First Steps Toward Healing Narcissistic Personality Traits
“Healing narcissistic traits” is a loaded phrase. Most of us working with these clients know it’s not about “fixing” or erasing deep personality structures. The goal is more about helping people develop greater self-awareness, more flexible defenses, and better relational functioning.
In my experience, the work gets muddy when clinicians either swing toward unrealistic optimism (“deep change is just around the corner!”) or cynical dismissal (“these clients never change”). The truth sits somewhere in between.
Narcissistic traits are ego-syntonic—they feel natural and right to the client. You’re not just asking someone to change behaviors; you’re asking them to question an identity scaffold they’ve depended on, sometimes for decades. So when we talk about first steps, we’re talking about helping clients begin to tolerate the idea that parts of their personality might be negotiable.
It’s slow work, but foundational—and that’s what makes it fascinating.
Helping Clients Even Want to Change
The Problem of “Why Should I Change?”
One of the first things I talk about with supervisees is this: clients with narcissistic traits often don’t walk into therapy thinking, “I want to be more empathic and emotionally attuned.” They come because something external has forced them in—a partner threatening to leave, a legal issue, an organizational HR mandate.
This creates a tricky paradox: on the one hand, external motivation can spark engagement. On the other, if we lean too hard on it, clients feel controlled, and their defenses spike. A key early task is to slowly help them locate some internal reasons for growth, however tentative.
For example, I once worked with a high-achieving executive who came in furious after a 360 review labeled him “toxic.” Initially, he wanted to use therapy to “show them I’m not the problem.” But by exploring his exhaustion and isolation, we eventually connected to an internal wish to feel less alone at work. That wish became an anchor for more authentic engagement.
Ego-Syntonicity: Why Change Feels Like Death
It’s vital to appreciate that for many clients, narcissistic adaptations were survival strategies. Grandiosity, entitlement, idealization—these aren’t arbitrary. They’re ways to manage deep vulnerability and shame.
When we ask clients to question these adaptations, they often experience it as a kind of identity threat. I’ve seen bright, seemingly self-aware clients suddenly derail after a small therapeutic gain because the emerging awareness was too painful to sustain.
One client, after a breakthrough about how much he needed constant admiration, came in the next week and insisted, “I think this therapy is making me worse.” Of course it wasn’t—but it was making him feel more vulnerable than he had in years. We need to normalize this backlash and pace the work accordingly.
Building a Therapeutic Alliance That Can Hold This Work
Experts often talk about “joining” with narcissistic clients, but it’s not about flattery or collusion. It’s about creating a relational space where grandiosity and shame can both be seen—without judgment.
One of the most useful shifts I’ve made in my own practice is to treat grandiosity as a signal of distress rather than as “bad behavior.” When a client starts monologuing about their brilliance after a difficult session, I see it as an effort to restore equilibrium.
If I can gently name that—”It seems like this might have touched something hard last time; I notice we’re back in storytelling mode today”—without shaming, we can often return to a more real conversation. Therapeutic patience and humility are essential here. The work is nonlinear, and ruptures are frequent.
How to Assess Readiness Without Pushing Too Fast
So how do we know when someone is ready for deeper work? Here are a few markers I look for:
- They show some capacity for reflective functioning, even if intermittent.
- They can acknowledge ambivalence (“part of me knows this isn’t working anymore”).
- They demonstrate moments of genuine curiosity about their impact on others.
- They can tolerate small doses of self-other differentiation without full collapse.
Early on, it’s about helping clients succeed in tolerating micro-exposures to vulnerability. When they can do this repeatedly, we can start building more sustained change.
The Bottom Line
The first phase of work with narcissistic traits isn’t about teaching empathy or fixing defenses. It’s about helping clients feel safe enough to stay in the room with the possibility of change—and to tolerate the small humiliations and heartbreaks that real growth requires.
And honestly?
That’s some of the hardest—and most rewarding—work we do.
What To Focus On In Early Therapy
When I’m supervising therapists who are new to working with narcissistic traits, one of the first things I tell them is this: early work is not about insight, and it’s not about “fixing” the narcissism.
It’s about creating enough stability and safety that the client can begin to notice the parts of their personality that aren’t serving them anymore.
I think we often rush to deep interpretations or assume that once someone has insight, change will follow.
But with narcissistic clients, insight is often used defensively—as a way to distance from actual emotional experience.
I once had a client say, “I completely understand why I devalue my partner—it’s a defense mechanism stemming from childhood neglect.” All true—and totally disconnected from any change in behavior or relational empathy.
In this phase of therapy, I focus on four core areas. I’ll walk you through each, with some real-world examples of how these show up.
Cultivating Reflective Functioning
Reflective functioning—the ability to think about one’s own and others’ mental states—is often impaired or fragile in clients with narcissistic traits. Grandiosity and entitlement function, in part, to defend against reflective capacity, because it invites uncertainty and shame.
Early in therapy, I’m looking for moments where I can gently invite curiosity about mental states:
“What do you think was happening for you in that meeting when you felt dismissed?”
“How do you imagine your colleague might have experienced your response?”
I’m not expecting deep empathy at this point—I just want to open a little space for thinking about self and other. For many clients, this is initially threatening. A common response is intellectualization, blame-shifting, or immediate dismissal of the question. That’s okay. It’s about tolerating the discomfort of the question itself.
