Maybe it is a partner, a parent, or a boss. You have watched the same pattern play out for years, and somewhere along the way you started wondering whether it will ever be different. It is a fair question, and an honest answer needs a little nuance. Change is possible for people with narcissistic personality disorder, but it is uncommon, slow, and depends almost entirely on the person choosing to do the work.
What Narcissistic Personality Disorder Actually Is
Narcissistic personality disorder, or NPD, is a mental health condition, not a personality insult. According to Mayo Clinic, people with NPD have an unreasonably high sense of their own importance, need constant and excessive admiration, and often struggle to recognize the needs and feelings of others.
Underneath that confidence, there is usually something fragile. Mayo Clinic notes that people with NPD can be easily upset by the slightest criticism and may respond with anger or contempt. That mix of grandiosity on the surface and sensitivity underneath is a big part of why change is hard.
It is also worth saying clearly: only a qualified clinician can diagnose NPD. Someone can be selfish, difficult, or hurtful without having a personality disorder, and calling a person a narcissist online or in an argument does not make it so. Our post on common myths about personality disorders clears up a few more misunderstandings.
Can a Narcissist Change?
Yes, it is possible, but it is not common, and it rarely happens without help.
The biggest barrier is recognition. Mayo Clinic points out that people with NPD may not want to think anything could be wrong with them, so most never seek treatment for the disorder at all. The ones who do end up in a therapist’s office usually come for something else. Depression is common. So is a drinking or drug problem, a marriage on the edge, or a performance review that went badly.
That is often where the opening is. A divorce, a firing, months of feeling flat and empty: when the pain lands on the person themselves, they may finally be willing to look at their part in it. Years of a spouse saying “you never listen” rarely makes a difference.
What Change Usually Looks Like
If you are hoping for a different person, that is probably not what you will get. Progress with NPD tends to be quiet and easy to miss. A man who used to walk out of meetings whenever his work was questioned starts staying in the room. A mother apologizes to her grown daughter, and for once the apology does not come with an explanation of why it was really the daughter’s fault. Small things, yes. To the people living with them, they can feel huge. The personality underneath stays largely the same, but the way it lands on others can soften.
What Makes Change More Likely
Most of it comes down to who wants the change. When therapy starts because a wife said “get help or I am leaving,” it often stops the moment she agrees to stay. When the person has a reason of their own, perhaps a lonely stretch after a divorce or a career that keeps stalling, they are more likely to stick around. And sticking around is the hard part. Sessions can be uncomfortable, sometimes every week, and a pattern that has been in place since someone’s twenties is not going to budge in a month or two. Many people quit before therapy has had a real chance.
How Therapy Treats Narcissistic Personality Disorder
The main treatment is talk therapy. Mayo Clinic is clear on this, and just as clear that no medicine treats NPD itself. Medication does have a place for the problems that often travel with it, like depression or anxiety, which is where medication management can help.
Therapy has practical goals. Mayo Clinic lists a few: getting along with people well enough that relationships feel closer and more rewarding, setting goals that are actually within reach, and accepting one’s real abilities so that criticism or failure does not feel like a catastrophe.
Therapy Approaches Clinicians May Use
There is no single method. Schema therapy is one that comes up often. It looks at the deep-rooted beliefs a person picked up early in life, such as “I have to be the best or I am nothing,” and how those beliefs shape the way they treat others today. Other approaches pay close attention to the relationship with the therapist itself. Say a client turns cold the moment the therapist questions them, or tries to charm their way past a hard topic. That reaction is useful, because it is probably the same thing their partner or coworkers see.
Research on NPD treatment is still more limited than for many other conditions, so no single method is clearly best. What tends to matter most is the person staying in therapy long enough to see change.
How Long It Takes
There is no set timeline. Therapy can be short-term during a crisis or ongoing to help someone reach and keep their goals. Because NPD involves patterns built over a lifetime, meaningful change usually takes a long time, and setbacks along the way are normal.
Will a Narcissist Ever Admit They Are Wrong?
Sometimes, but do not build your plans around it. Admitting fault can feel deeply threatening to someone with NPD, because it touches the fragile sense of self they work hard to protect. Even people making real progress in therapy may struggle with full apologies for a long time.
If you are waiting for an admission of guilt or accountability from a narcissist before you can move forward, it may help to shift the focus to what you need instead – whether or not that admission ever comes.
What You Can Do if Someone You Love Has Narcissistic Traits
You cannot make another adult change, and trying to force it usually backfires. What you can control is how you respond.
Boundaries are a good place to start. Decide what behavior you will accept, say it clearly and calmly, and follow through with the consequence you named. Our guide on how to handle a narcissistic person covers practical ways to protect yourself in day-to-day situations.
Support for you matters as much as anything else. Long-term relationships with someone who has narcissistic traits can wear down your confidence and leave you second-guessing yourself. Individual therapy gives you space to sort through that, and in Massachusetts, couples therapy and relationship counseling can help when both partners are willing to work on the relationship together.
If you feel unsafe in a relationship, or are being threatened or hurt, please reach out for help right away. Call 911 in an emergency.
Therapy and Support in Massachusetts at BNBA
BNBA offers therapy for personality disorders, along with individual therapy for anyone affected by a relationship with someone who has narcissistic traits. In Massachusetts, sessions are available in-person and via telehealth. Couples therapy and relationship counseling are offered in Massachusetts only.
If you are unsure where to start, call (508) 979-5557 or request an appointment online, and our intake team can help match you with the right clinician.
Frequently Asked Questions
Can Therapy Help a Narcissist?
It can – as long as the individual is willing to take part and stay with it. Treatment for NPD is talk therapy, and progress usually comes slowly, often showing up in the form of better relationships and an improved ability to handle criticism.
Is There Medication for Narcissistic Personality Disorder?
There are no medicines specifically used to treat NPD. Medication may help with related struggles such as depression or anxiety, but the primary treatment should be psychotherapy.
Why Do People With NPD Rarely Seek Treatment?
Many do not see their behavior as a problem, and admitting something is wrong can feel threatening. When they do start therapy, it is often for depression, substance use, or a life crisis rather than the personality disorder itself.
Should I Stay With Someone Who Has Narcissistic Traits?
That is a personal decision, and it helps to make it with support. Trusted friends and family members can help but professional support resources can also be very useful. A therapist can help you look at your needs, your safety, and the pattern of the relationship so that you can decide what is right for you.