Many of us are involved with narcissists (people who have difficulty empathizing with others, and behave accordingly, often manipulatively.)  The narcissist may be your parent, your significant other, even your child.  In order to decide what your options are in this relationship, you’re wondering: Can a narcissist change?

I’m a therapist because I believe in the human capacity for change.  That being said, some changes are a lot easier to make than others.

Let’s distinguish between Axis I and Axis II diagnoses (these categories are, themselves, going to change soon with the DSM-5, but it still gives you a good idea of what we’re dealing with.)  Axis I are diagnoses like depression and anxiety.   When a person comes into my office with an Axis I diagnosis, I’m going to treat the symptoms of the disorder (for example, depressed mood, lethargy, changes in eating or sleeping patterns.)

But if someone comes in and I think they’re on the Axis II spectrum, treatment looks different.  Axis II includes personality disorders (like Narcissistic Personality Disorder) and personality traits that are problematic (like narcissistic tendencies that do not meet the criteria for a full-blown disorder.)   These are chronically disturbed ways of relating to the world that have likely persisted since childhood, and are themselves generally a product of some sort of childhood abuse and/or neglect.

Often, the person seeking treatment does not conceptualize their issues as being characterological in nature.  Narcissists often frame their problems in terms of the other people in their lives: Their problem is that they’re misunderstood.  They often want a therapist who will offer excessive sympathy, or give suggestions of how to change others.  They want a therapist who will provide validation for their view of the world.

In my experience, people with Narcissistic Personality Disorder have a tough road in order to change.  Their fragile egos make it difficult for them to admit that they could be at fault.  Even suggesting their role can threaten the therapeutic alliance.

What I always stress to people is that accepting that you are part of the problem (if not the entire problem) can be tremendously empowering.  Isn’t it better to put your energy toward changing yourself, and thereby change your life, rather than rely on others to do the changing?  Isn’t it better to take the proverbial bull by the horns?

In my work with people with personality disorders, the prognosis is best when the treatment is transparent and agreed upon.  If I think the problem is narcissism but I collude with the client in saying it’s just depression, I’m not helping anyone.  The treatment will inevitably fail.

So what’s key is finding a therapist who is experienced with personality disorders, and  can get the narcissist to buy into the idea that he/she is not weaker for admitting there’s a problem, but stronger.  That therapist needs to instill hope in the client.  And while this type of therapy still won’t be easy, and it won’t be quick, the goal of treatment needs to be development of empathy–learning to consciously take the other person’s perspective, something which happens fairly naturally for the non-narcissist.

If you’re involved with a narcissist who can admit to the difficulties of taking your perspective–and agrees that that’s a valuable skill to learn–then change is a real possibility (ideally, with the assistance of an experienced therapist, or with self-help books.)  In broaching this conversation, be very mindful that the narcissist might seem hard-shelled but is very fragile underneath.  Most important is communicating in a way that is non-shaming.

You could say something like, “I love you very much, and I know we often have difficulties understanding each other.  I’ve noticed that you seem to have a hard time seeing things from my perspective, and I think that happens with other people in your life, too.  I think maybe a book or therapy could help.”

Realize that the person might be initially resistant–it’s a very scary thing to be told you have something seriously wrong with you–but don’t give up.  Continue to address this in a compassionate way, and insist that your experiences are valid.  Something that often happens in a relationship with a narcissist is that you lose sight of yourself and your own needs.

The other reason you need to have a conversation like this is because it gives valuable information.  If the narcissist is not willing to confront his/her deficits, then you have your answer: No, they’re not going to change.  The question then is, What do you do with that information?