I have to disagree with narcissism expert Dr Romani Durvasula (and Freud) here.

I believe that narcissists can change. And not just to make them more socially acceptable (although that would be a good start).

Many people with narcissistic traits don’t want to change. They are perfectly fine, thank you. It’s everyone else who has problems, not them.

But sometimes, the emptiness at the heart of narcissism can become, well, empty.

It can take a crisis.

Or possibly the ageing process.

When someone with narcissism is confronted with their growing fragility and limitations or with failure in their personal or professional life, things can get ugly. They may even be forced to admit their dependence on others, which can lead to deflation and intense pain (for you and them).

In some instances they may lose something of value that impacts on their identity. Their vocational dreams, an important relationship or a coveted role. A social shield allowing them to bypass the pain and low self-esteem at the core of their personality suddenly slips their grasp, leading to a difficult and unwelcome reckoning.

Forced to confront their own limits, the structure on which their personality is based comes crashing down.

This dismantling leaves them with the trauma and feelings of worthlessness that have been hidden and protected by their grandiosity and ambition.

At their lowest point they might come to therapy with a genuine will to change, and a willingness to do the hard work of transformation.

It’s not an easy journey.

In a Youtube address, Dr Romani Durvasula argues that narcissists can be taught the social niceties. Like a wild unsociable animal, they can be trained to be more amenable and considerate towards others, if they are motivated.

But I would argue that personality disorders, including narcissistic personality disorder can be transformed through the deeper work of engaging with and integrating the trauma that lies at the heart of these disorders.

Perhaps I am overly optimistic, but I truly believe it is possible for a narcissist to change, with hard work from therapist and client.

As a therapist it can be tricky to work with someone who is high on the narcissism scale. We have to support and empathically mirror them, whilst also confronting them with their sometimes unpleasant behaviour and unreasonable expectations.

It can be a lengthy, thankless process. If confrontation comes too early, the narcissist will leave therapy, blaming the therapist for their lack of support or “inadequacy.”

Finding the right therapist is key. “Someone who does not get overwhelmingly triggered or easily charmed by the narcissist ― this is hard to find ― who can set limits, empathically confront and hold the narcissist accountable while acting as a type of attuned parenting agent for the vulnerable part of them.” (Craig Malkin in Rethinking Narcissism.)

Restructuring the personality is not the work of a few weeks, or even a few months. It can take several years to get beyond narcissistic defences and allow people with this condition to experience their vulnerability in a safe space.

I can certainly understand why it is not for everyone.

For those who are doing OK in their personal and professional lives, there is no real reason to do the hard yards of therapeutic transformation.

But therapy can allow someone who is narcissistic to embrace a new, more authentic life, including better connections and more rewarding relationships.

Instead of relying on external feedback to manage their sense of self, people who are narcissistic can develop a more realistic and compassionate relationship with themselves - and those who are closest to them.