“To love one’s self is the beginning of a life-long romance.” ~Oscar Wilde~
A person diagnosed with Narcissistic Personality Disorder (NPD) has an abundance of treatment options open to them. Unfortunately, no one particular therapy or medication has proven to be highly effective, although most treatments can lessen some of the symptoms. NPD is an integral part of their personality and personality traits are difficult to change. Indeed, therapy may take several years. The short-term goal is to address issues such as depression, substance abuse, low self-esteem or shame. The long-term goal is to re-shape personality, at least to some degree, so that the person can create a realistic self-image. Other goals include learning to relate better to others, understanding emotions, understanding the strong need to compete, and to work on basic distrust of others.
Cognitive Behavioral Therapy
Cognitive behavioral therapy helps the narcissist learn to identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones. Generally, it seeks to identify maladaptive thoughts, appraisal, beliefs and reactions with the aim of influencing destructive negative emotions and problematic dysfunctional behaviors.
Psychotherapy (Dynamic or Psychoanalytic)
There is a difference between psychotherapy and psychoanalysis but the goal in both of these therapies is to strengthen the ego and to bring to the surface any unresolved conflicts or reasons for psychological tension so they may be resolved.
- Psychoanalytic – This was the first practice to be called a “psychotherapy”. It encourages the verbalization of all the patient’s thoughts, including free associations, fantasies, and dreams, from which the analyst formulates the nature of the unconscious conflicts which are causing the patient’s symptoms and character problems.
- Psychodynamic – A form of depth psychology, whose primary focus is to reveal the unconscious content of a client’s psyche in an effort to alleviate psychic tension. Although its roots are in psychoanalysis, psychodynamic therapy tends to be briefer and less intensive than traditional psychoanalysis.
This therapy brings the whole family together in therapy sessions to explore and resolve relationship difficulties. The client and his family examine conflicts, communication between members and utilize problem solving to cope with relationship problems.
Group therapy is where the person with NPD meets with a group of people with similar conditions. A word of caution here- a group should consist of only one or two NPD clients in the group; the rest should be made up from other disorders (see below). It can be helpful for teaching them how to relate better to others, how to listen to others, and how to learn about other peoples’ feelings as well as how to offer support.
However, narcissists are notoriously unsuitable for group efforts. They are individualists. They immediately distinguish others as either potential sources of ‘Narcissistic Supply’ or as potential competitors. They idealize the suppliers and belittle and denigrate the competitors. Obviously, this is not very conducive to group therapy.
Individuals with severe NPD are frequently hospitalized. This is especially true for those who are impulsive, self-destructive or who have poor reality-testing. Hospitalizations tend to be brief and the treatment should be specific to the involved symptom.
If long-term residential treatment is available, there is a second set of patients for whom hospitalization is indicated. These are patients who have poor motivation for outpatient treatment, fragile object relationships, chronic destructive acting out and chaotic lifestyles. An inpatient program offers an intensive therapeutic milieu including individual and family therapy as well as a structured residential environment.
There are no medications used specifically to treat NPD. However, there are medications that can effectively treat symptoms such as anxiety and depression or other conditions. Antidepressants or anti-anxiety medications have been proven to be helpful.
Can NPD be Cured?
Adult narcissists can rarely be “cured”, though some scholars and psychiatrists think otherwise. One thing is certain- the earlier the therapeutic intervention, the better the prognosis. However, an accurate diagnosis and the right combination of treatment modalities in early adolescence has shown success, without relapse, in approximately one third to one half of the cases. Additionally, aging seems to subdue or even vanquish some antisocial behaviors.
The third edition of the “Oxford Textbook of Psychiatry” (Oxford, Oxford University Press, reprinted 200, p. 128) cautions:
“… People cannot change their natures, but can only change their situations. There has been some progress in finding ways of effecting small changes in disorders of personality, but management still consists largely of helping the person to find a way of life that conflicts less with his character … Whatever treatment is used, aims should be modest and considerable time should be allowed to achieve them.”
One author believes the reason narcissism is under-reported and healing over-stated is that therapists are being fooled by smart narcissists (Sam Vaknin). Most narcissists are experts at manipulation and are consummate actors; they have learned how to deceive even their therapists.
Here are some facts postulated by Sam Vaknin, considered an expert in the field of narcissism:
- There are gradations and shades of narcissism. The differences between two narcissists can be great. The existences of grandiosity and empathy, or lack thereof, are not minor variations. They are serious predictors of future psychodynamics. The prognosis is much better if they do exist.
- There are cases of spontaneous healing, Acquired Situational Narcissism, and of “short-term NPD” [see Gunderson’s and Ronningstam work, 1996].
- The prognosis for a classical narcissist (grandiosity, lack of empathy, etc.) is decidedly not good as far as long-term, lasting, and complete healing.
BUT… Side effects, co-morbid disorders (such as Obsessive-Compulsive behaviors) and some aspects of NPD (the dysphorias, the persecutory delusions, the sense of entitlement, the pathological lying) can be modified (using talk therapy and, depending on the problem, medication). These are not long-term or complete solutions – but some of them do have long-term effects.