Treating Narcissists: Expert Interview on the Psychology of Narcissistic Personality Disorder

“They can behave as if they are empathic and caring when they have their masks on. They only show how controlling and nasty they can be when they know other people aren’t watching.”

Zoe, Host of YouTube’s Live Abuse Free & Narciscissm Expert

Variations of the word narcissism, which comes from a Greek myth about a handsome youth named Narcissus who fell in love with his own reflection, have been around for millennia. But in the early 20th century, Sigmund Freud published a paper on narcissism, generating interest from the psychology community. It has since been seen as a legitimate psychological condition.

Recently, the fascination with narcissism has spread into the landscape of pop-culture, becoming a buzzword that we hear in our everyday lives. Now, we tend to use it more loosely to describe any person that we deem to be arrogant or materialistic.

The classic traits of narcissism include anyone with a grandiose sense of self, a sense of entitlement, or an expectation to be recognized as superior even without the proper credentials to warrant it.

Many people display some traits of narcissism. After all, most people appreciate admiration and praise, can sometimes display a sense of entitlement, and post the occasional selfie on social media, looking for the approval of their peers.

But the condition called narcissistic personality disorder, or NPD, is much rarer. It’s a Cluster B personality disorder that (by one estimate) affects about 1 percent of the population—50 to 75 percent of whom are men. Another study from the Journal of Clinical Psychology put the lifetime prevalence of NPD at 6.2 percent.

Unlike those who simply display narcissistic personality traits, the treatment program Bridges to Recovery explains that people with NPD are characterized by a “fundamental and enduring distorted self-image and the inability to relate to the world around them in a healthy way,” causing them significant emotional and behavioral impairment.

NPD causes problems in many areas of an affected person’s life, such as in their personal relationships, work-life, or even their financial affairs. People with NPD tend to find their relationships unfulfilling, and in turn, others may not enjoy being around them.

But recognizing a person with NPD can sometimes be difficult for therapists. NPD is one of the least-studied personality disorders, which has led to widespread misinformation about the disorder, even within the psychology community.

We talked to an expert on NPD to understand more.

Meet the Expert: Zoe of Live Abuse Free

Zoe from the Live Abuse Free channel on YouTube has been making videos about Cluster B Personality disorders, abusive behavior, and healing since December 2018. In less than two years, she’s amassed more than 85,000 subscribers, mainly for talking about how narcissists’ minds work—diving into analyses of people like Chris Watts, a Colorado man who killed his family, and Onision, a famous YouTuber who is facing allegations of grooming minors online.

Zoe has done extensive research on narcissism, Cluster B personality disorders, and the effects of narcissistic abuse. She works as a therapeutic coach, specifically with people who have experienced abusive relationships. She holds a BSc (Hons) in psychology and has post-graduate diplomas in integrative counseling and counseling psychology.

While many of her videos focus on spotting red flags of abusive behavior in one’s own personal relationships and leaving abusive situations, we asked her to give us some insight on the flip side, and to talk about her experience of working with people with NPD.

Spotting Narcissistic Traits in Clients

Zoe says that she can sometimes spot signs that her clients may have narcissistic traits before she has had a real conversation with them.

“One thing that can jump out at me before I’ve even met the client is a sense of entitlement: an expectation that you will (and should), do more than is reasonable for the person,” she says. 

This could present itself when the client cancels the first session at the very last minute or when (s)he doesn’t show up and then expects not to pay for it.

“I send out a few basic questions for my clients to answer before we first meet and ask them to email their answers back at least 24 hours before-hand to give me time to read them. They are usually a page or two long at most. Someone once sent me answers that were 14 pages long, at about 10:30 at night, and expected me to read them all before our 9:00 a.m. session,” she says.

Another red flag that can present itself is a need to control the sessions: “This might mean someone continually interrupts or talks non-stop, and raises their voice when they see that I’m about to speak. They can try to use me as a sounding board while encouraging me to praise and admire them. They might boast about their work achievements every time we meet. One client wanted me to watch a video of her receiving an award at a work conference. Or they might tell me in every session about the successful and accomplished people they know.

“Another way these clients try to control the sessions is to refuse to do any of the exercises I suggest or try to postpone doing them, giving excuses every time they are given one until it becomes clear they are sabotaging our work together,” Zoe says.

“Other red flags are an obvious lack of empathy,” she continues. “They might only be able to see the pain of someone close to them as something inconvenient for them, not show any interest in it or be repulsed by it and talk about that person with contempt.”

