Can Narcissists Truly Change and Recover?
It’s one of the hardest questions we face as clinicians, isn’t it?
Narcissism—whether it’s full-blown NPD or subclinical patterns—cuts straight to the heart of what makes personality difficult to shift. Narcissistic traits are so often ego-syntonic; they feel right to the person. And yet, the demand from clients, families, and society is growing: can these individuals truly recover?
I’ve sat with this question a lot.
The research is mixed, the clinical anecdotes are all over the place, and the temptation is to say, “It depends.” But I think we can go deeper. There are mechanisms of change, and there are patterns in who is likely to shift and how.
The catch?
It’s far from guaranteed.
In this post, I’ll walk through some of the theoretical underpinnings and the emerging evidence. My goal isn’t to tie this up with a bow—but to offer some sharper tools for thinking about change in narcissistic clients.
How Change Might Actually Happen
The Dynamics We’re Up Against
Before we talk about change, let’s be clear about what we’re asking to change. Narcissism isn’t just a cluster of annoying traits. It’s a defensive system built to regulate a fragile self. Grandiosity, entitlement, devaluation of others—these are shields against deep shame, self-fragmentation, and unmet developmental needs.
As I’m sure many of you have seen, clients with narcissistic patterns often oscillate between brittle superiority and collapse into shame or rage. You can almost feel the defensive structure snap under relational strain. That makes therapy tough. We’re not just asking them to “be nicer” or “get more empathy”—we’re asking them to dismantle a core survival system.
What Theories Tell Us About Change
Psychodynamic models (Kernberg, Kohut) give us a crucial lens here. Kernberg emphasizes structural change in personality organization—essentially, moving from a pathological narcissistic structure toward more integrated object relations. Kohut, in contrast, focuses on repairing developmental deficits through empathic attunement and building self-cohesion.
Both perspectives highlight a paradox: narcissistic clients need relationships to heal, but relationships are precisely what they fear and distort.
CBT and schema therapy add complementary angles. They target maladaptive schemas (defectiveness, entitlement, mistrust) and automatic thought patterns. Recent work in mentalization-based therapy also points to the importance of enhancing reflective functioning—getting clients to step back and consider their own and others’ mental states.
Neuroscience hasn’t cracked this wide open yet, but early fMRI studies (e.g. Schulze et al., 2013) show that individuals with NPD exhibit reduced activity in brain areas linked to empathy and social cognition—but that activity can increase after certain interventions.
What Helps Change Happen?
So what are the actual mechanisms that might help these clients change? Here are a few I’ve seen across modalities—and that the literature supports:
Insight and Reflective Functioning
Clients who can develop even a glimmer of curiosity about their inner world tend to do better. In my own practice, I’ve seen moments where a client notices their devaluation impulse in real time—and that moment of reflection is gold.
Therapeutic Alliance
The alliance is everything, but it’s fragile. Narcissistic clients often idealize the therapist early on, then devalue. Staying steady through that cycle—without retaliating or collapsing—provides a reparative experience. Studies (e.g. Ronningstam, 2011) suggest that therapists who can tolerate this rupture-repair cycle facilitate deeper change.
Affect Tolerance
Helping clients feel and process shame, envy, and vulnerability is central. Without this, defensive patterns remain intact. Affect-focused psychotherapies (like AEDP) are doing fascinating work here—clients learn to stay with feelings they previously couldn’t tolerate, which shifts the need for grandiose defenses.
The Hard Limits
Of course, this is hard. Many clients with strong narcissistic traits drop out of therapy early. Motivation for change is often extrinsic (court-ordered, relationship crisis), and without internal motivation, progress is minimal. And as you all know, the deeper the pathological structure, the slower and more fragile the change.
Still—partial change is possible. I’ve seen clients move from exploitative, cold relational patterns to more mutual, empathic ones. Not perfectly. Not all the time. But meaningfully.
And isn’t that worth pursuing?
What the Research and Clinical Work Are Really Showing
I think most of us—whether we’re clinicians, researchers, or both—have at some point asked: Does the data really support the possibility of narcissistic change? Or are we just seeing hopeful anecdotes?
That’s a fair question. The answer is, predictably, complex. The empirical literature is still somewhat sparse and often inconsistent, but certain patterns are emerging. And what’s exciting is that some of these findings align with what many of us are seeing in clinical rooms around the world.
Let’s break it down.
What We’re Seeing in Psychotherapy Outcomes
Meta-analyses on the treatment of personality disorders often lump NPD in with other Cluster B diagnoses. That makes it tricky to parse out effects specific to narcissistic pathology. But the available evidence suggests a few things:
First: clients with NPD can improve—especially on certain dimensions like interpersonal functioning and emotional regulation—but full personality restructuring is rare and slow.
In a review by Kealy and Ogrodniczuk (2011), they noted that long-term psychodynamic therapy showed moderate improvements in relational functioning, defensive operations, and affect tolerance in narcissistic clients. Similarly, schema therapy (Young et al.) has demonstrated promising outcomes, particularly in reducing entitlement and fostering more adaptive interpersonal behaviors.
CBT-based approaches often yield quicker symptom relief but may struggle to impact deeper personality structures unless integrated with schema or relational techniques.
An important caveat: dropout rates are high—some studies report 30–50% attrition in narcissistic clients within the first 6 months of therapy. That skews the data toward those who are more motivated or better able to form a therapeutic alliance.
Factors That Predict Better Outcomes
In both the literature and my own experience, certain factors consistently show up as predictors of positive change. Here’s what stands out:
Early Relational Trauma Acknowledgment
Clients who can begin to process early attachment wounds tend to soften some of the defensive structures that maintain narcissistic patterns. This is consistent with Kernberg’s model: moving from split, idealized and devalued object relations toward more integrated ones.
