Almost all professionals who deal with narcissists and psychopaths insist they cannot be cured, but say that Cognitive-Behavioral therapy can help “train” them to act in more prosocial ways. Of course, this isn’t going to work unless there’s something to be gained for the narcissist in doing so. Most won’t even enter therapy. Cognitive-behavioral therapy isn’t a cure though and does nothing to address the underlying problem or access the “true self” which even the narcissist has obscured from their consciousness with their elaborate series of masks.

I was thinking about a much more intense form of therapy, that would be costly and difficult, and takes into account several different methods of treatment, that may actually be able to cure narcissism. This therapy would take place in several stages:

Stage One: The Narcissistic Crisis/Narcissistic Injury
I was skimming through Vaknin’s book and toward the end he has a chapter about curing a narcissist. He believes these incorrigible people can actually be cured (which of course begs the question, why isn’t he cured? Or is he?) However, in order to be open to being cured they must have undergone a “narcissistic crisis” or “narcissistic injury”–that is, his or her sources of narcissistic supply must have been removed (such as after a divorce or the death of their primary source of narcissistic supply, loss of a career, financial ruin, incarceration, what have you).

In a state like this, without anything to prop them up or continually affirm their “greatness,” a narcissist will usually sink into a deep depression, and will do ANYTHING to make themselves feel better, even voluntarily entering therapy.

The tricky part would be identifying the depressed patient as a narcissist, but there should be enough signs in the way they talk about the glory of their “former life” and they will still lack remorse and empathy and blame others for their sorry condition rather than themselves. So identifying a severely depressed narcissist shouldn’t be too difficult for a trained professional.

The therapist cannot, under any circumstances, give the narcissist any sources of narcissistic supply or affirm them in any way, or give them any sympathy, at least not at first. In other words, they cannot mirror them. That will just make the narcissist feel good enough that their masks will go back up and they may think they’re “cured” and leave.

Stage Two: “Cold Therapy:” Deny the narcissist any narcissistic supply!
In order to force the narcissist to face what’s inside, it’s important the therapist does not affirm or mirror the narcissist. Instead, the therapist should stay nearly silent at first and make sure the narcissist is forced to confront his own emptiness. This will be extremely painful to them. They may leave, but if the narcissist is desperate enough he will probably stay. However, he will likely become angry at the therapist (transference) and rage. Still, the therapist must not show any reaction. When even their rage fails to elicit a response, the narcissist has no choice but to regress to the infant he really is.

Stage Three: Catharsis/”Remothering”
This would be a breakthrough point, and the point at which some real therapy could possibly be done. Becoming an infant will turn the narcissist into a blubbering, sobbing, needy, vulnerable mess. And this is where I can begin to see why in “People of the Lie,” M. Scott Peck, in his chapter about “Charlene” (a narcissist who entered therapy voluntarily because of her inability to maintain a relationship), wanted her to become vulnerable and baby-like so he could become her surrogate “mother” and give her the maternal nurturing she never had as a child. This might have worked too, had Charlene been ripped of all her sources of narcissistic supply and been undergoing a narcissistic crisis. Dr. Peck’s mistake was affirming her too much in the beginning of therapy and engaging her fantasies. By the time he realized his mistake, it was too late.

At the time I read Dr. Peck’s thoughts about how he should have “mothered” Charlene and held her in his arms (in a nonsexual way), I thought it sounded very odd and even unethical. But knowing more about narcissism than I did when I read that book, and more about why they’re the way they are, I can understand why Dr. Peck’s wish to “mother” Charlene may have worked. But not only did Peck start out all wrong, Charlene was not depressed enough to be open to such a technique.

So a vulnerable narcissist stripped of all their elaborate defense mechanisms, reduced to a dependent infant, is going to be going through an emotional catharsis as the true self (which was arrested in infancy and is still an infant) begins to emerge. They are going to be in unbearable terror and pain. A good (and very strong) therapist can offer maternal support through holding the patient during catharsis, stroking them in a nonsexual manner, but still must not tell them anything they want to hear, such as how they’re not a bad person, how they don’t deserve their pain, and the like. The therapist must remain quiet and let the patient go through the catharsis and only offer support by their mere presence.

Stage Four: Retraining and Internalizing the Conscience
I’ve elaborated a lot on what Vaknin says about curing a narcissist in this post, and I’m going to elaborate even further. Because the narcissist, while rendered virtually harmless at this point in therapy, still doesn’t have a conscience. They would still go right back to their old ways if they stop therapy now or their circumstances suddenly improve. Psychologically, they are infants and an infant has no conscience: they must be taught by their parents and caregivers the difference between right and wrong.

So after a few sessions of this cathartic crisis (however long it lasts–by its nature it will eventually exhaust itself), I would propose something like the sort of treatment that was given to 6 year old Beth Thomas in the documentary “Child of Rage,” who at first wanted to kill her parents and brother and who tortured animals, but was cured of incipient psychopathy early enough that she was still able to develop a conscience and become an adult with normal levels of empathy and no desire to hurt anyone.

The narcissistic patient, if at all possible, should be in a setting, such as a hospital or residential treatment setting, where they are closely monitored and supervised by trained professionals. Any good behavior is to be rewarded, any bad behavior punished. Any privileges at all would have to be earned. Just like a small child, reward and punishment will train their brain to develop a conscience. This is basically the same thing as the cognitive-behavioral therapy currently used on narcissists, but it cannot cure a narcissist who hasn’t first been broken down by a narcissistic crisis and catharsis, because all their masks are still on. A narcissist who has been through the process of crisis and catharsis has lost their masks, and therefore cognitive-behavioral retraining would become internalized rather than just a “positive” mask they can wear to make them more bearable to others.

Disclaimer:
I am in no way a professional (though I did major in psychology in college). I’m certainly not qualified to propose new methods of treatment, but this process I’ve described isn’t one I made up: it’s basically a combination of Vaknin’s proposed method of breaking down all the narcissist’s defenses so they become infantile (with a little M. Scott Peck thrown in), followed up with cognitive-behavioral techniques for retraining the patient’s conscience in a highly supervised setting.

It would be a difficult and expensive therapy at the very least, but I really think it could work. Of course, it also requires the narcissist to voluntarily enter therapy, which means they would have to have suffered a grave loss that threw them into deep depression in the first place (the narcissistic injury or crisis).

I’d be interested to hear your thoughts.