How do narcissists stop their inner shame

10 stages in the treatment of narcissistic disorders

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The internet is full of websites run by non-psychologists who say Narcissistic Personality Disorder cannot be treated. They also say that narcissists are master manipulators who can fool even seasoned psychotherapists, and what appears as progress is just a temporary change in behavior. Or they claim that narcissists twist the truth and somehow manage to convince experienced psychotherapists that they are impeccable and that the real problem is someone else.

I want to get the record straight: none of the above statements are true. There are effective treatments for narcissistic personality disorder. Change is difficult, but possible. Everyone has the ability to grow and develop, and that includes people with NPD.

Note: In this article, I use the terms “narcissistic,” “narcissistic,” and “NPD” as shorthands to describe individuals who qualify for a diagnosis of narcissistic personality disorder.



Why do so many people believe that NPD cannot be treated? Psychotherapy?

There are three basic reasons we don't hear about successfully treating narcissistic personality disorders:

  1. There are very few psychotherapeutic training institutes that focus on teaching the diagnosis and treatment of NPD. Most psychotherapy training programs are aimed at general practitioners, not specialists.
  2. This is a difficult, expensive, and time-consuming specialty to learn properly. At least three years of advanced training are required to become competent in this area.
  3. Most narcissists avoid psychotherapy or give up prematurely when they feel threatened or uncomfortable.

In summary: There are not enough psychotherapists available who are adequately trained in the diagnosis and treatment of narcissistic personality disorders. Not many people with NPD actually want psychotherapy. And many who want psychotherapy fail to realize that their underlying problem is narcissism. Their ignorance of the true nature of their problems leads them to choose the wrong type of therapist. This means that the majority of narcissists entering therapy have psychotherapists who may not realize they have narcissistic personality disorder or, if they do, have no idea how to treat narcissistic problems.

In addition, most narcissists drop out of therapy prematurely, even if they have a good therapist. This is usually because they find self-reflection incredibly painful. It's about dropping their defenses and facing their own core value, shame and deep self-respect.



What is narcissistic personality disorder therapy like?

Any psychotherapy takes longer than most clients expect. There is no cure for complex problems in ten sessions. Full psychotherapy for the NPD usually takes at least 5-10 years. It's a long, slow, and complex process. It continues step by step. Customers can stop at any time. How far you get in therapy depends on how many stages you complete and how severely impaired you were initially. High-functioning narcissists who are self-reflective and handle most parts of their lives well are likely to perform better in therapy than low-functioning narcissists who cannot keep a job and have no friends.

The 10 levels of therapy for narcissistic disorders

Here's a very condensed look at the process. In reality, it can't be that neat or linear. And please remember that there are different forms of therapy for NPD and that everyone can see the therapy process a little differently than I do. I am describing what my experience in treating people with NPD has taught me for over 40 years.

Stage 1: symptom relief or appeasement. Most patients with NPD do not enter therapy to reflect or change. They usually come to get rid of uncomfortable feelings and symptoms, or to please someone they care about. Some leave as soon as they feel better or the person is appeased.

Stage 2: Avoid future pain.Some patients with NPD find the therapy more interesting than expected. If they are capable of self-reflection at all, they can go on long enough to understand their triggers and come up with a plan to help them avoid future pain. At this stage, everything still revolves around them without them understanding or wanting to change their impact on other people. It's about understanding the impact other people have on them.

Stage 3: Identify your coping mechanisms. In this phase I help people understand and identify their primary defense patterns. It may be looking at their childhood situation and how they learned to deal with it. This is still pretty easy as it can (in many cases) be investigated without them feeling judged.

Stage 4: Create new coping mechanisms. Now that the person knows what they are doing and why they are doing it, the old narcissistic strategies do not just go away. If you hold onto the edge of a cliff with both hands so you don't fall, don't just let go because your climbing technique is inefficient or painful. So we're discussing other ways they can meet their more constructive needs. Eventually they will identify new methods.

Level 5: Form new habits.Most narcissistic coping mechanisms can be thought of as habits encoded in the brain by neural connections. The basic goal now is twofold: (1) inhibiting the old, automatic narcissistic habits, and (2) replacing the new, more desirable patterns.

