Narcissists can have healthy relationships if they're willing to spend 'six figures' on treatment, says psychologist who's worked with dozens

Lee Hammock dubs himself a "self-aware narcissist." 

"Self-aware doesn't mean you're better," he says. "It just means you know this. Like how you're self-aware that you broke your leg." 

Hammock, 38, was professionally diagnosed with narcissistic personality disorder by a psychologist in 2017. His decision to seek help was propelled by his wife leaving him for the second time. 

"On her way out the door she called me a narcissist, and that's how the word got brought into my life," he says. 

He is part of a growing number of people who have either been diagnosed with NPD or have identified some narcissistic personality traits in themselves, and want to learn how to have more fulfilling relationships. 

Hammock worked in real estate but now mainly focuses on content creation. His TikTok page MentalHealness has 1.7 million followers.  

"After I got diagnosed I kind of had that lonely feeling," he said, "You Google it and it says 1% of people are diagnosed and you feel like you're by yourself, but you also feel kind of special at the same time." 

Experts say the path to healthy relationships for people with NPD or narcissistic personality traits is not impossible, but it's also not easy or affordable.

Especially because many insurance plans might not cover specific mental health treatments. 

Dr. Ramani Durvasula is a clinical psychologist in Los Angeles who focuses on how narcissistic and antagonistic personality types affect relationships. She also authored the book "Should I Stay or Should I Go?: Surviving a Relationship with a Narcissist." 

Throughout her career, she has treated about 50 narcissists. This doesn't mean she has cured people with NPD. In fact, she says, if you ask many of her patients' friends or family they would probably say she isn't making any difference at all. 

Generally, she says, there are two types of upbringings that lead a person to become a narcissist.

"There is the traumatized, neglected, poor attachment style pathway, and then there is the overindulged, spoiled child pathway," she says. 

If a client comes from the former type of childhood, where their parents were abusive or neglectful, they might be more amenable to change, she says: "You might be able to get in a little more purchase, get your feet in there with a client who is then starting to recognize why they are so 'me against the world,' why they feel so combative." 

With those who come from the latter type of childhood, Durvasula hasn't seen any success. 

"With the spoiled child narcissist, forget it," she says. "That is indoctrinated. People telling their kids they are the most special and you deserve everything. No you don't. I've never seen luck with those clients." 

Part of the reason treating someone with NPD is so tough, she says, is that one of their inoperative personality traits is self-awareness.

"By definition, these are people who have low levels of self-awareness and in tandem to that, an incapacity to recognize the needs and wants of other people," she says. 

It's unlikely that this type of person will walk into a therapist's office, let alone heed their advice. 

"They have to be aware that they have caused harm to other people," she says. "A very, very, very small percentage of narcissists are ever gonna get there." 

Plus, teaching people with NPD to adopt traits that will help them have healthy relationships is hard simply because changing a person's personality, no matter what their tendencies are, is hard. 

"I'm an agreeable introvert," Durvasula says. "It's very hard for me to be rude to people and any day of the week I'd like to be alone. I'm not going to be a b---h extrovert tomorrow." 

We also live in a society where narcissistic traits are rewarded, as they are often instrumental in professional success. Feeling you deserve power, bragging or exaggerating achievements, and perfectionism are all associated with narcissism. 

Coaching a narcissist out of these tendencies can feel, to them, like you want them to curb the parts of themselves that are most valuable.

"It's a tough sell in capitalist society, because the thing that makes them financially successful is the thing that is harming their kids and families," Durvasula says. 

Another obstacle to treating NPD is cost. 

Some talk therapy is covered by insurance, says Carolyn McClanahan, a physician turned certified financial planner and founder of Life Planning Partners in Jacksonville, Florida. But for someone with more demanding mental health problems, the out-of-pocket cost can make treatment prohibitive.

"There is a severe shortage of mental health therapists and many don't take insurance, as insurance companies pay very little for mental health therapy," she says. "Even if therapists take insurance, often the networks of mental health providers are very limited and the wait times to get therapy can be very long." 

It could be a couple hundred dollars a month, she says, or a few thousand, depending on how intense a treatment you need. 

For narcissists who are truly interested in changing their behaviors, treatment needs to be frequent and long-term, says Jessica MacNair, a licensed therapist who has worked with clients who have NPD. 

"To me, it's not dissimilar to addiction treatment," she says. "There is a committed accountability process. If you're really committed to the recovery process, you should surround yourself with other people who will also hold you accountable. If they go for two months then decide they are cured, I would see that as a red flag." 

The quality of the treatment can also drive up cost, Durvasula says. 

"The kind of therapy one would need access to push back in a permanent, consistent, sustained way from the maladaptive behavior is the highest quality therapist," she says. "It might even initially be a twice-a-week session. You start putting a number on that and it goes into six figures." 

And if you don't have the means to invest in extensive therapy, "it's pretty bleak," she adds. 

Hammock, the "self-aware narcissist," spends $150 per session and goes once every four weeks unless his therapist asks him to come in earlier. Overall, he spends between $1,800 and $3,600 on treatment a year. 

Hammock is clear that therapy has not cured him. It has helped him manage his behaviors, though. 

For example, he has a child from his previous relationship. His ex and his current wife, who he also has a child with, are friends. They talk and coordinate plans for the kids. Before treatment, he says, this would have frustrated him and caused tension. 

"I'd be silent and then pepper in some narcissistic rage to show my disdain and anger," he says. "Today, the same situation happened and I could feel the frustration setting in and I was like, 'okay, why am I actually frustrated?' I could see that I'm frustrated that I didn't communicate my schedule appropriately, as opposed to blaming them for the scenario and not including me." 

Instead of lashing out, he sat in his car and took some deep breaths. 

"My very first thought has not changed," he says. "The results have changed." 

For a narcissist, Durvasula says, if there is any shift, it won't be in their logic but in their actions. 

One client saw her for three years. He had a string of five ex-wives and was ready to break the pattern. 

"He was a client who was deeply narcissistic, very successful, serial infidelity, very entitled, all that stuff, but over the course of therapy actually did become very self-reflective about how his contempt for other peoples' emotions and dismissiveness was hurting them," she says. 

This didn't mean he started being a more thoughtful partner, though. Instead, he got another divorce and now doesn't pursue anyone romantically. 

"He got to a place where he was like, 'I understand I'm hurting these people, and I'm not looking to hurt anyone, but I know I'm not going to get to this place where I want to sit around and listen to their feelings,'" he told her. 

This, she says, she counts as a "win." 

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