Treatment of Narcissistic Personality Disorder

Treatment of Narcissistic Personality Disorder

According to Greek mythology, when Narcissus was born the seer Tiresias was asked whether the child would live a long life. The seer replied, “If he never knows himself.”

Although the Greeks had a phenomenal grasp of narcissistic personality disorder (NPD), they apparently didn’t have a clue about treating it. Perhaps they didn’t want to, since narcissism was such an important part of Greek culture.

At any rate, knowing oneself is central to coping with most mental disorders. Yet the Greeks may have been right all along. Direct confrontation is usually needed to breach a NPD victim’s strong defenses. However, this can result in severe depression, and we all know what killed Narcissus.

Of course, this doesn’t mean that people suffering from narcissistic personality disorder should not be treated. On the contrary, they should be treated by competent health care professionals.

Drugs are generally not part of a NPD treatment program except where used to treat symptoms or to treat symptoms or side effects of NPD or co-occurring disorders. In fact, patients may regard medication as a sign of personal defectiveness and balk at treatment.

Thus, counseling is prescribed for people afflicted with narcissistic personality disorder. They need to learn to accept their limitations and to connect with other people emotionally.

Difficult Patients

Mental health professionals often find narcissistic personality disorder patients difficult to work with. Remember, these aren’t always the most cooperative patients. They may be in denial, or they may make unreasonable demands or criticism. Conversely, if a service provider responds negatively to a patient’s arrogance, the patient may interpret it as rejection.

Individuals with narcissistic personality disorder who seek therapy are seldom interested in changing. Rather, they’re usually seeking relief from depression, which is often precipitated by a crisis that punctures their narcissistic bubble, forcing them to see the discrepancy between their expectations or fantasies and reality. Even this depression hiding beneath the arrogance may consist of narcissistic outrage and humiliation. Narcissists often feel they aren’t responsible for the difficulties they have with other people.

Narcissists may regard treatment as demeaning. Even when a severe crisis compels them to seek treatment, their goal may be to treat the symptoms or even to reaffirm their inflated self-image, rather than treat the root cause.

Yet narcissists are psychologically frail, and service providers must deal with the disillusionment that almost inevitably follows when they burst their bubbles. They must be tactful but firm when confronting patients with the reality they are denying, trivializing or avoiding, remembering that vanity may mask vulnerability. All the while, a NPD patient may persist in blaming others for their problems, interpreting professional feedback as criticism and even adopting an air of superiority over the service provider.

Alternatively, service providers may initially enjoy the company of clients with NPD, who may flatter their counselors. But the relationship changes when the provider realizes s/he is doing all the work. The provider may then feel devalued and may either work harder to win the patient’s approval or become angry or rejecting. Catch-22.

Other “countertransference” issues with NPD clients include boredom, frustration, anger and a feeling of being ignored; treatment providers may even come to feel that they don’t quite exist in the treatment room with their subject. For many people afflicted with narcissistic personality disorder, life is a one-man show, with no room even for mental health providers.

Mend it, Don’t End It

Mental health specialists should not attempt to make individuals with personality disorders what they can never be. Since all personality disorders have strengths, along with weaknesses, treatment should aim at the most adaptive expression of that particular personality style.

Remember, narcissism is merely an exaggeration of a healthy phenomenon, an exaggeration that has helped produce some of our greatest political leaders, movie stars and talk show hosts.

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