a. How narcissistic are they?

The best prospects for change are associated with the mildest versions of narcissism. Instead of describing mild narcissism, I find it helpful to think of narcissism on a continuum ranging from mild features (best prospect of change) to the Dark Triad, a constellation of extreme patterns of thinking, feeling and behavior. I’m going to share with you what more severe narcissism looks like to be able to know who is not a true candidate for long lasting change.

The Dark Triad

This is an extreme form of pathology, a constellation of behaviors. When narcissistic traits are part of a larger pattern of emotionally harmful, manipulative and exploitative behavior, change is less likely. The Dark Triad refers to three overlapping patterns of behavior:

1. Narcissism – A constant need for admiration, shallowness, fragile self-esteem, authoritarianism, envy and limited capacity for remorse or empathy. In their relationships, this shows up as recklessness with regard to other people’s mental health, entitlement, defensiveness, and prioritizing one’s own needs over others’.
2. Machiavellianism – A tendency toward manipulation, deceit, and strategic exploitation of others to achieve personal goals. People high in this trait are often calculating and emotionally detached.
3. Psychopathy – Impulsivity, a lack of remorse, shallow emotions, and disregard for others’ well-being. In relationships, this involves cruelty without guilt or concern for consequences.

When aspects of all three patterns are present, you cannot expect that therapy will yield a significant outcome. The damage to the victim caused by prolonged exposure to this form of pathology is often devastating, requiring extensive but achievable mental recovery.

Narcissism as described above is not the same as Narcissistic Personality Disorder (NPD), a diagnosable mental disorder found in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, text revision (DSM-5-TR). In order to be formally diagnosed with NPD by a mental health professional, a person must exhibit five of the following nine symptoms:

As shared on DukeHealth.org, the symptoms of NPD can be identified and remembered based on the acronym SPECIAL ME:

1. Sense of Self-Importance
2. Preoccupation with power, beauty or success
3. Entitlement
4. Can only be around people who are important or special
5. Interpersonally exploitative for their own gain
6. Arrogant
7. Lack of empathy
8. Must be admired and likes to be the center of attention
9. Envious of others or frequently believes that people are envious of them

People with NPD do not accept accountability for their behaviors, as opposed to people with narcissistic traits who have the capacity to own their actions and genuinely don’t want to hurt the people they love. Narcissistic tendencies usually does involve an aversion to taking responsibility and owning one’s actions, but the capacity is present.

Interpersonally, people with NPD rely on more manipulative, coercive and exploitative tactics.

b. Is the narcissistic individual intrinsically motivated for change?

When I have achieved success conducting therapy with clients who are labeled narcissistic, it has, without question, required that the individual shows intrinsic motivation to do better, be better, move on from past pain, create something new in life. This person needs to not be motivated to change based on external threats or conditions. Most often, a narcissistic individual will enter therapy based on an ultimatum from a loved one. In other words, there’s a situation that necessitates that they receive mental help, or else some negative consequence will occur. This could be the threat of a breakup, divorce, the cutting of of communication by a child of a narcissistic parent or sibling…some major threat.

When therapy has truly been effective with narcissistic individuals, it is because that person is extremely ready for change, and this readiness is because the individual, in their own private thoughts, wants to overcome problems (which they have fully owned) that have plagued them over the years AND they show a consistent pattern of remorse, not only when called out for their behavior,

c. Does the narcissistic individual have the capacity to sincerely apologize and take ownership of their behavior?

In order to move beyond narcissistic tendencies, you need to have the ability to naturally apologize and take responsibility for your actions. I don’t mean the type of apology that only gets pulled from you in response to extreme threats or the perception that all is lost if you don’t own your actions. A consistent pattern of genuine apologies requires that you have layers of perspective as to how your actions impact other people. You must be able to see that two people can have differing and equally valid perspectives and you must honor the other perspective as much as your own, especially when you’re dealing with a loved one who you have hurt.

You need to be able to genuinely acknowledge the hurt you caused AND you’re willing to pay the price needed to win back the trust of the people you hurt, even if it takes years. Accountability here is key. Without accountability and the willingness to verbally apologize, you have nothing to work with. If you tend to punish and blame people who make you have to look in the mirror at your own behavior, your ability to change is capped.

d. Does the narcissistic individual demonstrate long-term, committed action following their verbal agreements?

The people who overcome narcissistic tendencies tend to honor their commitments, vows, plans and dramatic declarations. Committed change in behavior doesn’t only follow being caught or hitting rock bottom in life. When there is a disruption in a relationship or when a commitment is broken, accountability follows in the form of ACTION, not just words. This ability to repair what you disrupt through ownership and committed action without the lies and manipulation is tell-tale sign of a better prognosis. A long term pattern of consistently repairing relationship disruptions tends to be reflective of a healthy motivation for change.

e. How much does the narcissistic individual rely on manipulation and lies to control the people they “love”?

