The psychological treatment of narcissistic disorder has been studied by several authors. Theodore Millon (American psychologist) warns that when the environment surrounding the narcissist provides him with a good dose of reinforcement, it is very difficult for the person to go to therapy, as feelings of defensive greatness vaccinate them against dysfunctional and depressive feelings.

The fact that the narcissist has strong defense mechanisms, and high ability to function successfully in society diminish the chances that accept willingly the “defective” patient role.

Moreover, many of the narcissists who go to therapy, moved by the fact that they have touched some feeling of emptiness and inefficiency, are not willing to give up their defense and seek in therapy to ally themselves with the best professional to perfect the self rather than understand it.

Therefore, their lack of humility in receiving the idea of impropriety makes confrontation a very thorny issue, even when the therapist believes they have established a strong bond.

On the other hand, psychologists accustomed to providing their patients with warm support can reinforce the patient’s pride in the session and strengthen their defense by confirming their greatness. Although it may also happen that, from the warmth of support, the narcissist suddenly comes out of his/her defensive shell and leaves therapy denying his/her need for affection.

Theodore Millonstates that one of the most frequent mistakes made in therapy with these patients is to give rapid relief to depressive symptoms as soon as they appear, offering an excessive reinforcement of the achievements made in other sessions, without considering that the narcissist is usually considered “cured” as soon as his/her dysphoric symptoms return, when in reality the underlying pathology of the personality that causes them remains intact.

Because of the defensive automation of the patient with Narcissistic Personality Disorder, deep intervention is necessary if a truly structural and permanent change is to be brought about. It is necessary to bear in mind that these patients face a hard task as a consequence of their polar conception; if they are not magnificent they are nothing, and being nothing threatens their psychic existence.

Narcissism Treatment: The Perception of Nuances

Neither everything is white nor black. The narcissistic patient is polar in his conception of the world, or something/someone is magnificent or it is crap, and the war that he keeps out is the same one he sustains within, as far as the perception of himself is concerned. In this sense, it can be said that the narcissistic patient has a great resemblance to the adolescent, who in the search for his identity travels between the magnificent and the painful.

Narcissism Treatment

This conception of the world makes the narcissist suffer an emotional lability that leads to sudden mood swings and mood. The narcissist’s inflated expectations will lead him to have to endure acute frustration; a great anger due to his Oceanic desire; “I want everything and I want it already.”

A realistic disillusionment needs consolation, and this is what is most lacking in its early history, then its grandiose position largely obeys a hypo-developed ability to console itself.

During the therapeutic process the narcissist will go through the experience of suffering the loss; the patient will realize that the world of interpersonal contact will only approach what he desires in his fantasy and that the generous and perfect parents who are always there when they are needed and absent when the child needs space, are not possible even in childhood; in adult life, even less.

As the narcissistic patient contacts his most genuine feeling he begins to touch with one of the most thorny aspects of his process; frustration. All that does not fit your expectations will be an ordeal at the beginning of this new awareness. Awareness of your inner child may be gratifying in terms of winning your most playful and creative part. On the other hand, the emotional world of children is also shaped by tantrums, which emerge when things are not exactly as they expect.

Anger, Disappointment and Realistic Acceptance

It is hard for the narcissist to see that all the dreams he had built within him regarding the possibilities of Human Relations do not come far from the painful reality.

This lowering expectations produces emotions very similar to the stages of a duel, where it is not easy to give up the dream. The narcissistic patient finds himself in a renunciation problem, and the worst renunciation is that of what was never held.

We must not forget that the narcissist bases his search for love (more or less consciously) on the dream of finding that perfect and idealized bond. This leads him to maternal relationships.

From the disillusionment of the possibilities of contact with the other, the narcissist can begin to understand that love means to accept in the other a quota of defective humanity.

Psychotherapy is for the narcissist a second opportunity to find a point of anchorage and trust from where to begin to build something more solid, free and realistic, with the help of an adult bond to lean on.


Gestalt therapy has shown that from an excessive ego the person prevents himself from optimal contact with his environment, where he can satisfy affective needs that he fears so much.

Gestalt Therapy Rules

It is assumed that the narcissist who is being able to relax his rigid posture before the world can contact his affective needs without denying them, expand his arsenal of responses to relate from a more spontaneous attitude, and live the present without so much need for manipulation, compensatory fantasies, intellectualizations, self-deception, etc.

Feelings Of Emptiness

The process of change that a narcissistic patient will go through is to accept his other feeling of deflection (versus infliction), where the fall of the idea brings feelings of grief and a good dose of rage to destroy and shatter a fantasy situation in the face of the painful reality that has to be accepted.

As the narcissist becomes aware of the discrepancy between his image and reality, he can develop grief and abandon the energies employed in the maintenance of defense, in order to obtain the freedom to be what he is instead of what he pretends to be.

Throughout the therapeutic process the narcissistic patient goes through feelings of loneliness, and with the first feelings of loneliness also emerge the first needs of genuine contact with others, and the possibility of experiencing identifications with the other.


Therapeutic success is related to the abandonment of the need for perfection and the acceptance of what is more than obsession in what should be.

Gary Yontef provides data on the lack of authentic contact that narcissistic patients maintain with their parents and how this phenomenon is not discovered at the beginning of therapy, due to the great idealization that the patient brings from his family, especially from his mother.

The most important aspect of the childhood of this type of patient and one of the causes of his pathology is the feeling that he has not been properly perceived and reciprocated in such a way as to recognize his / her own self, including his / her emotional experience, needs, abilities, and weaknesses.


If the psychologist is able to establish a link with this patient, it is easier for the narcissist to unravel his false self constructed of fantasies and allow its authenticity to be made known.

From sensitivity and empathy, the therapist can report to the narcissist a corrective experience, where he is collected into his or her feelings and recognized as a valuable person, helping him or her in rebuilding his or her identity.

Then the successful completion of narcissistic personality disorder therapy is related to a profound change and an encounter with your true personal identity; a job that is always long in time if you want the person to gain a deep understanding of their functioning structure.


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