Question:

You seem to be very sceptical that someone with a Narcissistic Personality Disorder can be treated successfully.

Answer:

The Narcissistic Personality Disorder has been recognised as a distinct mental health diagnosis a little more than two decades ago. There are few who can honestly claim expertise or even in-depth understanding of this complex condition.

No one knows whether therapy works. What is known is that therapists find narcissists repulsive, overbearing and unnerving. It is also known that narcissists try to co-opt, idolize, or humiliate the therapist.

But what if the narcissist really wants to improve? Even if complete healing is out of the question - behaviour modification is not.

To a narcissist, I would recommend a functional approach, along the following lines:

1. Know and accept thyself. This is who you are. You have good traits and bad traits and you are a narcissist. These are facts. Narcissism is an adaptive mechanism. It is dysfunctional now, but, once, it saved you from a lot more dysfunction or even non-function. Make a list: what does it mean to be a narcissist in your specific case? What are your typical behaviour patterns? Which types of conduct do you find to be counterproductive, irritating, self-defeating or self-destructive? Which are productive, constructive and should be enhanced despite their pathological origin?
2. Decide to suppress the first type of behaviours and to promote the second. Construct lists of self-punishments, negative feedback and negative reinforcements. Impose them upon yourself when you have behaved negatively. Make a list of prizes, little indulgences, positive feedbacks and positive reinforcements. Use them to reward yourself when you adopted a behaviour of the second kind.
3. Keep doing this with the express intent of conditioning yourself. Be objective, predictable and just in the administration of both punishments and awards, positive and negative reinforcements and feedback. Learn to trust your "inner court". Constrain the sadistic, immature and ideal parts of your personality by applying a uniform codex, a set of immutable and invariably applied rules.
4. Once sufficiently conditioned, monitor yourself incessantly. Narcissism is sneaky and it possesses all your resources because it is you. Your disorder is intelligent because you are. Beware and never lose control. With time this onerous regime will become a second habit and supplant the narcissistic (pathological) superstructure.

You might have noticed that all the above can be amply summed by suggesting to you to become your own parent. This is what parents do and the process is called "education" or "socialisation". Re-parent yourself. Be your own parent. If therapy is helpful or needed, go ahead.

The heart of the beast is the inability of the narcissist to distinguish true from false, appearances from reality, posing from being, Narcissistic Supply from genuine relationships, and compulsive drives from true interests and avocations. Narcissism is about deceit. It blurs the distinction between authentic actions, true motives, real desires, and original emotions - and their malignant forms

Narcissists are no longer capable of knowing themselves. Terrified by their internal apparitions, paralysed by their lack of authenticity, suppressed by the weight of their repressed emotions - they occupy a hall of mirrors. Edvard Munch-like, their elongated figures stare at them, on the verge of the scream, yet somehow, soundless.

The narcissist's childlike, curious, vibrant, and optimistic True Self is dead. His False Self is, well, false. How can anyone on a permanent diet of echoes and reflections ever acquaint himself with reality? How can the narcissist ever love - he, whose essence is to devour meaningful others?

The answer is: discipline, decisiveness, clear targets, conditioning, justice. The narcissist is the product of unjust, capricious and cruel treatment. He is the finished product off a production line of self-recrimination, guilt and fear. He needs to take the antidote to counter the narcissistic poison. Unfortunately, there is no drug which can ameliorate pathological narcissism.

Confronting one's parents about one's childhood is a good idea if the narcissist feels that he can take it and cope with new and painful truths. But the narcissist must be careful. He is playing with fire. Still, if he feels confident that he can withstand anything revealed to him in such a confrontation, it is a good and wise move in the right direction.

My advice to the narcissist would then be: dedicate a lot of time to rehearsing this critical encounter and define well what is it exactly that you want to achieve. Do not turn this reunion into a monodrama, group therapy, or trial. Get some answers and get at the truth. Don't try to prove anything, to vindicate, to take revenge, to win the argument, or to exculpate. Talk to them, heart to heart, as you would with yourself. Do not try to sound professional, mature, intelligent, knowledgeable and distanced. There is no "problem to solve" - just a condition to adjust yourself to.

More generally, try to take life and yourself much less seriously. Being immersed in one's self and in one's mental health condition is never the recipe to full functionality, let alone happiness. The world is an absurd place. It is indeed a theatre to be enjoyed. It is full of colours and smells and sounds to be treasured and cherished. It is varied and it accommodates and tolerates everyone and everything, even narcissists.