Narcissism is often understood as something that cannot meaningfully change: that once a person is labeled a narcissist, there is little possibility for treatment or psychological growth. From a psychodynamic perspective, however, genuine change in narcissism is possible. It is often marked not by the disappearance of narcissistic defenses overnight, but by subtle shifts in how those defenses operate. At the center of the narcissistic defensive organization is a grandiose structure—a way of experiencing the self as exceptional, superior, self-sufficient, or entitled. The grandiose sense of self protects against more vulnerable experiences of the self.
One of the most central vulnerabilities protected against by the grandiose structure is the experience of dependency. Beneath the grandiose structure is often a profound fear of dependency and vulnerability. This does not mean that a person with narcissistic patterns does not need other people. In fact, the need for others may be quite powerful.
The difficulty is in experiencing oneself as genuinely dependent on another person and tolerating the vulnerability that comes with needing and receiving from someone else. To depend on someone emotionally means risking disappointment, rejection, humiliation, or injury. The narcissistic solution is often to elevate the self above need altogether: “I don’t need anyone,” “I’m fine on my own,” or to reverse the position of dependency by becoming the person who gives, provides, rescues, succeeds, or is needed rather than the person who needs or receives.
The podcasts, videos, and articles on this page explore the treatment and healing of narcissism through a psychodynamic lens. Here, you will discover what narcissistic defenses are protecting against and why experiences such as dependency, need, vulnerability, inadequacy, and emotional exposure can be so difficult to tolerate. We also explore and demonstrate the process through which these previously defended-against experiences can gradually become more conscious and emotionally tolerable, allowing previously split-off aspects of the self to become more integrated—and ultimately leading to meaningful psychological change and the healing of narcissism.
“Genuine change in narcissism is often marked not by the disappearance of grandiosity overnight, but by subtle shifts in this defensive structure itself.”
– Dr. Anthony Mazzella
Q&A
Yes. Genuine change in narcissism is possible. It is often marked not by the disappearance of grandiosity overnight, but by subtle shifts in the defensive structure itself. Change is not simply insight. It is the gradual capacity for previously split-off experiences—dependency, need, and vulnerability—to begin to be held together without collapse.
In part, what produces change is the accumulation of lived emotional experiences in the treatment where a person risks a small degree of connection, and discovers—repeatedly—that the anticipated outcome of humiliation, rejection, or loss of self does not occur in the way they had expected.
Meaningful change can look like a gradual shift from a rigid internal rule to something far more nuanced and psychologically flexible. Instead of “If I need someone, I will be humiliated—or hurt,” a person can begin to recognize that dependence can feel good, and “I feel supported,” without necessarily collapsing into humiliation.
The goal is to gently bring attention to moments where something begins to emerge—where another part of the person comes forward, where they can acknowledge that something mattered, that they were affected, or that another person had an impact on them. These small moments can begin to loosen the rigidity of the defensive structure.
One of the most central features of narcissism is the inability to truly depend. Beneath the grandiose structure is often a profound fear of dependency and vulnerability. To depend on someone emotionally means risking disappointment, rejection, humiliation, or injury. The narcissistic solution is often to elevate the self above need altogether: “I don’t need anyone.” “I’m fine on my own.”
In treatment, these defensive reversals can slowly become conscious, observable, and eventually emotionally tolerable within the relationship itself. The work increasingly focuses on helping a person observe, in real time, the ways they block out dependency and emotional reliance, and to experience that needing or relying on another person does not necessarily mean becoming diminished or “less than.”
The narcissistic internal world can be organized around a division between two self-states that cannot easily coexist. On one side, there is an idealized self-representation: completely independent, invulnerable, self-sufficient, needing no one. On the other side, there are ordinary human dependency needs, which are experienced as threatening, shameful, or destabilizing. Rather than these states being integrated, they are kept apart.
Change involves the gradual capacity to hold these previously split-off parts of experience in the same internal space. A moment of appreciation, reliance, or recognition of the usefulness of another person can reflect a temporary reduction in splitting—a small but meaningful movement toward integration. Dependency is no longer defended against and entirely split off.
