Skip to main content

Verified by Psychology Today

Therapy

Can Someone With BPD or NPD Change?

With appropriate therapy, it is possible to create change.

Key points

  • There are generally three requirements in order for someone with BPD or NPD to change.
  • Those who suffer from either of these disorders have built up defensive walls that often prevent them from changing.
  • There are special types of therapies that have proven effective for this population.
Beverly Engel
Source: Beverly Engel

The most common cause of both BPD and NPD is basically the same—severe neglect, abuse, or abandonment in childhood. But as we have discussed, not everyone with these experiences develops a personality disorder. The difference is that those who develop BPD or NPD experienced such extreme shame that they needed to build up a wall in order to protect themselves from being further shamed.

When most survivors of abuse and neglect reach adulthood and are around other people outside the home, they notice that their behavior is not acceptable to others. Or they experience a great deal of pain whenever they are in an intimate relationship. Once this occurs, many seek out counseling, self-help books, or seminars in order to change what they now realize is harmful behavior. But unfortunately, those who have developed a personality disorder due to the defensive wall they have built up are usually blind to the fact that their behavior is unacceptable or even damaging to others, even when it is brought to their attention. Instead, they are convinced that there is nothing wrong with them. Even when they are forced to acknowledge that their behavior is unacceptable, they refuse to actually believe it. They developed such powerful defenses that they are convinced that they are always right and that other people just don’t understand them.

Even though they may not consciously become abusive in their relationships, those with BPD or NPD frequently behave in abusive ways in their relationships. And unfortunately, they cannot readily change and are usually not motivated to do so. Even those who are willing to make changes typically need years of specialized psychotherapy in order to do so.

Basically, three things are generally required in order for someone with BPD or NPD to change:

  1. The person needs to become aware that they have a serious problem and that this problem is negatively affecting those around them (their partner, their children, their employees, or co-workers).
  2. The person needs to be highly motivated to change, either because their partner is threatening to leave them, their children are becoming alienated from them, or there is the threat of losing their job.
  3. They are willing to engage in appropriate therapy and willing to work hard to change.

Sadly, even when such a person does go into therapy, they seldom continue for long. And any so-called “changes” they make are usually short-lived. One of the main reasons for this is that they cannot or will not be self-reflective and therefore risk exposing their true self—even to themselves. It is always someone else’s fault. It is always the other person who needs fixing.

Even with good therapy, in which they are encouraged to become aware of how the walls they have built up keep them from true intimacy and how much better their life could be without those walls, most are not willing to do the work required to let down those walls. It is just too difficult for them to become vulnerable and to let down their defensive walls—even with a compassionate therapist.

Can Someone With BPD Change?

Until fairly recently, the diagnosis of BPD became associated with treatment resistance and poor prognosis. One important source of resistance in treating patients with BPD is their notion that change may entail betraying their family, as well as giving up habits they may feel work well for them in avoiding feelings. Another issue is that patients with BPD often feel entitled to special treatment and often seek only approving forms of attention from those who treat them. Such appeals for special treatment may prompt clinicians to worry that gratifying them can reinforce unrealistic interpersonal expectations, but that withholding may elicit reactive worsening of symptoms or dropping out of therapy.

Currently, thanks to the public being educated about this personality disorder, more and more people who suffer from BPD are getting the kind of help they need and are not as resistant to. Research has shown that therapies need to be specifically tailored to this population in order to achieve successful treatment. The most effective short-term treatment for BPD is called cognitive behavioral therapy or dialectical behavior therapy (DBT). DBT was developed only after it was realized that patients with BPD resisted a traditional behavioral approach. DBT incorporates techniques of validation and the concept of acceptance to a cognitive-behavioral framework.

Can a Narcissist Change?

Unfortunately, once a narcissistic individual loses respect for you, it may be nearly impossible to regain it. If he or she shows no signs of respect for you whatsoever—he sighs and rolls his eyes when you talk, she laughs at you when you try to stand up to her, he challenges you to try to live without him—then there is little chance of ever regaining his respect, and the relationship will continue to be an abusive one. Your best bet is to work on gaining enough strength to end the relationship. If you choose to stay, all you can do is cut off his aggressiveness and abusiveness by confronting it at the moment and work on building a strong enough sense of self that your partner cannot erode your identity.

On the other hand, there are some people with NPD or narcissistic tendencies who are willing to recognize how their behavior is damaging to their loved ones. But even those who are highly motivated to change will constantly be tempted to blame others for all the problems in the relationship or talk themselves out of taking a deep, serious look at themselves.

The most effective treatment for those suffering from NPD is psychodynamic psychotherapy. Due to the fact that their primary problems involve their relationships with others—namely: their lack of empathy, their sense of entitlement, their inability to trust others, and their rage—one-on-one therapy can teach them how to have an open, honest relationship that is not manipulative or exploitative.

Make sure to ask if the therapist has had specific training and experience working with those who have narcissistic tendencies. Some therapists are open to working with narcissists and others are not. The following forms of therapy have been effective in treating narcissism:

Cognitive behavior therapy (CBT): This form of therapy is often effective in changing destructive thought and behavior patterns. The goal of treatment is to alter distorted thoughts and create a more realistic self-image.

EMDR (eye movement desensitization): This treatment model can also be successful for those with narcissistic features (specifically within an AIP model). Narcissistic people can be described as overly focused on and protective of a highly valued image of self, an image that is often idealized, including having excessive self-valuation, attitudes of specialness, superiority, entitlement, and immunity to some of the common rules of appropriate behavior. This type of overly positive self-image, often based to a large degree on prior experience, is susceptible to targeting and resolution through EMDR-related interventions, just as the procedures of EMDR can resolve unpleasant emotion and overly negative self-definition.

Be Realistic About Your Partner Changing

While I strongly believe that any abuser who seeks professional help has a chance of stopping his or her behavior, unfortunately many refuse to get help, and even those who do often end therapy prematurely. One-on-one individual therapy offers an abuser the opportunity to show their true self to someone else in a safe environment. But this can be very threatening to someone who is abusive because in order to change, they must let down their defensive wall and allow the therapist to really see them. This act of vulnerability can be almost impossible for some.

There are definitely emotionally abusive partners who are not going to change, certainly not without professional help. Some are so shut down emotionally and so defended that they refuse to admit they have been abusive. Others are too afraid to look at their own history of being abused or neglected. Others lack the empathy to comprehend the pain they have caused. They can only focus on how their partner has hurt them.

If your abusive partner has shown you, by word or by action, that he (or she) does not respect you or the relationship enough to listen to you when you tell him he is being abusive and to take an honest look at himself and his behavior, I recommend you read my books, The Emotionally Abused Woman or Escaping Emotional Abuse. These books can help you to gain the necessary strength and courage to end the relationship.

To find a therapist, please visit the Psychology Today Therapy Directory.

References

Escaping Emotional Abuse: Healing from the Shame You Don't Deserve. (2021). Citadel Press: New York: NY.

advertisement