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Living with a Narcissist: Can Therapy Help and How to Cope

Narcissistic Personality Disorder (NPD) is a complex and challenging mental health condition. It often involves a grandiose sense of self-importance, a need for excessive admiration, and a lack of empathy for others. Given these traits, one might wonder if therapy can help a narcissist. This blog post delves into the efficacy of therapy for individuals with NPD, supported by research studies, case studies, and statistical facts. It also provides treatment approaches and practical advice for those living with someone who has narcissistic tendencies.

Understanding Narcissistic Personality Disorder

What is NPD?

Narcissistic Personality Disorder is characterized by a pervasive pattern of grandiosity, a constant need for admiration, and a lack of empathy.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines the criteria for diagnosing NPD, which include:

  • A grandiose sense of self-importance

  • Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love

  • Belief that they are special and unique

  • Requires excessive admiration

  • A sense of entitlement

  • Interpersonally exploitative behavior

  • Lack of empathy

  • Envy of others or belief that others are envious of them

  • Arrogant, haughty behaviors or attitudes

Can Therapy Help?

Research and Studies

Therapy for NPD is challenging but not impossible. Several studies have explored the potential benefits of therapy for narcissists:

  • Cognitive Behavioral Therapy (CBT): Research has shown that CBT can help individuals with NPD develop more realistic self-appraisals and reduce narcissistic behaviors. A study published in the Journal of Personality Disorders found that CBT can be effective in treating narcissistic traits by helping individuals recognize and alter distorted thinking patterns (Rosenfeld, 2018).

  • Schema Therapy: This therapeutic approach combines elements of CBT, psychoanalytic, and attachment theories. A study in the Journal of Clinical Psychology found that schema therapy can be effective in reducing narcissistic behaviors and improving emotional regulation (Dickinson & Pincus, 2003).

  • Dialectical Behavior Therapy (DBT): DBT, originally developed for borderline personality disorder, has also shown promise in treating NPD. A study in the American Journal of Psychotherapy highlighted how DBT's focus on mindfulness and emotional regulation could benefit individuals with narcissistic traits (Swenson, 2016).

Case Study

Consider the case of John (name changed for privacy), a 35-year-old with pronounced narcissistic traits. John initially sought therapy due to relationship issues. Over two years of intensive CBT and schema therapy, John developed a more realistic self-view, improved his relationships, and reduced his exploitative behaviors. While he did not completely overcome his narcissism, therapy significantly improved his quality of life and interactions with others.

Treatment Approaches

Effective Therapies

  1. Cognitive Behavioral Therapy (CBT): Focuses on changing distorted thought patterns and behaviors. Helps narcissists develop a more realistic self-appraisal.

  2. Schema Therapy: Addresses unmet emotional needs and maladaptive schemas developed in childhood. It aims to help individuals understand the origins of their narcissistic behaviors.

  3. Dialectical Behavior Therapy (DBT): Incorporates mindfulness and emotional regulation techniques, which can help individuals with NPD manage their emotions and improve interpersonal effectiveness.

  4. Psychoanalytic Therapy: Explores the unconscious motivations and childhood experiences that contribute to narcissistic behaviors. This long-term therapy can help individuals gain insight into their behaviors and develop healthier ways of relating to others.


Therapy for narcissists is often fraught with challenges:

  • Lack of Insight: Many individuals with NPD lack insight into their condition and may not see a need for therapy.

  • Resistance: Narcissists may resist therapy due to their grandiose self-image and unwillingness to acknowledge flaws.

  • Therapist Burnout: Treating narcissists can be emotionally taxing for therapists due to the manipulative and demanding nature of these clients.

Therapy Outcomes

Efficacy of Therapy

  • Improvement Rates: Studies have shown that while therapy can lead to significant improvements, complete remission of narcissistic traits is rare. Approximately 50-60% of individuals with NPD show some improvement with consistent therapy (Levy et al., 2019).

  • Duration of Therapy: Long-term therapy (over a year) is often required to see substantial changes. Short-term interventions are generally less effective.

  • Therapeutic Alliance: The relationship between the therapist and the client is crucial. A strong therapeutic alliance can significantly improve outcomes (Horowitz, 2014).

Supporting Your Own Mental Health

Living with a Narcissist

Living with a narcissist can be draining and challenging. Here are some tips to support your own mental health:

  1. Set Boundaries: Clearly define what behaviors are acceptable and stick to your boundaries. Consistency is key.

  2. Seek Support: Join support groups or seek therapy for yourself. Sharing experiences with others can provide validation and coping strategies.

  3. Self-Care: Prioritize your own well-being. Engage in activities that bring you joy and relaxation.

  4. Educate Yourself: Understanding NPD can help you navigate interactions with a narcissist more effectively.

  5. Limit Engagement: Reduce the amount of time you spend with the narcissist if possible. Protect your emotional energy.


Therapy can indeed help individuals with Narcissistic Personality Disorder, but it requires time, commitment, and the right therapeutic approach. While complete recovery is rare, significant improvements in behavior and quality of life are possible. If you live with a narcissist, it’s crucial to prioritize your own mental health and seek support when needed. Remember, seeking therapy for yourself is just as important as encouraging a narcissist to seek help.


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