Is Narcissistic Personality Disorder (NPD) more amenable to Cognitive-Behavioural therapies or to Psychodynamic/Psychoanalytic ones?

Answer:

Narcissism pervades entire personality. It is all-pervasive. Being a narcissist is akin to being an alcoholic but much more so. Alcoholism is an impulsive behaviour. Narcissists exhibit dozens of similarly reckless behaviours, some of them uncontrollable (like their rage, outcome of their wounded grandiosity). Narcissism is not a vocation. Narcissism resembles depression or other disorders and cannot be changed at will.

Adult pathological narcissism is no more "curable" than entirety of one's personality is disposable. The patient is a narcissist. Narcissism is more akin to colour of one's skin rather than to one's choice of subjects at university.

Moreover, Narcissistic Personality Disorder (NPD) is frequently diagnosed with other, even more intractable personality disorders, mental illnesses, and substance abuse.

Cognitive-Behavioral Therapies (CBTs)

The CBTs postulate that insight – even if merely verbal and intellectual – is sufficient to induce an emotional outcome. Verbal cues, analyses of mantras we keep repeating ("I am ugly", "I am afraid no one would like to be with me"), itemizing of our inner dialogues and narratives and of our repeated behavioural patterns (learned behaviours) coupled with positive (and, rarely, negative) reinforcements – are used to induce a cumulative emotional effect tantamount to healing.

Psychodynamic theories reject notion that cognition can influence emotion. Healing requires access to and study of much deeper strata by both patient and therapist. The very exposure of these strata to therapeutic is considered sufficient to induce a dynamic of healing.

The therapist's role is either to interpret material revealed to patient (psychoanalysis) by allowing patient to transfer past experience and superimpose it on therapist – or to provide a safe emotional and holding environment conducive to changes in patient.

The sad fact is that no known therapy is effective with narcissism itself, though a few therapies are reasonably successful as far as coping with some of its effects goes (behavioural modification).

Dynamic Psychotherapy Or Psychodynamic Therapy, Psychoanalytic Psychotherapy

This is not psychoanalysis. It is an intensive psychotherapy based on psychoanalytic theory without (very important) element of free association. This is not to say that free association is not used in these therapies – only that it is not a pillar of technique. Dynamic therapies are usually applied to patients not considered "suitable" for psychoanalysis (such as those suffering from personality disorders, except Avoidant PD).

Typically, different modes of interpretation are employed and other techniques borrowed from other treatments modalities. But material interpreted is not necessarily result of free association or dreams and psychotherapist is a lot more active than psychoanalyst.

The narcissist – like other types of addicts – derives pleasure from these exploits. But they also sustain and enhance his grandiose fantasies as "unique", "superior", "entitled", and "chosen". They place him above laws and pressures of mundane and away from humiliating and sobering demands of reality. They render him centre of attention – but also place him in "splendid isolation" from madding and inferior crowd.

Such compulsory and wild pursuits provide a psychological exoskeleton. They are a substitute to quotidian existence. They afford narcissist with an agenda, with timetables, goals, and faux achievements. The narcissist – adrenaline junkie – feels that he is in control, alert, excited, and vital. He does not regard his condition as dependence. The narcissist firmly believes that he is in charge of his addiction, that he can quit at will and on short notice.

The narcissist denies his cravings for fear of "losing face" and subverting flawless, perfect, immaculate, and omnipotent image he projects. When caught red handed, narcissist underestimates, rationalises, or intellectualises his addictive and reckless behaviours – converting them into an integral part of his grandiose and fantastic False Self.

Thus, a drug abusing narcissist may claim to be conducting first hand research for benefit of humanity – or that his substance abuse results in enhanced creativity and productivity. The dependence of some narcissists becomes a way of life: busy corporate executives, race car drivers, or professional gamblers come to mind.