Yes, narcissistic personality disorder (NPD) can be treated with psychotherapy, though it remains one of the more challenging personality disorders to address. No medication can treat NPD itself, but several specialized therapy approaches have shown real results in reducing narcissistic traits, improving relationships, and helping people develop greater emotional awareness. The catch is that treatment requires sustained commitment, and roughly 63% to 64% of people with a formal NPD diagnosis drop out of therapy before finishing.
Why NPD Is Harder to Treat Than Most Conditions
NPD is what clinicians call an “egosyntonic” disorder. That means the person’s inflated self-image doesn’t feel like a problem to them. It feels like who they are. Someone with depression typically knows something is wrong and wants relief. Someone with NPD often sees their difficulties as other people’s fault, which makes the first step of seeking help an unusual one.
Even when someone with NPD does enter therapy, the process tends to hit specific roadblocks. The grandiosity that defines NPD is often a defense against deep internal vulnerability, and therapy requires lowering that defense. Patients frequently resist exploring their inner emotional states, engage in power struggles with their therapist, reject their diagnosis, or leave treatment when it starts to feel uncomfortable. These aren’t signs that therapy has failed. They’re predictable features of the disorder itself, and experienced therapists plan for them.
People with NPD also tend to overestimate their own ability to read others and understand social situations, which can make them dismissive of feedback. They often struggle to identify and express their own emotions, a trait called alexithymia. These gaps in self-awareness are central to the disorder and central to what treatment aims to change.
Mentalization-Based Therapy
One of the most promising approaches is mentalization-based therapy, or MBT. “Mentalizing” is the ability to understand that other people have their own thoughts, feelings, and motivations, and to accurately read what’s going on inside yourself. People with NPD have significant deficits in both areas: they struggle with empathy, have difficulty naming their own emotions, and tend to assume they understand others better than they actually do.
MBT works by helping patients slow down and examine what’s really happening in their interactions with others and within themselves. The theory behind it is rooted in early development. Children typically learn to mentalize through empathic, attuned interactions with caregivers, and that process gets disrupted in people who later develop pathological narcissism. MBT essentially rebuilds those skills in adulthood.
The evidence is encouraging. In an 18-month outpatient trial, about 75% of patients in MBT showed full recovery by the end of treatment, compared with just 25% in standard therapy. Patients in MBT also improved faster in areas like depression, social adjustment, and interpersonal functioning. A larger study of 205 patients confirmed that the ability to mentalize directly mediated the relationship between narcissistic traits and treatment outcomes, meaning that as mentalizing improved, symptoms like depression, anxiety, and even physical complaints decreased.
Schema Therapy
Schema therapy targets the deep, long-standing patterns (called schemas) that drive narcissistic behavior. These patterns typically form in childhood and operate below conscious awareness, shaping how someone interprets the world and reacts to it.
In people with NPD, the most prominent patterns tend to cluster around disconnection and rejection, along with feelings of entitlement, a need for approval, and a tendency toward subjugation. In practical terms, this means someone might simultaneously feel deeply unworthy of love, believe they deserve special treatment, and suppress their own needs while demanding recognition. These contradictions aren’t random. They’re layered defenses built over a lifetime.
Schema therapy also works with “modes,” which are the emotional states a person cycles through. Someone with NPD typically shifts between a vulnerable, hurt inner state and an outward self-aggrandizing mode that compensates for it, with a harsh internal critic driving both. Treatment involves helping the person recognize these shifts, connect with the vulnerability underneath, and gradually build a healthier, more integrated sense of self. The process is slow and intensive, often lasting two years or more.
Other Therapy Approaches
Dialectical behavior therapy (DBT), originally developed for borderline personality disorder, has been adapted for narcissistic traits as well. It focuses on four core skill areas: identifying and regulating emotions, tolerating distressing experiences without lashing out or shutting down, navigating relationships more effectively, and practicing mindfulness to manage unwanted feelings. For someone with NPD, these skills directly address the emotional volatility and interpersonal friction that cause the most day-to-day problems.
Cognitive behavioral therapy (CBT) in various forms is also used, sometimes blended with psychodynamic approaches. The common thread across all effective treatments is the same: helping the person develop a more accurate understanding of themselves and others, tolerate emotional discomfort, and build genuine (rather than transactional) connections.
What Medication Can and Can’t Do
No FDA-approved medication exists for NPD. You cannot take a pill to reduce narcissistic traits. However, NPD rarely shows up alone. Among people with a lifetime diagnosis of NPD, about 40% also struggle with substance abuse, 29% have mood disorders like depression, and 40% have anxiety disorders. Antidepressants, mood stabilizers, or other psychiatric medications can help manage these co-occurring conditions, which often makes the person more stable and better able to engage in therapy.
What Drives People With NPD to Seek Help
Because NPD feels normal to the person experiencing it, the trigger for seeking treatment is rarely the narcissism itself. More often, people enter therapy because of a crisis: a relationship falling apart, job loss, depression, substance use, or a growing sense of emptiness that their usual coping strategies can’t fill. Sometimes a partner or family member issues an ultimatum. The narcissistic patterns emerge during treatment as the underlying driver of these surface-level problems.
This matters because it shapes what treatment looks like in practice. A therapist working with someone with NPD typically won’t confront the narcissism head-on in early sessions. Instead, they’ll work with whatever brought the person in, build a therapeutic relationship, and gradually help the person see patterns they couldn’t see before. Pushing too hard too early is one of the fastest routes to that 63% dropout rate.
How Long Treatment Takes
NPD is a personality disorder, meaning the patterns are woven into someone’s identity and have been reinforced for decades. Treatment is not a matter of weeks or months. Most evidence-based approaches for NPD involve at least 18 months to two years of consistent therapy, often with sessions once or twice per week. The MBT trial that showed 75% recovery rates ran for 18 months. Schema therapy protocols for personality disorders typically run even longer.
Progress tends to come in stages. Early gains often show up as reduced depression and anxiety, better impulse control, and fewer interpersonal blowups. Deeper changes, like genuine empathy, more stable self-worth, and the ability to maintain close relationships without exploiting or devaluing the other person, take longer to develop and require the person to tolerate significant discomfort along the way. The vulnerability that narcissistic defenses were built to protect against has to be faced directly, which is exactly why so many people leave treatment before reaching that point.
For those who stay, though, the outcomes are real. Treatment doesn’t erase someone’s personality. It loosens the grip of patterns that cause suffering, both for the person with NPD and for the people around them.