Many people ask whether narcissists can change or benefit from therapy. Because narcissists see the cause of their problems as external due to their defenses of denial, distortion, and projection, their ability to look at themselves introspectively is limited. Thus, they don’t often come to individual therapy.
Narcissists only comprise 2-16 percent of therapy clients (McClean, 2007). When they seek treatment, it’s usually to manage an external problem, such as a divorce or work-related issue, or following a major blow to their fragile self. Sometimes they come because their spouse insisted on conjoint counseling, and occasionally, they seek treatment for loneliness and depression. Medication is sometimes used to treat their depression, but it isn’t effective to treat narcissistic personality disorder (NPD). But treatment can help.
Many therapists believe depth work should be avoided not only because the narcissists don’t believe their difficulties are a problem or due to themselves, but also because they need to strengthen their defenses against primitive feelings (Russell, 1985). One client who entered therapy during a tumultuous divorce soon quit. Self-examination tarnished his self-image, and he claimed it lowered his self-esteem. He complained that he needed a drink to get through each session and also resented the analyst’s fees. He felt they were exploitative, “typical of women,” including his soon to be ex-wife. (In fact, they were very high, but not atypical for NYC.)