A recent German multi-site study, conducted by researchers from Jena University Hospital and the University of Münster, has shed light on the impact of narcissistic personality traits on psychotherapeutic treatment. The study, encompassing over 2,000 participants receiving inpatient and outpatient psychotherapy, has been published in The Lancet Psychiatry, offering valuable insights into tailoring psychotherapy to individual needs.
Narcissistic traits, characterized by an exaggerated sense of grandiosity and entitlement, are at the heart of the study. To assess how these dimensions influence the treatment of mental health issues, the research team evaluated participants’ levels of narcissistic personality traits and depressive symptoms both before and after undergoing two different psychotherapy methods.
The study’s findings revealed that strong narcissistic rivalry was associated with more severe depression symptoms prior to therapy initiation in both the inpatient and outpatient groups. In contrast, the need for admiration was linked to lower depression severity.
Maike Richter, the study’s primary author, emphasized the results, stating, “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.” Notably, the rivalry dimension had a notably adverse impact.
The study also highlighted the role of narcissism in shaping the therapeutic relationship. When examining treatment with psychoanalytic-interactional therapy, a method tailored for individuals with interpersonal difficulties, the researchers did not find the same negative effects of narcissism on treatment response. They attributed this difference to the interpersonal dynamics between the patient and therapist.
According to Professor Nils Opel from Jena University Hospital, further analyses reinforced this hypothesis. Opel explained, “We found evidence that the negative effects of narcissism are based on a weaker therapeutic relationship.” The study’s authors regard these findings as a significant contribution to comprehending narcissistic personality characteristics and their relevance in the treatment of mental disorders in general.
Professor Mitja Back from the University of Münster emphasized the importance of considering narcissism in mental health, stating, “Narcissism can be a relevant factor for mental health, leading to psychotherapy being less effective.” As a result, the researchers recommend that therapists conduct careful assessments of their patients’ narcissistic tendencies and place special emphasis on cultivating a strong therapeutic relationship.
The study’s extensive analysis of over 2,000 participants undergoing psychotherapy in Germany has unveiled the intricate relationship between narcissistic personality traits and treatment outcomes. While strong narcissistic rivalry was associated with more severe depression symptoms before therapy, the need for admiration had a contrasting effect. Additionally, the study demonstrated that the impact of narcissism on treatment response varied depending on the psychotherapy method used.
Cognitive behavioral therapy appeared less effective for patients with high levels of narcissism, especially in the rivalry dimension, while psychoanalytic-interactional therapy showed more promising results. The key differentiator between these methods was identified as the quality of the therapeutic relationship, with the latter benefiting from stronger patient-therapist interpersonal dynamics.
The study’s insights have significant implications for mental health professionals, emphasizing the need to consider and address narcissistic traits in therapy. By recognizing and adapting treatment strategies to accommodate these traits, therapists can improve the overall effectiveness of psychotherapeutic interventions, ultimately enhancing the well-being of individuals with narcissistic personality characteristics.
Reference
Maike Richter et al, Narcissistic dimensions and depressive symptoms in patients across mental disorders in cognitive behavioral therapy and in psychoanalytic interactional therapy in Germany: a prospective cohort study, The Lancet Psychiatry (2023). DOI: 10.1016/S2215-0366(23)00293-6.
