim that narcissists twist the truth and somehow manage to convince experienced therapists that they are blameless and that the real problem lies with someone else.

I want to make things clear: None of this is true. There are effective treatments for Narcissistic Personality Disorder. Change is difficult, but it is possible. Everyone can grow and develop, and that includes people with Narcissistic Personality Disorder.

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

So why do so many people believe that Narcissistic Personality Disorder cannot be treated with therapy?

There are three main reasons why we don’t hear about successful treatment for Narcissistic Personality Disorder:

There are very few psychotherapy training institutions that focus on teaching the diagnosis and treatment of Narcissistic Personality Disorder. Most psychotherapy training programs are designed to produce general practitioners, not specialists.

This is a difficult, expensive, and time-consuming specialty to learn properly. It takes at least three years of advanced training to become competent in this field.

Most narcissists avoid psychotherapy or stop prematurely when they feel threatened or uncomfortable.

In short: There aren’t enough therapists available who are properly trained in diagnosing and treating NPD. Many people with NPD don’t want therapy. And many who do want therapy don’t realize that their underlying problem is narcissism. Their ignorance of the true nature of their problems leads them to choose the wrong type of therapist. This means that the majority of narcissists who enter therapy end up with therapists who may not recognize that they have NPD, or if they do, have no idea how to treat narcissistic issues.

To make matters worse, most narcissists leave therapy prematurely, even when they have a good therapist. This is usually because they find self-reflection incredibly painful. This involves letting down their guard and confronting their underlying shame and low self-esteem.

What Is Treatment for Narcissistic Personality Disorder Actually Like?

All therapy takes longer than most clients expect. There is no ten-session treatment for complex problems. Full psychotherapy for Narcissistic Personality Disorder typically takes at least 5-10 years. It is a long, slow, and complex process. It is done in stages. Clients can stop at any point. How far they progress in treatment depends on how many stages they have completed and how disabled they were to begin with. High-functioning narcissists who are self-reflective and doing well in most parts of their lives are likely to do better in treatment than low-functioning narcissists who can’t hold down a job and have no friends.

The 10 Stages of Narcissistic Personality Disorder Treatment

Here’s a very brief look at the process. In reality, it may not be that simple or linear. Please keep in mind that there are different forms of treatment for Narcissistic Personality Disorder, and each may see the treatment process somewhat differently than I do. I am describing what my experience treating people with Narcissistic Personality Disorder for over 40 years has taught me.

Stage 1: Symptom Relief or Remission. Most clients with Narcissistic Personality Disorder do not enter therapy with the goal of reflection or change. They usually come to relieve unpleasant feelings and symptoms or to please someone important to them. Some leave treatment once they feel better or the person is appeased.

Stage 2: Avoiding Future Pain. Some clients with NPD find the treatment more engaging than they anticipated. If they can self-reflect, they may stay long enough to understand their triggers and develop a plan to help them avoid future pain. It is still all about them at this stage with no desire to understand or change their impact on others. It is about understanding how others impact them.

Stage 3: Identifying Coping Mechanisms. At this stage, I help people understand and identify their core defense patterns. This may involve looking back 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.

Stage 4: Creating New Coping Mechanisms. Now that the person knows what they are doing and why they are doing it, old narcissistic strategies don’t just go away. If you were holding onto the edge of a cliff with both hands, so you wouldn’t fall, don’t let go simply because your climbing technique is ineffective or painful. So, we start discussing other ways they can meet their needs more constructively. Eventually, they will come up with new methods.

Stage 5: Forming New Habits. Most narcissistic coping mechanisms can be thought of as habits encoded in the brain through neural connections. The primary goal now is twofold: (1) to inhibit old, automatic narcissistic habits and (2) to replace them with new, more desirable patterns.

If this is done a few hundred times, the new method will eventually be encoded in the brain. The old narcissistic pattern of neural connections is weakened by disuse, and new coping mechanisms are now the default.

If you want to learn more about what happens at the neural level when you try to change a habit, I suggest checking out the work of Nobel Prize-winning biologist Gerald Edelman (1929-2014), especially his 1987 book, Neural Darwinism.

Stage 6: Impact on Others. Clients with defensive, narcissistic coping styles often can’t think seriously about their impact on others until they’ve implemented new coping styles. They feel a lot of shame.

Their success in understanding themselves and forming new habits creates some real pride. This gives them less incentive to brag and increases their tolerance for the idea that considering others’ needs can improve their lives. It’s not about more emotional empathy. We still see everything through the lens of how it benefits them.

Stage 7: Focus on Childhood Pain. At this stage, clients become calmer and their lives are generally calmer. They have learned what triggers 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 begin to take center stage in therapy. If all goes well, some healing occurs and in the process, they develop some emotional compassion for themselves as children.

They also begin to develop the ability to form a stable, realistic, and integrated image of themselves (whole-object relations). This allows them to begin to see other people in a more integrated way as well—neither all good nor all bad.

Stage 8: Updating the Inner Voice. Before they can develop emotional compassion for others, most people with NPD need to have compassion for themselves. Very early in therapy—at almost any stage—I start talking about how children automatically internalize their understanding of how caregivers see them, their caregivers’ ideas of right and wrong, and their ideas of what is praiseworthy and blameworthy.

I point out that we update our cell phones, computers, and apps, but most of us still run our lives based on an internal “program” that was programmed by a very young child. I suggest that they examine how their inner guiding voice speaks to them and pay attention to the following:

• Do you like the tone of your inner voice?
• Is it kind, loving, tough, or scary?
• Is it fair?
• Is it a reliable guide throughout life?
• Does it reward you when you do well?
• Can you please do it?
• Does it punish you with shame or guilt when you need to hold back?
• Is the punishment too harsh?
• Do you need that harshness to get the message?

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

Making changes requires awareness and a willingness to challenge and curb the inner voice. Sometimes all that is needed is a simple “Stop that!” when the voice is too harsh. Clients then practice talking to themselves in the new way they have decided will be preferable. As with changing coping mechanisms, this can take mindfulness and many repetitions.

Note: You can usually tell how harsh someone is on themselves by listening to how harsh they are on others. Inner harshness is proportional to outer harshness. Blaming and judging others is a way of redirecting the harsh inner critic outward. This buys them some inner peace at the expense of others.

Stage 9: Empathizing with Others. Once they understand their pain and have more control over their harsh, devaluing inner voice, they can begin to look outward at others. In general, the first real emotional empathy for others occurs in these narcissists when the following conditions are met:

• They are not a threat to the narcissist.
• The other person reminds them of themselves.
• This person is traumatized or has been traumatized in a way very similar to what the narcissist has been through.

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

Stage 10: Authenticity. My continued interest in them, their nonjudgment, and their dropping of their defenses improve our relationship. It can be a redemptive emotional experience. They feel confident in their ability to be honest with me because I have seen their “bad side” and nothing terrible has happened to either of us.

They take small steps forward and try to be more authentic with others. If all goes well, their reliance on their old defenses of the “false self” diminishes and they become more spontaneous and happy.

The above is a very brief outline of treatment for Narcissistic Personality Disorder. It is complex, involves many stages, and is likely to take a long time. There is a lot to cover. Sometimes people don’t want to do it all, or can’t do it all. Anyone who continues to work hard to improve eventually gets better. How much they improve depends on their willingness to continue working on themselves.