How Narcissists Can Relearn Empathy and Compassion

If you’ve worked with narcissistic clients, you’ve probably heard it: “They’ll never change.” It’s a common refrain, and I get it. Narcissistic traits—especially empathy deficits—can feel baked in. But the truth is more nuanced. Emerging neuroscience and clinical work suggest that empathy isn’t an on/off switch; it’s a skill that can be reconditioned—if the right conditions are present.

I’m not claiming it’s easy or guaranteed. But we’re now seeing cases where clients with NPD or high narcissistic traits can gradually rebuild their empathic capacity, especially when shame and defensive structures are addressed. And this isn’t just about “being nicer”—it has profound effects on relationships, self-concept, and emotional regulation.

In this article, I’ll walk through how empathy deficits arise neurologically, why they persist, and—critically—how they can be unlearned and re-learned. My aim is to give us as practitioners new tools and new hope, backed by solid evidence. Let’s dive in.

How Empathy Gets Blocked in Narcissism—and Why Change is Possible

Cognitive vs. Affective Empathy: The Split You Need to Understand

One thing I always remind myself when working with narcissistic clients: they usually have intact cognitive empathy. They can understand what someone else is thinking. Where they struggle is with affective empathy—actually feeling what the other person feels.

This is supported by neuroimaging studies (Fan et al., 2011; Schulze et al., 2013) showing that while the medial prefrontal cortex (cognitive empathy) remains active, there is reduced activation in the anterior insula and anterior cingulate cortex, areas linked to affective resonance.

In other words: narcissists often know what others feel but can’t—or won’t—let themselves feel it too. This is a protective mechanism. Allowing in others’ feelings risks overwhelming shame or loss of control.

The Role of Shame and Emotional Avoidance

It’s impossible to talk about empathy deficits in narcissism without talking about shame. Narcissistic clients typically operate under an elaborate defensive structure designed to avoid shame at all costs (Tangney & Dearing, 2002).

When we ask these clients to tune into someone else’s distress, we’re asking them to lower defenses that have protected them since childhood. This can trigger a cascade of shame responses, including anger, withdrawal, or intellectualization.

Example: I once worked with a high-functioning executive client who could easily describe how her employees felt in performance reviews—but when I asked her to imagine how those feelings landed in their bodies, she became visibly agitated and said, “Why would I want to feel that? It’s not useful.”

That’s the defense in action. To relearn empathy, we must first help clients tolerate the emotional states that arise when those defenses soften.

Why Relearning Empathy Is Neurologically Possible

Now here’s the hopeful part. The adult brain remains plastic, especially in networks related to social cognition (Singer et al., 2004). Compassion training studies (Klimecki et al., 2014) show measurable increases in empathic brain activation after targeted interventions, even in populations with reduced baseline empathy.

Moreover, a recent fMRI study (Schreiter et al., 2023) showed that clients with NPD who underwent structured perspective-taking exercises exhibited increased functional connectivity between the default mode network and affective empathy regions over time. The brain can literally be rewired toward greater empathy.

The Impact of Attachment and Mentalization

Another key factor is attachment. Narcissistic traits often arise from early relational trauma or inconsistent attachment (Fonagy & Bateman, 2008). Mentalization-based interventions that address these attachment wounds can open pathways for affective empathy to reemerge.

Example: In one MBT group I facilitated, a client with pronounced grandiose traits initially mocked another member’s vulnerability. After several months of work focused on reflective functioning, he spontaneously expressed sadness for that same member’s struggles—a moment that neither he nor the group would have thought possible in the first session.

When clients feel safer and more securely attached, they can risk empathic connection. The key is pacing and supporting this process carefully.

Why This Should Change How We Practice

If we assume that narcissistic empathy deficits are fixed, we risk giving up on our clients—or worse, colluding with their defenses. The data tell us otherwise. Empathy is a skill that can be trained, even in difficult cases. But it requires us to address the core emotional obstacles, not just teach “better behavior.”

