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Narcissistic personality disorder (NPD) is best treated with talk therapy, which could involve cognitive behavioral therapy, dialectical behavior therapy, schema therapy, gestalt therapy, or similar approaches. A therapist will help a patient uncover the feelings that may drive their behavior and discover how to engage with themselves and those around them with greater empathy and understanding, fewer demands, and less defensiveness, with the goal of developing a more authentic sense of self that enables healthier relationships.

By developing a strong therapeutic relationship, and continually focusing patients on relationships, community, and connection, a therapist, through talk therapy, may be able to help someone with NPD change. In sessions, a therapist will help an individual achieve relief from their current stressors, including the treatment of co-occurring conditions such as anxiety or depression. A therapist may also help an individual to recognize unhealthy coping mechanisms, learn new ways of interacting with others, and eventually become able to feel and display empathy.

Therapy can be effective. After a serious setback or great loss, someone with NPD may be forced to recognize that they are not immune to life’s challenges. That can spur feelings of melancholy and depression that lead them to seek professional help. Once an individual decides to seek help, they have already taken a step that the majority of those with NPD never will. Still, people with NPD often quit therapy as they naturally resist feeling vulnerable, being challenged, or admitting to flaws.

It is notoriously difficult to convince someone with NPD to seek help. With their feelings of superiority, they may be unlikely to recognize or acknowledge that they have a problem, or that their problem is narcissism. Sometimes, they are aware that they are arrogant and that others resent them but they don’t see it as a problem because they are convinced of their superiority. People with NPD have trouble maintaining relationships, but family members and others who do feel close to them, and whose presence they value, may be able to encourage them to seek therapy.