Ultimately, what produces change is not insight alone, or reassurance, or even interpretation in isolation. Change in narcissism is complex and multifaceted, and the process will look different depending on the particular pattern of narcissism, the person’s level of psychological functioning, the rigidity of their defenses, their capacity to reflect on their internal experience, and the nature of the therapeutic relationship.
I encourage you to explore the resources on this page, particularly the podcasts on healing narcissism, where I explore the different dimensions of treatment and demonstrate the processes through which meaningful psychological change can occur.
Narcissism Decoder Podcast Episodes:
Healing Narcissism: If You Want to See Change – Start Here
Explore the real work of healing narcissism by understanding and slowly dismantling the defenses that protect it, with emotional regulation and integration playing a central role in lasting change.
Healing Narcissism: What to Do When You Can’t Win
Understand the hidden dance between grandiosity and vulnerability in narcissism, including how to recognize shifts in process, understand why timing matters, and intervene without triggering shame or rupture.
Healing Narcissism: They Finally Open Up—Now What?
Examine what happens when grandiose defenses begin to soften, and how containment, timing, and psychodynamic work support emotional regulation and meaningful change.
Healing Narcissism: What Follows the Collapse of Narcissism?
Discover how emotional unraveling, mourning, and ambivalence can mark the beginning of real change and a shift toward genuine connection and inner integration.
Why Arguing with a Narcissist Never Works – and What Helps
Explore how shifting away from labels and facts toward moment-to-moment process, containment, and curiosity can deescalate conflict and open space for real change in narcissistic relationships.
Can Narcissism Change? What ‘Healing Narcissism’ Looks Like
Learn how real change in narcissism begins to take shape through subtle internal shifts in how closeness, need, and recognition are experienced.
Can Narcissists Change? What Actually Works
Understand what makes therapy effective for narcissistic patterns, including how trust develops over time and how staying with difficult emotions can create real change.
Can Someone with Narcissism Truly Change—and Heal from Within?
Explore what happens when the illusion of the grandiose self begins to crack, how narcissistic defenses break down and modes of repair can become destructive, and why these patterns can blur into borderline dynamics.
Articles
What Does It Mean to “Heal” Narcissism?
Learn why narcissism is not necessarily fixed or unchangeable, and how meaningful psychological growth begins with subtle internal shifts that gradually make the defensive structure more flexible.
Can a Narcissist Change: Four Signs of Real Growth
Discover what real progress in narcissism looks like, including the signs that matter, the traps that can be misleading, and how the “two worlds” framework can help you recognize meaningful movement over time.
Can Narcissistic Personality Disorder Be Treated?
Examine how psychodynamic approaches to narcissistic personality disorder can support meaningful change, including the role of splitting and the gradual development of more balanced views of others.
Can Psychodynamic Therapy Truly Help Treat Narcissistic Personality Disorder?
Explore how psychodynamic therapy approaches narcissistic personality disorder by exploring unconscious processes and early experiences to support greater self-understanding, emotional regulation, reality testing, and healthier interpersonal functioning.
How Does Therapy Help People with Narcissism Improve Their Relationships?
Understand the reasons reactions to gentle feedback can trigger anger, defensiveness, or self-attack, and how these responses often reflect deeper fears of inadequacy, shame, and disconnection rooted in early narcissistic family dynamics.
Healing From Narcissism: How Collapse Leads to Growth
Learn what happens when the dream of being ‘special’ is broken and how that loss can lead to both the hope and challenges of healing from narcissism.
Healing Narcissism: A Psychodynamic Approach to Treating NPD from the Inside Out
Examine 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 produces change is not insight alone, or reassurance, or even interpretation in isolation. It is the accumulation of lived emotional experiences in the treatment where one risks a small degree of connection, and discovers that the anticipated outcome of humiliation, rejection, or loss of self does not occur in the way one had expected.”
– Dr. Anthony Mazzella