In the next section, I’ll share practical, evidence-based methods you can use to facilitate this process—including techniques you may not have tried yet. Some will surprise you. Let’s keep going.

Practical Ways to Help Narcissists Relearn Empathy

When it comes to helping narcissistic clients relearn empathy, there’s no silver bullet. It’s an incremental process, one that depends heavily on timing, pacing, and trust. What I’ve learned over the years (often the hard way!) is that you can’t just throw standard empathy-building exercises at a narcissistic client and expect success. You have to work with their defenses—not against them—and scaffold empathy in ways that feel safe and tolerable.

Here’s a mix of methods I’ve seen work, both in clinical research and real-world practice. Some will seem familiar; others might be new. What matters is how you sequence them and adapt them to each client’s unique profile.

Motivation and Readiness Work

Before we can expect a client to engage in empathy training, they need to be motivated to change. Many narcissistic clients arrive in therapy under external pressure (from partners, employers, courts), and their initial buy-in can be shaky.

That’s why I often spend early sessions using motivational interviewing and values clarification techniques. We collaboratively explore what they want—better relationships, less conflict, more respect—and how increasing empathy might help them get there.

Example: One client only became willing to practice perspective-taking when we reframed it as a way to “become a more effective leader.” For him, compassion for others wasn’t the initial hook—competence and mastery were. That was okay; it got us in the door.

Mentalization-Based Therapy (MBT)

Mentalization—the ability to reflect on the mental states of self and others—is often underdeveloped or distorted in narcissistic clients. MBT provides structured exercises to build this capacity gradually.

In MBT, we help clients move from concrete, black-and-white thinking about others (“They hate me,” “They’re stupid”) toward more nuanced reflections (“They seemed frustrated because they felt unheard”).

One powerful intervention I’ve used is the stop and mentalize pause: when a client describes an interpersonal event, I ask them to pause and generate at least three possible mental states the other person might have been experiencing. This forces them out of defensive certainty and into curious reflection.

Compassion-Focused Therapy (CFT)

CFT is a natural fit for this work because it explicitly targets shame and self-criticism—two forces that block empathic connection in narcissistic clients.

Early in CFT, I guide clients through compassionate imagery practices. We start with cultivating compassion for neutral or mildly positive figures (a mentor, a pet, a fictional character), because direct self-compassion is often too threatening at first.

Gradually, clients can extend this compassionate mindset toward others in their lives. The imagery work also builds tolerance for affiliative emotions, which many narcissistic clients find unfamiliar and uncomfortable.

Perspective-Taking Training

This is where more traditional empathy training comes in—but with careful preparation. I never start here; it follows after initial shame reduction and mentalization work.

One of my favorite tools is structured role-play, where I take on the role of someone in the client’s life (e.g., a partner, employee) and we enact a real-life conflict. Afterward, I ask the client to replay the scenario as that person—using their voice, perspective, and emotional experience.

It’s uncomfortable but powerful. Clients often resist initially, but with support, they can experience how their actions are perceived and felt by others in a way that cognitive analysis alone won’t achieve.

Mindfulness-Based Interventions

Mindfulness helps clients develop the core skills needed for empathy: emotional awareness, distress tolerance, and present-moment focus.

I often integrate body scan practices and emotional labeling exercises early in treatment. Narcissistic clients are typically alexithymic to some degree; they need to build a basic vocabulary of internal states before they can tune into others’ emotions.

As clients become more comfortable with their own affective experience, we expand the mindfulness work to include interpersonal mindfulness—paying full attention to another person’s verbal and nonverbal cues without judgment or defensive interpretation.

Targeted Psychoeducation

Never underestimate the power of good psychoeducation. Many narcissistic clients genuinely don’t understand how their empathy deficits impact others.

I use brief, targeted psychoeducational interventions to illustrate the social costs of empathy gaps—for example, how perceived coldness erodes trust and connection.

