Jeff Young, PhD.

The number one thing family members want to know about their high conflict relative is, will they seek therapy? The next question should be, even if they do, will they be able to find the right person?

Jeffrey Young, Ph.D., who developed Schema Therapy at the Cognitive Therapy Center of New York specifically for people with borderline and/or narcissistic personality disorders, says that narcissists only seek therapy when they’re completely desperate: for example, if they’ve had a major defeat or a low level rejection that threatens their status. What is needed, essentially, is a strong enough trigger and intense internal pain that will not only motivate them to seek therapy, but will enable them to stay with it and stop blaming everyone else for their situation.

Once they start feeling a little better or the threat is gone, they will want to drop out. Then, clinicians must continually remind them of why they went into therapy in the first place. Therapists need to keep pointing out the long-term benefits of making changes.

The other difficulty is finding a qualified therapist who can see through the narcissist’s charming exterior and who won’t get beaten down by the narcissist’s constant criticism of their therapy methods. “Narcissists constantly criticize the therapist and challenge them in the same way they test everyone else,” says Jeffrey Young. “They try to control the therapy and do what they want to do instead of what the therapist thinks they need to do.”

Young says, “Perhaps you can convince 50% of narcissists in therapy to take responsibility for their problems, depending on the skill of the therapist. It could range from 0% in the case of a very inexperienced therapist; up to 60% for a very experienced therapist. The other 40% will leave therapy because they don’t like what the therapist has to say or because they don’t want to face it.”

Young says it’s harder to find a good NPD therapist than it is to find a good one for BPD—and that’s saying something. “Even though at Cognitive Therapy Center of New York we specialize in BPD and NPD, about a third of the therapists won’t see NPD patients because they trigger too many of the therapist’s own issues.”

Even if your narcissistic partner does go to therapy, has a great therapist, and sticks with it, do not expect her fundamental personality to change. She will still have the same urges to keep thinking, feeling, and behaving the same way. It’s a deep habit that feels good—or at least prevents her from feeling bad. Habits are hard to break, and making changes is a process, not an event, that can take years.

Your partner will not magically change into a sensitive, giving person who thinks of others first. This is completely unrealistic. Think of NPD as a chronic illness that will always prove challenging and can flare up at any time. It is truly up to you as to how much change you want and need before you feel comfortable in the relationship.

Copyright © 2015, Randi Kreger. This post (or any part of it) may not be reproduced without prior written permission.

Randi Kreger is the owner of BPDCentral.com and the Welcome to Oz online family community. You can find her books "The Essential Family Guide to Borderline Personality Disorder," "The Stop Walking on Eggshells Workbook," "Stop Walking on Eggshells," and "Splitting: Protecting Yourself While Divorcing a Borderline or Narcissist," at her store at BPDCentral.com.

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