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How Narcissism Can Derail Therapy

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Narcissistic personality traits are related to poorer response to psychotherapeutic treatment. This is the result of a German multi-site study with more than 2,000 participants receiving inpatient and outpatient psychotherapy. The findings of the research team at Jena University Hospital and University of Münster, now published in the scientific journal The Lancet Psychiatry, can contribute to further individualization of psychotherapy.

After Narcissus, the figure from Greek mythology, a person with particularly high sense of grandiosity and entitlement is called a narcissist. In a Germany-wide study with more than 2,000 patients from inpatient and outpatient psychotherapy, a team of researchers from Jena University Hospital and the University of Münster examined how narcissistic dimensions affect the treatment of mental health complaints. To this end, the study team recorded the participants' level of narcissistic personality traits and depressive symptoms before and after the treatment with two different psychotherapy methods.

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Strong narcissistic rivalry is associated with more severe depression symptoms before the start of therapy in both groups, the study team found. In contrast, the need to be admired was related to lower depression severity. Maike Richter, first author of the study, summarizes the study’s main findings as such: "In the group of patients treated with cognitive behavioral therapy, narcissism was associated with a poorer response to treatment, even when a narcissistic personality disorder was not fully developed." In particular, the rivalry dimension had a negative impact.

Narcissism affects therapeutic relationship

However, in treatment with psychoanalytic-interactional therapy, which was developed specifically for people with difficulties in interpersonal relationships, adverse effects of narcissism on treatment response were not found. The researchers assume, that this difference between the treatment methods was due to interpersonal behavior patterns between patient and therapist. According to Prof. Nils Opel, Jena University Hospital, further analyses support this hypothesis: "We found evidence that the negative effects of narcissism are based on a weaker therapeutic relationship."

The authors consider the findings an important contribution to the understanding of narcissistic personality characteristics and their inclusion in the therapy of mental disorders in general. "Narcissism can be a relevant factor for mental health, leading to psychotherapy being less effective," emphasizes Prof. Mitja Back, University of Münster. The researchers therefore recommend that therapists carefully assess their patients' narcissistic tendencies and pay special attention to the therapeutic relationship.

Reference: Richter M, Mota S, Hater L, et al. Narcissistic dimensions and depressive symptoms in patients across mental disorders in cognitive behavioural therapy and in psychoanalytic interactional therapy in Germany: a prospective cohort study. The Lancet Psychiatry. 2023:S2215036623002936. doi: 10.1016/S2215-0366(23)00293-6

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