Crucially, I avoid moralistic framing (“You should be more empathetic”) and instead focus on pragmatic benefits (“You’ll be more successful in relationships and leadership roles if you can understand and respond to others’ emotions effectively”).

Putting It All Together

These interventions aren’t linear; they overlap and reinforce each other. The art is in knowing which lever to pull when. Here’s a rough progression I often use:

• Motivation and readiness first
  
• Shame reduction and mentalization second
  
• Compassion and perspective-taking next
  
• Mindfulness and psychoeducation throughout
  

When done skillfully, this work can help even highly narcissistic clients develop a more genuine, embodied sense of empathy and compassion—not just performative niceness, but real attunement to others.

Things to Keep in Mind When Working with Narcissistic Clients

While these interventions can be transformative, they’re also delicate. The process of relearning empathy is full of traps and pitfalls—for both client and therapist. Here are some key considerations to help navigate this work wisely.

The Relationship is Everything

I can’t stress this enough: the therapeutic alliance is the primary vehicle for change. Without trust and safety, clients won’t risk softening their defenses or exploring painful feelings.

Paradoxically, it’s the moments when they hurt or disappoint us that offer the biggest opportunities. If we can stay empathically attuned even when they’re grandiose or devaluing, we model the kind of relational security they’ve rarely experienced.

Expect Resistance—and Normalize It

When clients start to connect empathically with others, it often triggers a flood of shame and self-recrimination. I prepare them for this in advance, framing it as a normal part of the growth process.

Example: A client who succeeded in perspective-taking with his daughter later confessed feeling “like a total failure as a father.” We had to spend time normalizing this response and building his capacity to tolerate it—otherwise, he would have shut the process down entirely.

Tailor Interventions to Narcissistic Subtypes

Not all narcissistic clients are the same. Grandiose narcissists often need help softening defensive entitlement and developing authentic concern for others. Vulnerable narcissists may already feel too much shame and need support building self-compassion first.

I adjust the intervention mix accordingly. For example, I might use more CFT and mindfulness with vulnerable clients, and more MBT and psychoeducation with grandiose clients.

Watch for Premature Affect Focus

One of the biggest mistakes I made early in my career was trying to push clients into affective empathy work too soon. If their shame defenses aren’t ready, it can backfire—leading to emotional flooding, avoidance, or even dropout.

Now, I track clients’ window of tolerance carefully and scaffold affective work very gradually. Sometimes we spend months on cognitive empathy and mentalization first.

Group Therapy Can Accelerate Learning

When the timing is right, group therapy provides a powerful relational lab for practicing empathy and compassion.

In groups I’ve run, narcissistic clients often get real-time feedback about how their behaviors impact others—something individual therapy alone can’t fully replicate. With support, they can learn to take this feedback in without collapsing into shame or defensiveness.

Don’t Moralize—Pragmatize

Narcissistic clients respond poorly to moralistic appeals (“You should care more about others”). Instead, I frame empathy as a pragmatic skill that improves relationships, reputation, and personal effectiveness.

This framing helps bypass defensive resistance and aligns the work with their existing motivations.

Your Own Self-Work Matters

Finally, be prepared to do your own emotional work. Narcissistic clients will test your empathy and boundaries like few others. You’ll need strong supervision, self-reflection, and self-compassion to stay grounded and open-hearted throughout the process.

When we can meet their defenses with genuine curiosity and compassion, we create the relational conditions where real change becomes possible.

Final Thoughts

Helping narcissistic clients relearn empathy and compassion is some of the most challenging—and most rewarding—work we can do as therapists. It demands clinical precision, emotional courage, and a lot of patience.

But it’s worth it. I’ve seen clients once written off as “incapable of change” develop deep, authentic connections with others. The research is clear: empathy is not a fixed trait—it’s a trainable skill.

As experts, we have the tools to help our clients reclaim this vital human capacity. Let’s keep learning, experimenting, and supporting each other in this complex, transformative work.