It’s not that narcissists never show up for therapy: Many are resistant, but many are often genuinely seeking relief from suffering.
Some even find themselves in a psychologist’s chair due to entanglements with the justice system or mandated addiction treatment, or treatment after ER visits due to self-harm during a narcissistic collapse.
In severe cases in which narcissists find themselves dangerously lacking in supply sources, they may go into psychosis or hallucinations, leading them to becoming institutionalized for periods of time.
NPD and ASPD are the least funded disorders for research and treatment in the United States, but many European countries have worked diligently on forms of rehabilitative justice or restorative justice. While they are markedly successful in reducing the recidivism rates, the research on curing NPD or ASPD is still less hopeful.
This is not to say there’s no hope in the future: I believe in scientific progress. We must always seek answers, remedies, and hope for all things that ail humanity.
However, in my own work with narcissists — as well as in my experiences going to couple’s therapy with them, or urging family members I love towards attaining psychological care — I’ve come to the same conclusions as many others.
You can’t hold onto any hope that they can or will heal because of one major roadblock.
Their Relationship to Truth
Therapy that heals depends on radical honesty and self reflection — about behavior, motivations, emotions, and history.
You have to be able to hold nuanced truths about yourself and wrestle with traumas, shames, and difficult emotions. You have to be vulnerable and honest with yourself and your practitioner (and you need a practitioner who is a safe person, not a narcissist themselves).
Without that foundation, the process of healing can’t function.
For many people with strong narcissistic or antisocial patterns, truth isn’t simply avoided; it’s fundamentally distorted.
Pathological lying becomes a way of life; over time, those lies are both told to others and internalized. The person begins to believe their own false narratives.
In therapy, this creates a profound obstacle. Rather than using the space to examine their behavior or explore responsibility, narcissistic individuals often use therapy the same way they use other relationships: as a source of validation.
Because narcissists can’t feel love for others or the self, they constantly seek validation to boost the ego of their false self.
The Therapist Becomes Another Audience for the Story They Prefer to Tell About Themselves
And that story almost always centers on victimhood.
They recount betrayals, misunderstandings, and injustices done to them, but rarely their own harm toward others.
Therapy becomes a stage where the false self seeks affirmation rather than a laboratory for self-examination, growth, learning, and change.
This dynamic is deeply tied to shame.
Shame isn’t the same as guilt. Guilt is feeling bad for what you’ve done. Shame is feeling bad for who you are.
Narcissistic personality structures are built around a fragile core that cannot tolerate the experience of being flawed or culpable. Admitting wrongdoing would threaten the carefully constructed identity they rely on to function.
They have a deep need to continue to feel as they did in early childhood: The golden child identity. Perfect. Better than others.
As a result, responsibility is externalized. Someone else is always to blame: Partners, friends, coworkers, society, or circumstances.
Maintaining the role of victim allows them to escape the unbearable experience of shame. The goal isn’t healing: It’s preservation of the false self.
Because of this, there’s often very little genuine desire to move past victimhood. For many narcissistic individuals, victimhood itself becomes a form of psychological “supply.”
The only goal of therapy is to avoid seeing themselves as a perpetrator. And with split thinking, they only have those two options: Perpetrator means all bad. Victim means all good.
Even narcissists who maintain some semblance of honesty, such as admitting to crimes as some famous serial killers have, will still avoid telling the FULL truth due to shame. They may be happy to discuss their crimes against adults but mum about their crimes toward children.
They frequently still maintain victimhood as a cognitive distortion. But victims of their abuse without NPD present in grief with desires to heal, and they’re generally less attached to a victimhood identity and more interested in surviving their abuses and navigating danger and extreme psychological impacts.
Narcissistic personalities are unable to grieve: They never developed the emotional strength to be able to do so. This is why they move on quickly and pivot to blame. Grief is something they can’t psychologically survive, so they never get over their GRUDGES (don’t mistake their collapses for grief: a narcissistic collapse is short-lived. Grief is long-term).
In reality, narcissists are victims: They were victims to narcissistic parents and they often have other narcissists as partners, but they refuse to see their own accountability in their own abusive behaviors and lack of empathy.
Therefore, the greatest fantasy of any abuser is to be a victim who never, ever heals — only one who feels justified in eternal vengeance.
Victimhood brings attention, sympathy, and moral superiority. If they’re always the injured party, they never have to confront their own aggression or cruelty.
They never have to resolve their anger, hatred, or envy.
Therapy that challenges their eternal victimhood narrative may be abandoned quickly, or the therapist may be recast as another person who has “wronged” them.
Another major barrier involves childhood history. Most effective therapy for trauma eventually requires exploring formative experiences, including family dynamics and early trauma.
Yet many narcissistic or antisocial individuals show a striking resistance to this process. Discussions about parents often trigger deflection, minimization, or anger. When the topic arises, this is often when they stop coming to therapy.
In some cases, narcissists report large gaps in memory about their childhood altogether. It’s not uncommon to hear statements such as, “I don’t really remember my childhood,” or “Nothing much happened.”
These memory gaps may reflect defensive psychological processes. Revisiting early experiences can threaten the protective narrative the person has built around themselves.
If their identity depends on believing they are always right and others are always wrong and they’re always in control and superior, examining childhood vulnerability or trauma may feel intolerable. Avoidance and denial therefore become survival strategies.
For therapists, this creates a difficult situation. Therapy requires honesty, accountability, and curiosity about oneself. Narcissistic and sociopathic structures resist all three.
When the therapeutic space becomes another arena for performance rather than reflection, progress is limited. And the problem with narcissism is that it’s persistent theater.
This doesn’t mean change is impossible. I see hope in ideas around early intervention; increased cultural awareness about abuse and mental health, and neurological studies — especially around PTSD and neuroplasticity.
But without a willingness to confront truth — including painful truths about oneself — therapy as it exists today can’t reach its intended purpose.
Healing begins where denial ends, and for many narcissistic personalities, that threshold is the very thing they’re determined never to cross.
If you’d like to support my writing, check out my books, or buy me a coffee.
Subscribe to my blog, Blooming on the Borderline!
A new blog sent to your email twice a week for $5 a month.
