Can Psychotherapy Help a Narcissist?

Freudian Perspective on Narcissistic Personality Disorder.

From a Freudian perspective, narcissistic personality disorder is
viewed as stemming from arrested development at the narcissistic
stage, where the individual fails to properly transition from
primitive narcissism to mature object-love.

Role of Early Childhood Experiences

The Freudian approach holds that early childhood experiences and
relationships, particularly with primary caregivers, play a
significant role in shaping personality development and
psychopathology later in life. With narcissism, it is theorized that
deficiencies in parental empathy, mirroring, and appropriate
frustration during that pivotal stage prevented the child from
developing a cohesive sense of self separate from others.

Psychoanalytic Psychotherapy for Narcissists

Psychoanalytic psychotherapy aims to bring the unconscious
motivations, defense mechanisms, and relational patterns into
conscious awareness. For the narcissist, this could involve exploring
the origins of their grandiose self-image, entitled expectations, lack
of empathy, and sensitivity to criticism or narcissistic injury. The
therapy relationship itself provides an opportunity to re-experience
some of those early dynamics from childhood in a more reparative way.

Challenges in Treating Narcissists
However, from this perspective, narcissists can be notoriously
resistant to psychotherapy due to their defenses against fragility in
the self-concept. They may seek therapy only for externalization of
blame rather than true self-exploration. Prolonged, intensive analysis
is often required to make substantive progress.