When a complicated web of lies and manipulation is revealed, the prospects of true change is quite limited, especially when the truth has just been revealed. A narcissist might strongly agree to therapy and other changes, but the appearance of motivation after being “found out” and “outed” is not indicative of anything long lasting. In fact, my experience working in therapy with narcissistic clients who enter therapy because the lies were recently revealed tends to be short term.

If there is a true capacity for empathy and a consistent appreciation for the well-being and perspective of people they hurt, then change is possible. However, more often than not, narcissistic individuals who are pressured to enter therapy after severe lies and complex manipulations were revealed, plus the presence of an ultimatum, do not stay genuinely motivated for therapy or real accountable, long-lasting change.

Growth Potential vs. Resistance

f. What form of narcissism does psychotherapy have the best chance of helping?

First, implied in this question is the idea that some form of psychotherapy is necessary to bring about change in someone with narcissistic traits. Have you ever heard of a narcissist just changing on their own? In my experience, if this did actually occur, then the individual was most likely improperly labelled as a narcissist.

I have helped people to overcome narcissistic tendencies. The best outcomes seem to occur when the patient maintains a strong sense of righteousness and self-importance, but also has the capacity to see other people’s perspectives with mild to moderate redirection and reframing. Some people learn a pattern of expanding their ego by needing to be right and making other people wrong in a perpetual, addictive pattern (For more on this, see my article on the need to be right.)

An intolerance for opposing opinions can look narcissistic, but some people are full of love and very motivated to feel connected with people. They just get stuck on the the idea of being right.

Another thought pattern that can be helped in therapy is the idea that the world owes you something, a painful form of global resentment that represents a recipe for misery and disconnection from people. Life becomes repeatedly disappointing if you carry an expectation that people, relationships, specific events or the world as a whole is supposed to pay you back for something that happened to you. People who carry these unreasonable expectations tend to feel authorized to make their perspective known even when the situation doesn’t call for it. This sense of entitlement pushes people away and makes it hard for the individual to naturally empathize with other people’s problems.

When can narcissistic habits of thought be helped significantly in therapy with the right psychologist?

1. When the individual doesn’t exhibit the Machiavellianism and psychopathy emblematic of the Dark Triad. In other words, when the individual does not rely on manipulation, exploitation, lies and deceit, severe impulse-control issues and a chronic lack of remorse in addition to other narcissistic tendencies such as an inflated sense of self-importance and a need to be the center of attention. Another way of saying it is that people who have chronically relied on an intricate web of lies and deceit to manipulate others over a long period of time are very unlikely to change significantly in therapy.
2. When the individual has endured clearly identifiable a traumatic event(s). The original trauma can be treated, which can potentially lead to a reduction in the problematic thought patterns that developed out of a desperate attempt to cope with life-shaking trauma in early life.
3. When the individual tends to show deep remorse, guilt and an active conscience, even after relying on severe defensiveness and blaming others to handle being called out for something. I’m not talking about the kind of remorse that comes after many rounds of fighting and severe mental damage has been inflicted. I’m referring to enough of a self-reflective function that a person can snap out of their avoidance of accountability and step into full ownership of their behavior after only mild to moderate disagreement.
4. When the individual maintains deep friendships in which they can be vulnerable, honest and open to feedback. The ability to lean on close people in your life, even when sharing makes you feel shameful and vulnerable, suggests that you have an internal foundation for change. Most people with significant narcissistic tendencies maintain superficial relationships that rely more on what people can do for them. There is a lack of reciprocal sharing and open feedback. Please note that many people get fooled by a narcissist’s initial love bombing and future faking tactics in which the narcissist seems to completely bare their soul to the partner. So many people are fooled by this, marveling at how mentally healthy and open the narcissist is. Inevitably, in a romantic relationship with a narcissist, this level of incredible openness shuts down and only comes back in rare circumstances.

Essentially, there are people who, in an impulsive moment show a sudden need to self-protect by blaming others for their problems. They hold this stance for a period of time until they relent after a short time (maybe less than a day). For this person, blaming others is just a way to deflect and avoid the shame and sadness of their own choices. With some calm discussion they can shift from blaming others into an active and healthy stance of accountability without getting self-destructive, manipulative and threatening. If the narcissistic individual shows this pattern AND can empathize easily with people who are close to them, then the prognosis is much better. 

If we had to boil it down to one trait that predicts no change in therapy, it would be the presence of a chronic lack of empathy and remorse.

Please feel free to contact me with any questions or to schedule an initial consultation. I would like the opportunity to help you!

Wishing you all the best,

Gregory Kushnick, Psy.D.

Licensed Psychologist in New York City

Tel. 917-566-7312

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