If this is done a few hundred times, the new method will eventually be coded in the brain. The older narcissistic pattern of neural connections weakens with lack of use, and now the new coping mechanisms are becoming the standard automatic pattern.

If you want to learn more about what happens at the neural level when you try to change a habit, we recommend reading the work of Nobel Prize winner Gerald Edelman (1929-2014), especially his book from 1987: Neural Darwinism.

Level 6: Effects on other people.In most cases, clients with narcissistic defensive coping patterns cannot seriously consider their effects on other people until they have newer coping patterns. You will be too ashamed.

Your success in understanding yourself and developing new habits creates realistic pride. This gives them less incentive to be grandiose and more ability to tolerate the idea that taking other people's needs into account could make their lives better. This is not about being more emotional with empathy. We are still looking at everything through the lens as it is useful to them.

Level 7: focus on childhood pain. At this point, customers are calmer and their lives are generally calmer. They have learned what kind of things they trigger and have developed more productive methods of dealing with situations.

Now that some of your shame defenses are less necessary and painful, past trauma is beginning to be the focus of therapy. If this goes well, some healing will take place and in the process you will develop an emotional empathy for yourself as a child.

You will also begin to develop the ability to create a stable, realistic and integrated picture of yourself (Whole Object Relations). This enables them to see other people in a more integrated way - neither all good nor all bad.

Stage 8: Update the inner voice.Before they can develop emotional empathy for other people, most people with NPD need to empathize with themselves. Very early in therapy - at almost every stage - I start talking about how children automatically internalize their understanding of how their caregivers saw them, their caregivers' ideas about right and wrong, and also their ideas about praise and guilt earned.

I point out that we update our phones, computers and apps, but most of us still live on internal "software" programmed by a very young child. I suggest that you investigate how your inner guide voice speaks to you and pay attention to the following:

  • Do you like the tone of your inner voice?
  • Is it cute, loving, harsh, or scary?
  • Is it fair
  • Is it a reliable guide through life?
  • Does it reward you when you do it well?
  • Can you please
  • Does it punish you with shame or guilt When do you need to be contained?
  • Is the punishment too harsh?
  • Do you really need such harshness to get the message?

Once you are aware of the tone and content of your inner voice, and understand that the way you talk to yourself can be changed, let's examine what changes you might want to make.

Making changes requires awareness and a willingness to challenge and inhibit the inner voice. Sometimes just a firm "Stop that!" when the voice is too harsh. Then clients practice talking to themselves in the new way they thought was preferable. As with changing coping mechanisms, this can require vigilance and a lot of repetition.

Note: You can usually tell how tough someone is with themselves by hearing how tough they are with other people. The internal hardness is proportional to the external hardness. Blaming and judging other people is one way to redirect the tough ones of inner critics outward. This gives them peace of mind at the expense of other people.

Level 9: empathy for other people. Once you understand your own pain and have better control of your harsh, devaluing inner voice, you can begin to look outward at other people. Generally, their first real emotional empathy for other people comes from someone who meets the following conditions:

  • You are not a threat to the narcissist.
  • The other person reminds them of themselves.
  • That person is being traumatized or has been traumatized in a way very similar to what the narcissist experienced.

If all goes well, some of these clients will slowly develop their emotional empathy skills.

Level 10: authenticity.My consistent and non-judgmental interest in them and their degradation of their defenses improve our relationship. It can be a reparative emotional experience. They trust that they can be authentic with me because I've seen their "bad side" and nothing terrible has happened to either of us.

You take small steps forward and try to be more authentic with other people. When this goes well, their dependence on their old "false self" defenses diminishes and they become more spontaneous and joyful.

The above is a heavily abbreviated sketch of Narcissistic Personality Disorder Therapy. It is complex, has many phases, and will likely take a long time. There is much to do. Sometimes people don't want or can't do all of this. Anyone who keeps evolving will eventually improve. How much depends on their willingness to continue working on themselves.

This article is based on a Quora article (6/28/19).

Facebook picture: February_Love / Shutterstock