NPD Therapy? Is There HOPE? (Clip Interview New York Magazine)

Añadido: 2026-05-12

[00:00:00]All we must make a distinction between or you should make a distinction between narcissism as a trait and narcissistic personality disorder.

[00:00:11]Narcissism as a trait is something that we all have. We have healthy narcissism.

[00:00:17]Healthy narcissism is the cornerstone of self-esteem, self-confidence, a sense of self-worth, and in most people, one's self-concept. A healthy narcissism is as the name implies healthy. Traits traits are hereditary.

[00:00:34]Traits are genetic. All traits are hereditary.

[00:00:38]So narcissism is something you inherit, something that is carried forth or forward in your genes.

[00:00:46]Whereas narcissistic personality disorder is a kind of deformation or or torsion or um of of the trait of narcissism. It's when the trait of narcissism which I remind you is universal when the trait of narcissism is exposed to an environment in early childhood in most cases which is dysfunctional in a variety of ways. the various various developmental paths that lead to pathological narcissism. And this environment actually converts healthy narcissism into malignantism or pathological narcissism.

[00:01:31]And so whereas narcissism is hereditary and genetic, narcissistic personality disorder is a result of nurture, not nature. and nature nature of the wrong kind.

[00:01:45]Consequently, the prognosis the the the um efficacy of treatments when they are applied to narcissistic personality disorder rests solely on one's personal biography history. Um and depending on the severity of the abuse and trauma in early childhood, the prognosis is more or less uh good or bad.

[00:02:15]So the prognosis is a derivative of the severity, extent, intensity and length, duration of the early childhood abuse and trauma and also of the time in your life at which you embark on you you kind of begin to receive treatment. If you are if you're 18 years old or 21 years old, your prognosis is a lot better than if you're 45 years old.

[00:02:42]>> Right? Having having established all these caveats, let me try to answer your question for a change.

[00:02:51]So yes, narcissism cannot be healed or cured, whatever that may mean. Cannot be it's irreversible.

[00:03:00]It's it's it's also extensive, an extensive parameter. In other words, narcissism is who you are. Pathological.

[00:03:07]When I say narcissism, henceforth from now on, it's pathological.

[00:03:11]>> Mhm. Narcissism is who you are. The patient or the client with narcissism is a narcissist because narcissism is as the diagnostic and statistical manual enlightens us. Narcissism is all pervasive.

[00:03:28]Narcissism affects every realm and every field of your life, every type of interaction, every environment, every type of functioning. So in the workplace, in romantic relationships, in friendships such as they are in whatever you do, whoever you're interacting with, your interpersonal relationships, everything internally and externally is imbued, not to say in infected with pathological narcissism. So there's no way to take the narcissism out of the narcissist, thus rendering the narcissist a healthy person because the narcissist is he is or her narcissism.

[00:04:10]>> Now this is not a popular view but any clinician would you know off the record confirm this. It's not a popular view because it's politically incorrect. We are not supposed to call people by their disorders. We're not supposed to say borderline or narcissist. We're supposed to say someone with narcissistic personality disorder. But the minute you open the diagnostic and statistical manual, the first thing it says is that narcissistic personality disorder is an all pervasive rigid pattern.

[00:04:42]Period.

[00:04:44]>> Right?

[00:04:44]>> So healing or cure are an impossibility.

[00:04:49]>> Right? What we can accomplish with with narcissists, people who diagnosed with narcissistic personality disorder, what we can accomplish is we can modify their behaviors.

[00:05:02]We can help them to become less abrasive, less exploitative, less antisocial, less aggressive, less grandio. We can we can help them to become um more socially adaptable, more so we can help them with this. We can modify their behaviors. Sometimes we leverage features, clinical features of pathological narcissism in order to induce behavioral change. For example, we challenge the narcissist grandiosity.

[00:05:34]We would tell the narcissist, "No way you can accomplish this." And then, of course, he accomplishes this.

[00:05:40]Because narcissists are very immature.

[00:05:42]They're children. Clinically speaking, psychologically speaking, narcissists are 2 years old, 3 years old. And so, but yes, we can modify behaviors. The modifications don't last for long. So, they require repeat sessions, maintenance sessions and and so on. But all in all, this is possible. What is not possible is any change in the core clinical features of narcissism. For example, in the need for self-enhancement, um grandio fantasy, um in the relative absence of a functional self because pathological narcissism is a disruption in the formation of a healthy functioning self or ego. So there's there's this all these issues. A lack of empathy or a lack of effective empathy, a lack of emotional empathy because narcissists are capable of empathy. They're capable of cognitive and reflexive empathy. In other words, they can identify your state of mind and they can put they can slap a label on it and say, "He's crying, so therefore he's sad." This is cognitive empathy. But then they're not going to feel anything. They're not going to experience your sadness, you know, not going to resonate with your sadness. And this is not something that is reversible, right?

[00:07:06]>> Recently, there has been a slew of studies which claim otherwise.

[00:07:13]A most recent study has been published a few in July 2024, 2024.

[00:07:21]In this study, the co-authors are among the most prominent scholars of narcissism. Ron, Ela Ron Stum and Gunderson, you know, they're the big names in the field.

[00:07:32]And the study claimed that with the application of two and a half to 5 years of therapy or multiple types of therapy to be precise, narcissism can be cured, can be healed. In other words, the person could no longer be diagnosed with narcissistic personality disorder.

[00:07:50]However, the study is dramatically flawed and I mean dramatically.

[00:07:57]The number of people who have been studied is eight.

[00:08:01]All these people have additional mental health issues which are severe. So four of them have borderline personality disorder in addition to narcissistic personality disorder. Right?

[00:08:13]>> Several of them abuse substances. And we know for example that alcohol creates a temporary or transient state of narcissism, pathological narcissism.

[00:08:24]It's called alcohol myopia.

[00:08:27]The study is is so dramatically flawed that I think the best thing to do is to completely ignore it. You know, another study a few about a year ago um claimed that narcissists develop empathy as they grow older.

[00:08:45]However, this this study is equally flawed if not even more so because the people who have been studied are people with dark personalities.

[00:08:55]There is a god god awful confusion online and among scholars because dark personality, dark triad personality, dark tetra personality, these are not narcissists.

[00:09:09]These are people with subclinicalism, subclinical psychopathy, machavelianism and in the case of dark tetrat sadism.

[00:09:19]Subclinical means they cannot be diagnosed.

[00:09:23]So these are not narcissism. If you study these people and then publish a study about narcissist, you have no idea what you're talking about.

[00:09:31]>> Which is exactly what I told the BBC which didn't make them happy. M >> so the p the picture right now is that we have several pretty efficacious effective treatment modalities schema therapy transference therapy transference based therapy um to some extent some types of CBT um even gestalt to some extent so we have certain treatment modalities which have a positive impact on the social functioning of the narcissist However, one must not confuse social functioning with the disease or the disorder.

[00:10:13]Social functioning is superficial, is acquired, can be learned. It does not say anything or does not reflect at all on the psychonamics of the disorder on on what's really happening on the internal psychological processes of the individual. Has nothing to do with it. I can teach you to behave in a certain way. It has no bearing on who you are.

[00:10:38]So >> this is the situation. This is where this is state-ofthe-art right now. Okay.