Can you treat a narcissist?

Perhaps you know someone who always deflects blame onto you. Someone who smirks when caught in a lie, who twists your words until you’re apologising for their mistakes. And over time, you may start to wonder, can someone like this ever truly change?

You could be talking about a narcissist.

When people high in narcissism feel slighted or criticised, it threatens their fragile or inflated self-esteem, prompting them to react with aggression to protect their self-image. Naturally, when confronted with such behaviour, people often demand change from the narcissist.

But sometimes, the impact isn’t just on others – it’s on the narcissist themselves. Narcissists can be particularly prone to feeling rejected, likely due to the very behaviour that pushes people away. So, can narcissists change with psychological intervention?

First, it’s helpful to understand narcissism as viewed in psychology.

There are generally two types, grandiose and vulnerable. Grandiose narcissists tend to view themselves as superior to others whereas vulnerable narcissists tend to be hypersensitive to criticism. In both cases, narcissists can be arrogant and self-centred. If these traits become extreme, a person may be diagnosed with something like narcissistic personality disorder (NPD) or be described as having pathological narcissism.

Narcissists can act in a passive aggressive way to undermine you. For instance, such people may socially exclude others and withhold love and affection as a form of punishment.

Other times it may not be so subtle. Research has shown that narcissists can be prone to violence, even when unprovoked.

Pathological narcissism

While someone with NPD has a lifelong mental health disorder, meaning there is no “cure”, research does suggest that treatment can help manage the symptoms. Treating narcissism normally starts with talking therapies.

This is the classic therapeutic approach where a counsellor sits and talks to their client. The most common technique a counsellor will use for narcissists is cognitive behavioural therapy, which may help people notice and challenge inaccurate or unhelpful thoughts and change their behaviour.

But, when therapists were asked what they thought was the most effective approach as part of a 2015 study, they said they preferred introspective relational techniques. This involves the client exploring their feelings and motivations while the counsellor is nonjudgmental and understanding. That approach is key when working with narcissists because some patients assume the counsellor thinks they are vulnerable.

Fear of vulnerability often goes hand-in-hand with difficulty building a trusting relationship and rapport between the client and counsellor. For example, the client might feel the need to impress their therapist or maintain a confident image, rather than admitting any potential weakness.

Feelings of inadequacy, shame, guilt, aggression and victimisation, can all contribute to this defensiveness in people with narcissism. Counsellors have to recognise and work through these barriers for the intervention to be successful, which takes skill.

When they seek treatment narcissistic patients are often in a vulnerable symptom state, rather than grandiose. But these presentations can co-occur meaning grandiose traits will start to emerge during treatment. The counsellor may then recognise symptoms of NPD in that client and begin to tailor counselling to that diagnosis.

Woman in suit sits on a sofa opposite a therapist taking notes. The woman is wearing a white mask. — It takes skill to work with a narcissist in therapy. Elnur/Shutterstock

When those barriers hold steadfast, a patient may end their therapy early. There are several other reasons why a patient may drop out, but drop out rates for therapy in general range from 10–50% compared to 63-64% in narcissists.

It is also rare for someone with NPD to seek out therapy in the first place, as they often do not believe that they have a problem. People with NPD often visit their doctor or therapist for a different reason, such as an external problem (like a job loss or divorce) or emotional issue (perhaps depression from perceived rejection).

What are the alternatives?

Most innovations in personality disorder treatment comes from borderline personality disorder, and a few borderline personality disorder treatments have been adapted and tested for narcissists. These approaches tend to be successful in treating borderline personality disorder and examples include dialectical behaviour therapy, mentalisation-based therapy and schema therapy.

Dialectical behaviour therapy focuses on challenging negative thoughts and intense emotions, while accepting who you are. Mentalisation-based therapy helps you make sense of thoughts and beliefs and link them to your behaviour.

In comparison, schema therapy helps challenge unhelpful mental blueprints for how the world works. For instance, if you were neglected as a child you could develop a blueprint that says your needs will never be met by anyone.

But there is limited evidence that these approaches are effective for NPD. And they have the same barriers seen in introspective relational techniques like long treatment times and challenges in building rapport.

In light of these issues, in April 2025 psychiatric researchers Alexa Albert and Anthony Back suggested using psychedelic drugs during therapy could create a window of opportunity where narcissistic clients are more open and emotionally receptive.

MDMA, more commonly known as ecstasy, can enhance empathy, prosocial behaviour, and feelings of closeness to others. Although, MDMA-assisted therapy has seen success for some conditions, such as post traumatic stress disorder, it may also lead to worsening mental health.

Also, rapport is even more important when you introduce substances to therapy. Rapport is needed in MDMA-assisted therapy so the patient feels safe to trust their therapist while under the influence of the drug.

The treatment faces legal barriers too, since ecstasy is under Schedule 1 of the Misuse of Drugs regulations, meaning it has no recognised medicinal use in the UK. Researchers, mental health charities, patients, and some MPs have called for its movement into Schedule 2 to allow clinical trials, but no change has been made yet.

It is important to note that Albert and Back’s suggestion is theoretical, because they haven’t finished any clinical trials yet.

For now, therapists must rely on their skills to build rapport with patients and overcome treatment barriers without chemical assistance. So, yes, narcissists may change, but it takes great care from the therapist and the patience of both counsellor and client.

This article is republished from The Conversation, a nonprofit, independent news organization bringing you facts and trustworthy analysis to help you make sense of our complex world. It was written by: Jodie Raybould, Coventry University and Daniel Waldeck, Coventry University