If you’ve ever asked yourself, “Can someone with narcissistic traits truly change?”, you’re not alone. This is one of the most common and emotionally loaded questions people have when it comes to treating NPD. Healing narcissism isn’t about forcing change or pushing quick fixes. It’s about slowly untangling the emotional knots that keep someone stuck in patterns of grandiosity, defensiveness, and deep vulnerability.
A psychodynamic approach to treating narcissism offers a thoughtful and compassionate way to do just that, to explore what lies beneath the surface and to support real change from the inside out. In this article, we’ll walk through the essential principles behind treating NPD through a psychodynamic lens. We’ll look at what healing narcissism really means, why grandiosity isn’t always what it seems, and how deep change begins when someone feels safe enough to reflect.
What Does Treating NPD Really Involve?
When people think of narcissism, they often picture someone loud, arrogant, or self-absorbed. But treating NPD, narcissistic personality disorder, is much more complex than addressing behaviors alone.
At the heart of narcissism is something surprisingly tender: a deeply vulnerable self that hasn’t had the chance to develop in a safe, connected way. This self gets hidden beneath what’s known as the grandiose self, a kind of psychological armor designed to protect against feelings of shame, inadequacy, or helplessness. Healing narcissism means gently, patiently helping someone peel back that armor and reconnect with the authentic parts underneath.
In psychodynamic therapy, this work focuses on understanding not just what someone is doing, but why, what drives their defenses, what emotions are being protected, and what old wounds still feel active in the present.
Grandiosity Isn’t Always Obvious
It’s easy to spot narcissism when someone is acting larger-than-life, dominating conversations, or putting others down. But the grandiose self doesn’t always show up with a bang. Sometimes it whispers.
Let’s say a man explodes with anger after receiving a small request at work. On the surface, it looks like overreaction or arrogance. But if we look through a psychodynamic lens, we see something else: a storm of feelings he doesn’t yet know how to regulate. The request reminds him, unconsciously, of past experiences where he felt incapable or unsupported. The shame is overwhelming, so his mind flips into defense mode. The anger, the defiance, “This project is beneath me”, is a shield. That shield is grandiosity, protecting him from an unbearable feeling of “I can’t.”
Healing narcissism in moments like this starts with containment, helping the person stay grounded and safe enough to begin reflecting instead of reacting. Without that, nothing else gets off the ground.
Containment: The First Step Toward Healing
Containment is the foundation of treating NPD. It doesn’t mean holding someone back or controlling them. It means offering a space that feels steady enough for the storm inside to begin to settle. Without that sense of psychological safety, the grandiose self stays firmly in charge.
Think of containment like helping someone catch their breath after being thrown into rough water. Before they can swim, they need to stop thrashing. That pause, that breath, is where the healing work begins.
Once in a more regulated state of mind, I begin to help this gentleman explore what’s really going on beneath his defensive explosion. This is where the psychodynamic process shines: by fostering insight, curiosity, and emotional awareness in a safe environment.
Vulnerability Hiding Behind Certainty
In treating NPD, grandiosity and vulnerability are often two sides of the same coin. Someone may appear certain, dismissive, or above it all, but underneath, there’s often a flood of self-doubt, fear of rejection, or shame.
A psychodynamic therapist doesn’t rush to correct or challenge. Instead, they invite reflection. If someone says, “She didn’t text me back. I know she’s done with me!” I might say, “That sounds really disappointing.” And if there’s space, and they are listening, I may add, “Perhaps you are feeling anxious about being rejected, is that something that resonates with you? Could there be any other reason she didn’t text you back yet?”
That shift, from certainty to curiosity, is subtle but powerful. It’s the beginning of mentalization, a capacity that helps someone see their thoughts and feelings as one version of reality, not absolute truth. And it’s a key step in healing narcissism.
What Does Change Look Like in Healing Narcissism?
People often want to know: What does actual progress look like when treating NPD? It’s not about eliminating traits. It’s about integration.
Narcissistic individuals often carry split images of themselves and others, either idealized or devalued, with no middle ground. This makes relationships unstable and emotional reactions intense. Healing narcissism means helping the person bring these extremes together, to tolerate contradiction and develop a fuller, more grounded sense of self and others.
In real terms, this might look like a person who once exploded in shame when criticized now pausing to reflect. They might say, “That was hard to hear, but maybe there’s some truth to it.” That moment of openness, even a small one, is meaningful. It signals a shift from rigid defense to emotional flexibility.
Treating Narcissism Is a Journey, Not a Quick Fix
There’s no one-size-fits-all solution for healing narcissism. It’s slow work. It requires patience, empathy, and a willingness to stay present through discomfort. The psychodynamic approach focuses on helping the individual become more aware of their inner world and more capable of navigating it.
The ultimate goal isn’t perfection, it’s connection. A greater capacity for intimacy, a deeper understanding of self and others, and the ability to tolerate emotional pain without falling apart. And it all starts with safety, reflection, and the courage to ask: What’s really going on inside me?
Ready to Explore More?
If you’re interested in understanding more about this approach to treating NPD, please feel free to contact me directly to learn how healing narcissism can begin.
You can also dive deeper into these ideas by listening to the Narcissism Decoder Podcast for real insights and compassionate, expert guidance.