For someone with true narcissistic personality disorder (NPD), counseling is a longshot. Because one of the hallmarks of NPD is to deny you have the disorder, most people with it do not seek help. Many narcissists don’t even know they have a problem. 

Having said that, those who do seek help—likely at the urging of a partner or family member—will struggle to accept that their narcissism is problematic, but do have some ability to respond. If they can accept that their inner self is fragile, then they can tackle some of their narcissistic habits.

Change doesn’t come easily to a narcissist. Their delusions of grandeur and egocentric view of the world resist most therapeutic interventions. Still, counselors of all kinds have derived treatments with varying degrees of success.

If you are dealing with a narcissist, read further for some therapeutic interventions that might help—if not them, then you.

Prospects and Pitfalls

A lot of the reason why people with NPD don’t seek treatment is because they are actually quite successful, at least in one area of their lives. Many narcissists achieve high goals in their professional careers, and this may obscure the fact that they are living with a disorder that impacts the quality of their life otherwise.

Or, individuals with NPD create such elaborate fantasy worlds that they do not wish to relinquish those delusions. They are masking deep-seated insecurities and an incoherent sense of self, so to let go of the fantasy they’ve created would be truly devastating.

Still, if a narcissist is prompted by a loved one, insofar as a narcissist can love, then they can gain some insight into their personality and behavior through certain kinds of counseling. Many professionals agree, however, that this takes a lot of time and patience, with no guarantee of success.

Traits of NPD Therapy

Getting an individual with NPD to show up for counseling is the first step in their therapy. Just admitting that there may be an issue that they should confront is the first, and perhaps hardest, part of the battle.

Next, the counselor will work with the narcissist patient in order to identify what parts of their life aren’t working, pointing out that their interpersonal relationships often suffer. Showing the narcissist the consequences of their manipulative and demeaning actions can compel them to think about why they behave in those manners. This might lead to a reflection on their upbringing and family influences.

Finally, the counselor will help the narcissist to replace some of their harmful behavior with more positive habits. They will work together to encourage the narcissist to see that these new behaviors have better results. Of course, this is all crucially dependent on the narcissist accepting the fact that they have a disorder that actually requires treatment.

Types of NPD Therapy

There are numerous types of therapy that counselors might try with someone diagnosed with NPD, sometimes in combination. The various types aim to get at some of the underlying motivations and to work on behavioral change.

Of course, the standard is psychotherapy, or talk therapy, where you examine your history and the motivations for your actions. A successful offshoot of that therapy is cognitive behavioral therapy (CBT), which helps the patient recognize negative behavior and work to replace it with more positive conduct. This helps the narcissist develop better coping skills.

There are also several specific kinds of psychotherapy and CBT which each focus on something slightly different. For example, gestalt therapy focuses more on the present rather than finding instigations for behavior in the past. Mentalization-based therapy (MBT) focuses specifically on developing your ability for self-reflection. Dialectical behavioral therapy (DBT) is another form of CBT that involves mindfulness, in particular, and interpersonal skills.

Successful NPD Therapy

Some of the most successful therapeutic interventions into NPD are based on tackling the underlying issues with self-esteem. If a counselor is able to help the narcissist figure out the reasons behind their profound insecurities, then they are able to work together to rebuild that foundation.

Once the primary cause of the narcissistic behavior is acknowledged, the narcissist can begin to shed some of the bad habits that cause friction in their lives. The lack of self-worth that demands attention and inflates the ego for survival is gradually replaced by a more stable sense of self.

Other interventions focus on how the patient’s relationship with their parents affected them and influenced their narcissistic tendencies. Uncovering the fact that a narcissist was raised by narcissistic parents is often liberating for the patient. It enables them to separate themselves from that abusive upbringing, and through healing, learn better patterns of behavior.

Partners of Narcissists

Still, most true narcissists won’t seek help and may not benefit substantially from it. In these cases, counseling can be of great interest and assistance to family members, partners, and friends of narcissists. They can learn more effective ways in which to interact with the narcissist without leaving themselves open for emotional degradation or psychological manipulation.

RELATED: Check out this post about the ways you can support a narcissistic husband who is trying to heal.

The aim of this counseling is to help the loved ones of narcissists to recognize the behavior and understand that it is not their fault. It also helps these victims of narcissistic relationships to work on their own issues with self-esteem and begin to establish and maintain clear boundaries with the narcissist.

If the narcissist cannot or will not heal themselves, then it falls to the people in their lives to get help for their own recovery. In some cases, leading by example will convince the narcissist to move forward with their own counseling efforts.

Final Thoughts

While many narcissists are both resistant and unreceptive to therapy, some can be convinced that counseling will help, especially if their façade begins to crumble. Allowing the narcissist to take charge and to believe that this intervention is their idea will often help in breaking the ice.

If that narcissist, who always acts in self-interest, begins to see positive benefits from the counseling, then they may be more inclined to stick with it. However, don’t neglect your own needs and seek your own therapy should you be obligated to deal with a narcissist. Knowing what to expect when you have to stand up to a narcissist can also help you manage their manipulations.