Building Affect Tolerance and Regulation
Underneath the narcissistic presentation, you’ll often find poor affect tolerance—especially for shame, envy, and rage. Early work often involves helping clients learn to notice and regulate these emotions, rather than acting them out through devaluation or withdrawal.
For instance, one client with a history of explosive anger outbursts at work began to recognize that these moments were often preceded by subtle feelings of envy—seeing a peer succeed triggered deep feelings of inadequacy he couldn’t tolerate. Once we could name that sequence, we could begin to work on strategies to pause and self-soothe before the rage took over.
Mindfulness techniques, somatic awareness, and pacing the therapeutic process so that clients aren’t overwhelmed by shame are all key here. If you move too fast, the client will either shut down or escalate defensive behavior.
Fostering Relational Empathy
Relational empathy is often absent or performative in clients with narcissistic traits—not because they are incapable of it, but because their defensive structures don’t permit the vulnerability required for genuine empathy.
Here, small experiential exercises can be more effective than intellectual discussions. I might ask a client to imagine how a specific person felt in a recent interaction—not to moralize or guilt-trip them, but to practice perspective-taking in a contained way.
One client initially responded to this kind of exercise with frustration: “I can’t know what they felt—it’s pointless to guess.” Over time, with careful titration, he became more able to tolerate the ambiguity and emotional complexity of imagining another person’s experience. This was a game changer for his ability to maintain relationships.
Addressing Maladaptive Coping Mechanisms
Finally, we have to help clients recognize and eventually modify the defensive behaviors that maintain their narcissistic adaptations. Common ones include:
- Devaluation of others
- Entitlement and special pleading
- Splitting and black-and-white thinking
- Idealization and subsequent devaluation cycles
But—and this is crucial—we don’t attack these defenses head-on. If you confront entitlement aggressively, for example, the client will almost always retreat into deeper defensiveness.
Instead, I use a stance of collaborative curiosity:
“I noticed that when we talked about your manager’s feedback, you immediately described them as incompetent. I wonder what that helps you manage in that moment?”
Helping clients see the function of their defenses allows them to begin considering alternatives. It also models a non-shaming, non-attacking stance toward their inner world—a key corrective experience.
Common Pitfalls and How To Avoid Them
Working with narcissistic traits is not for the faint of heart. The work will test your patience, your tolerance for ambiguity, and your own narcissistic vulnerabilities. Over the years, I’ve made just about every mistake possible—and here are some of the big ones I warn my students about.
Overestimating Capacity for Insight
Just because a client can articulate deep psychological concepts does not mean they can integrate them emotionally. Narcissistic clients are often brilliant at intellectualizing—and therapists can be seduced by this apparent insight.
One of my early clients could give a textbook explanation of his defenses. But the moment we tried to explore the feelings underneath, he became sarcastic and disengaged. It took me a while to realize that his “insight” was actually a defense—a way to avoid real vulnerability.
Lesson learned: don’t mistake intellectual understanding for readiness to change.
Colluding With Narcissistic Defenses
Another common trap is subtle collusion—getting pulled into the client’s grandiosity or devaluation cycles. I’ve seen this happen when therapists become overly focused on “joining” the client or when they enjoy the flattering transference that narcissistic clients often offer.
For example, I once caught myself taking the client’s side too enthusiastically in their description of a “foolish” colleague. On reflection, I realized I had been subtly reinforcing their devaluation pattern instead of inviting curiosity about it.
Now, I consciously aim to validate the underlying feeling (hurt, shame, fear) without endorsing the devaluing narrative.
Managing Countertransference
Working with narcissistic traits will inevitably evoke strong countertransference. You might feel idealized, devalued, bored, frustrated, or even thrilled. All of these reactions are normal—and potentially useful—if you can recognize and work with them.
One thing I’ve found helpful is regular consultation with trusted colleagues. Naming and processing my own reactions helps me stay grounded and attuned in the room.
For example, when I notice myself becoming subtly competitive with a client, I take it as a signal to reflect on what’s happening in the dynamic—and to return to a more curious, compassionate stance.
Navigating Ruptures and Repair
Ruptures are inevitable with these clients. The work touches on core vulnerabilities, and defensive blowback is to be expected.
The key is to normalize rupture as part of the process and to model repair. I might say something like:
“I noticed that last session felt really tense between us. I wonder if something I said didn’t land well, and if we can explore that together.”
Successfully navigating ruptures builds trust and models a more flexible, resilient relational style.
One caveat: Not every rupture can be repaired. Some clients will drop out when the work gets too close to core wounds. I view this not as failure, but as part of a longer arc of readiness.
Final Thoughts
If there’s one message I want to leave you with, it’s this: working with narcissistic traits is a marathon, not a sprint. The first steps—building reflective capacity, affect tolerance, relational empathy, and awareness of defenses—are slow and incremental. And that’s okay.
As experts, we need to approach this work with humility, patience, and deep respect for the protective function of these traits. The fact that a client is even willing to sit in the room with us is a testament to some flicker of hope for change.
We won’t always see dramatic transformations—and that’s not the point. If we can help our clients stay a little longer with their own vulnerability, tolerate a bit more complexity in their relationships, and find some new ways of coping, that is meaningful, life-changing work.
And frankly?
It’s some of the most rewarding therapy you’ll ever do.
