Treating narcissism is difficult in part because most narcissists don’t believe they have a problem. Even if they do see that they need some help, it is difficult for them because of the internalized self-loathing they experience that causes them to view any guidance as criticism. Their self-esteem is so fragile that it requires a very delicate balancing act for a therapist to be able to guide them through a treatment plan. 

Most experts agree that psychotherapy rather than drug therapy is the best approach to treating narcissistic personality disorder (NPD), but there are different kinds of therapeutic approaches. The therapist also has to specifically avoid several potential pitfalls when treating a narcissist. 

Let’s take a closer look at the types of psychotherapy that work best for the patient with NPD and the particular pitfalls that therapists have to guard against when treating the narcissist. 

What Kinds of Therapy Work Best for Narcissists? 

As psychologist Mike King notes, “The literature is in general agreement that NPD is treated primarily with psychotherapy (talking therapy).” He also adds that the therapist should seek to change the narcissist’s grandiose manner of thinking and help them to both correct their self-centered behavior as well as regulate their emotions. 

It may also be necessary to teach them better social methods to interact with the other people in their lives. This can help to prevent them from abusing their children or spouse, and it can improve their friendships and workplace interactions. 

King states that it may occasionally be necessary to use medications to combat problems with depression or anxiety that typically occur in the NPD patient. Still, the question remains what specific kinds of talk therapy work best? 

What Types of Talk Therapy Work Best for NPD Patients? 

There are different kinds of talk therapy, and not all work equally well for treating NPD. Of the different kinds of psychotherapies that are used for NPD, the one that has shown the most promise is cognitive behavioral therapy (CBT), but let’s examine each of the different types and what they offer the NPD patient. 

Cognitive Behavioral Therapy

CBT combines cognitive therapy and behavioral therapy techniques to both examine how thoughts and beliefs affect the actions and mood of a narcissist with techniques that can help change unhealthy behavior patterns. 

This type of therapy will help a narcissist to focus on their current problems while developing solutions at the same time. Specifically, narcissists learn to identify irrational thoughts and those infamous distortions of reality they experience and then replace them with rational ideas. 

As an example, narcissists typically think in binary terms, that is, black and white with no gray areas. They also experience magical thinking and magnification so they blow things up into much more than what really occurred. CBT uses cognitive restructuring to help them see why their thoughts are irrational or blown out of proportion, and then they are able to work through rational solutions to any problems that remain. 

CBT also uses behavioral modification to help narcissists replace their harmful behaviors with healthy ones, exposure therapy to help them overcome fears, psychoeducation to teach them about their own disorder, and skills training to help them learn healthy problem-solving techniques. 

One useful form of CBT is dialectical behavior therapy (DBT) which helps those narcissists who have not experienced improvement with other techniques. It focuses on acceptance and problem-solving strategies specifically by bringing together opposite concepts like change and acceptance. The narcissist can learn to accept their cognitive distortion while at the same time learning to make helpful changes. 

Mentalization-Based Therapy

This is a technique used to treat borderline personality disorder, but it can also be helpful for NPD. It is rooted in attachment theory and operates based on the idea that people with certain types of personality disorders have a limited ability to mentalize due to neglect early in life that caused them to develop an insecure attachment to their primary caregiver. 

This limited ability to mentalize then causes them to have difficulty in identifying their own thoughts and emotions as well as those of other people. The goal of the therapy, therefore, is to help them improve their ability to mentalize. 

The therapist focuses on the narcissist’s mental state and their thoughts, feelings, and desires. By doing so, they can then help them to stabilize how they express emotion to reduce impulsive behaviors. Once they are successful at doing that, they can then more fully explore their own mind as well as the minds of other people. That can ultimately help a narcissist to become more empathetic. 

Schema Therapy

This type of therapy helps narcissists to recognize their unhealthy thoughts and behavioral patterns so that they can uncover the origins of their unmet emotional needs. By doing so, they can help to heal those past traumas and develop a greater sense of self, improved self-esteem, and greater self-worth. That will assist them in learning new methods to construct more nurturing relationships and experience more satisfaction from their life. 

Transference

This technique allows the narcissist to transfer the feelings and expectations they have for someone in their life onto the therapist. They then interact with the therapist as if they were that person. In this way, the therapist can help the narcissist develop healthier communication skills, and they can also work to heal old wounds. 

Can a Narcissist Be Cured? 

When talking about a personality disorder, it’s unlikely the person will be completely cured. It’s similar to the idea that an alcoholic is never cured, but they can stop drinking. They are considered a recovering alcoholic for the remainder of their life. 

In the same way, it would be more appropriate to say that someone can be a recovering narcissist. Therapy can help them to learn new ways of interacting, improve their own self-esteem and sense of self-worth, and heal old traumas that led to their mental disorder, but it can never completely rid them of the problem. 

It can, however, give them new ways of coping that will allow them to stop engaging in unhealthy behavioral patterns. It’s much the same as an alcoholic learning new techniques for coping with their illness so that they won’t drink. 

Final Thoughts

While a narcissist cannot be cured with psychotherapy, they can learn new ways to cope with their personality disorder so that they can experience a happier, healthier life. Cognitive behavioral therapy is one of the best types of therapy for NPD, though there are other methods that may work better for some narcissists. 

With a better understanding of the best types of therapy for NPD, you might also be interested in this blog article about the categories of personality disorders.