 Misconceptions About NPD

Because of the prevalence of the use of the word narcissism in our everyday lives, it has begun to lose some of its meaning, leading to some misconceptions about the disorder. Let’s go over some of the common myths about what it means to have NPD.

They are Sociopaths

We tend to think that NPD and sociopathy, (which now falls under “Antisocial Personality Disorder” in the DSM V Criteria), are one and the same. True, there are some commonalities between the two disorders:

They both can be controlling, selfish, disingenuous, and dishonest, Psychology Today writes. 

As Zoe explains, “Approximately a quarter of people with NPD will also have ASPD, and there are some malignant narcissists who have traits of Antisocial Personality Disorder, who like to abuse others and who enjoy inflicting emotional (and sometimes physical) pain. 

“But while some people assume all narcissists are like this, many are not. They might be hurtful towards people who they feel are getting in the way of their goals, by expressing anger or contempt for them, but they won’t all maliciously hunt out victims. “  

They Demonstrate Obvious Behaviors

“Another misconception is that everyone who has NPD behaves like they are really superior to everyone and comes across as arrogant, vain, self-obsessed, and uncaring,” Zoe says.

“There are different kinds of narcissists: overt and covert. The former are easier to recognize because of their clear display of grandiosity. The latter are more difficult to spot because they may initially come across as shy, humble, and unassuming.”

“[They can] behave as if they are empathic and caring in public and when they have their masks on. They only show how controlling and contemptuous they can be in private, when they know other people aren’t watching or in subtle ways that other people won’t notice.”

The figurative “mask” is a psychology term used to describe the façade put on to disguise their vulnerable and insecure true self. Only when a covert narcissist’s “mask” slips does their true self shine through.

They are Untreatable

“Another misconception is that they can’t change,” Zoe says. “This can be a good mistake to make if you are in a relationship with a narcissist because most of them never do change—and they will never change because someone else wants them to; they have to want it themselves. Narcissists who really want to change and who can keep up the motivation to, can.”

The Challenge of Treating NPD

While making a correct diagnosis and administering therapy can be challenging, it’s not impossible if the patient can stay committed to the process and allow themselves to be vulnerable.

“These are the biggest challenges and the reason why many are unable to change. Narcissists wear masks to protect themselves from being hurt. So, this means they tend to not be themselves much of the time. This can make treating a narcissist very difficult because it’s hard to get to the real person inside who you want to help. Their masks are born out of a belief that people won’t accept them for who they are, so they can find it hard to accept empathy from a therapist beyond seeing it as a cue to try to manipulate them. This makes it hard to form a therapeutic alliance.”

Also, to be committed, “they need to have a reason to want to change,” Zoe explains. “By its very nature, NPD means only thinking of yourself and your own needs, so narcissists don’t tend to want to change for anyone else’s benefit. For some, they can hit a period of depression and want to change at that time, but then lose motivation when they are feeling better again. 

“Long-term psychotherapy can be useful, but it’s important for people with NPD to find one that suits them. For example, someone with NPD might find Psychodynamic Therapy too intrusive and this could feel threatening. So, they might end up intellectualizing about their behavior without ever trusting the therapist enough to be vulnerable.”

Person-centered counseling might not be useful for every patient, as it could be too gentle. “They could end up using the counselor as a sounding board and not getting anywhere,” Zoe says.

Schema Therapy is considered helpful for people who have personality disorders and don’t respond to other therapies. It’s an integrated therapeutic approach that emphasizes lifelong patterns, affective change techniques, and the therapeutic relationship, integrating all of these strategies together to best help the patient.

“It’s a practical way to work that encourages clients to go beyond intellectual talk and hypothesizing,” Zoe says. “The ‘reparenting’ aspect of Schema Therapy can help people to re-experience past events in a different way, undoing some of the trauma associated with their memories.”

“Reparenting” refers to the therapist establishing a secure attachment with the patient to meet the patient’s early childhood needs that were not met in the past.

“This can be a good way to get around some of the things narcissists can do that block therapy from working,” Zoe says.

According to Psychology Today, there are not enough psychotherapists available who are properly trained in the diagnosis and treatment of narcissistic personality disorder.

Nina Chamlou

Nina Chamlou


Nina Chamlou is a freelance writer from Portland, OR. She writes about healthcare, psychology, economic trends, business, technology, digitization, supply chains, education, aviation, and travel. You can find her floating around the Pacific Northwest in diners and coffee shops, or traveling abroad, studying the locale from behind her MacBook. Visit her personal website at