I remember a client who for years maintained a grandiose narrative about a “perfect childhood”—until grief work around a distant, emotionally unavailable father cracked something open. From there, deeper shifts became possible.
Capacity for Attachment-Based Relating
Those who can form at least a tenuous attachment to the therapist (even if it’s idealizing at first) have a better shot. Without any capacity to trust, therapy remains a cognitive exercise—useful, but limited.
Presence of Co-occurring Depressive Symptoms
Interestingly, clients who exhibit narcissistic vulnerability—characterized by shame, depression, and hypersensitivity to rejection—often have more treatment traction than those operating in a pure grandiose mode.
This aligns with Pincus and Lukowitsky’s (2010) two-factor model of narcissism: those who can access their vulnerable side are more reachable, because they have more subjective distress driving motivation for change.
The Big Barriers to Change
Of course, change isn’t easy. Several common barriers show up again and again:
Premature Dropout
As mentioned, dropout is a chronic problem. Once narcissistic clients experience a threat to their grandiose self or encounter empathic failures in therapy, they often bolt.
Resistance to Vulnerability and Dependency
Clients may intellectually endorse change but resist the lived experience of dependency or shame. I’ve had clients who could eloquently talk about their narcissism while remaining emotionally armored in every relationship.
Defensive Fragmentation Under Stress
During times of relational stress, even clients who have made progress often regress into old defensive patterns—splitting, rage, devaluation. Therapists must remain attuned to these moments as critical opportunities, not failures.
Case Examples and Clinical Observations
It’s always the stories that stick with us. Let me share two brief clinical examples that mirror what many studies are starting to suggest:
Case 1: Partial Structural Change
A midlife client with pronounced grandiose narcissism entered therapy after repeated professional failures. Over 3 years of transference-focused therapy, he moved from exploitative relational patterns toward more mutual relationships—especially with his children and ex-wife. His core self-centered tendencies didn’t vanish, but empathy increased, entitlement softened, and relationships improved.
Case 2: Defensive Collapse and Recovery
A younger client with narcissistic vulnerability experienced severe depressive collapse after a romantic rejection. Schema therapy helped her tolerate shame and build healthier self-soothing strategies. While she remained sensitive to narcissistic injury, her interpersonal functioning improved dramatically over 18 months.
Both cases reflect partial but meaningful change—not full recovery, but shifts that tangibly improved life quality.
How We Define “Recovery” (And Why It Matters)
Now let’s tackle the million-dollar question: what does “recovery” even mean when it comes to narcissism?
Symptom Reduction vs. Structural Change
In some circles, “recovery” gets used too loosely. If we define it as complete remission of narcissistic traits, that bar is probably unrealistic for most clients. But if we take a more dimensional, process-oriented view, we can identify different levels of meaningful change:
Symptomatic Improvement
This includes reduced grandiose behaviors, increased affect tolerance, improved interpersonal functioning. Many clients can reach this level—and it often makes a big difference in their relationships and professional lives.
Structural Personality Change
This is deeper and slower. It involves increased object constancy, reduced splitting, more stable self-esteem, and a more integrated self-concept. Some clients achieve elements of this through sustained therapy, but it’s rare and often partial.
Relational Repair and Capacity for Intimacy
Perhaps the most clinically meaningful outcome: clients becoming capable of more genuine, reciprocal relationships. This usually correlates with gains in empathy and reflective functioning. I’ve seen even highly defended clients, after years of work, begin to experience this shift. It’s one of the most rewarding outcomes we can witness.
Ethical Questions We Need to Face
All of this raises important ethical considerations:
Should we market “recovery” as an attainable goal?
I lean toward caution here. Promising full recovery risks setting up false hope—for clients, families, and even ourselves. I prefer to talk about growth, improvement, and increased relational capacity.
What are the risks of reinforcing unrealistic expectations?
If families or partners believe therapy will produce a fully “normal” person, they may stay in harmful dynamics too long. As therapists, we have a duty to educate about what’s realistically possible—and what may not be.
How do we navigate our own countertransference?
Working with narcissistic clients is hard. It stirs up therapist narcissism, idealization, rage, and hopelessness. Staying grounded in both hope and realism is key. A supervisor once told me: “If you can tolerate the narcissistic client not fully changing, you’re in a better position to help them change as much as they can.” Wise words.
Open Questions for Future Research
The field is still evolving, and we need much more data. Some promising directions include:
- Longitudinal studies tracking change trajectories over 5–10 years
- More research on vulnerable narcissism and treatment responsiveness
- Neuroscientific markers of change—what shifts in the brain as narcissistic patterns soften?
- Cultural and systemic factors—how do different societal contexts shape narcissistic defenses and their malleability?
There’s so much more to learn. And that’s part of what keeps this work endlessly fascinating.
Final Thoughts
If there’s one thing I’ve come to believe, it’s this: narcissists can change—but it’s rarely easy, and it’s never linear. The defensive structures we’re trying to shift are old, adaptive, and deeply entwined with identity. But under the right conditions—with a strong therapeutic alliance, a tolerable dose of relational stress, and a client who’s at least a little bit curious about themselves—meaningful change is possible.
As experts, we owe it to ourselves and our clients to hold both skepticism and hope. Neither cynicism nor naive optimism serves us well. If we stay curious and grounded, we can help narcissistic clients move toward greater relational capacity, emotional depth, and personal growth—even if “full recovery” remains elusive.
And honestly?
That kind of change is pretty profound in itself.
