APA Citation
Arntz, A., Jacob, G., Lee, C., & Brand-de Wilde, O. (2015). Effectiveness of psychotherapy for personality disorders. *Annual Review of Clinical Psychology*, 11, 547-575.
Summary
This comprehensive review examines the effectiveness of various psychotherapy approaches for treating personality disorders, including Narcissistic Personality Disorder (NPD). The authors analyze decades of research on therapeutic interventions, finding that specialized treatments like Schema Therapy, Dialectical Behavior Therapy, and psychodynamic approaches show significant effectiveness. The review highlights that personality disorders, once considered untreatable, can respond well to targeted therapeutic interventions when properly implemented by trained clinicians over sufficient time periods.
Why This Matters for Survivors
For survivors of narcissistic abuse, this research provides hope that personality disorders can be treated, meaning recovery is possible for both survivors and, in some cases, those who caused harm. Understanding that effective treatments exist validates the real psychological impact of narcissistic abuse and supports survivors' healing journeys through evidence-based therapeutic approaches designed specifically for complex trauma and personality-related wounds.
What This Research Establishes
Personality disorders are treatable conditions - contrary to outdated beliefs, specialized psychotherapy approaches demonstrate significant effectiveness in treating personality disorders, including those involving narcissistic patterns and traits.
Schema Therapy shows particular promise - this integrative approach, combining cognitive, behavioral, and psychodynamic elements, proves especially effective for complex personality presentations and their underlying childhood origins.
Treatment requires specialized training and time - effective personality disorder therapy demands clinicians with specific training and patients committed to longer-term treatment, typically lasting 2-4 years for substantial change.
Multiple therapeutic approaches work - the research validates various evidence-based treatments including Dialectical Behavior Therapy, psychodynamic therapy, and cognitive-behavioral approaches, giving hope for individualized treatment matching.
Why This Matters for Survivors
This research offers profound validation that the deep wounds caused by narcissistic abuse can heal. When you’ve been told you’re “too sensitive” or “overreacting,” knowing that specialized treatments exist for personality-related trauma confirms that your pain is real and treatable. The evidence shows that the complex emotional patterns you may struggle with—difficulty trusting, emotional dysregulation, or identity confusion—aren’t character flaws but treatable responses to psychological injury.
Understanding that personality disorders themselves can be treated may bring complex feelings if your abuser had narcissistic traits. While this doesn’t excuse their behavior or obligate your forgiveness, it can help reduce the helpless feeling that some people are simply “evil” or unchangeable. This perspective can be particularly healing for survivors who blame themselves for not being able to “fix” their abuser.
The research emphasizes that effective treatment requires specialized approaches and significant time investment. This validates why your healing journey may feel long and complex—you’re not “failing” at recovery if progress feels slow. Deep psychological wounds require patient, skilled treatment, just as severe physical injuries need specialized medical care.
Most importantly, these findings support seeking specialized trauma therapy for yourself. The same therapeutic innovations helping people with personality disorders can be powerfully effective for survivors dealing with complex trauma, attachment wounds, and the lasting effects of psychological abuse.
Clinical Implications
Clinicians working with narcissistic abuse survivors should recognize that many clients may benefit from therapeutic approaches originally developed for personality disorders. Schema Therapy’s focus on early maladaptive schemas proves particularly relevant, as survivors often develop schemas around defectiveness, abandonment, or emotional deprivation that mirror those seen in personality disorder presentations.
The research underscores the importance of specialized training when treating complex cases. Survivors of narcissistic abuse often present with intricate combinations of trauma symptoms, attachment disruption, and identity wounds that require sophisticated therapeutic skills. Clinicians should seek additional training in approaches like Schema Therapy, DBT skills, or trauma-focused treatments to serve these clients effectively.
Understanding the timeline for personality-related change helps clinicians set realistic expectations with survivor clients. Just as personality disorder treatment typically requires years rather than months, survivors of severe narcissistic abuse may need extended therapy to heal deep relational and identity wounds. This perspective helps prevent premature treatment termination and reduces client shame about “slow” progress.
The effectiveness of multiple therapeutic modalities suggests that treatment should be individualized based on each survivor’s specific presentation and preferences. Some may respond better to the structured skills approach of DBT, while others benefit more from the integrative, childhood-focused work of Schema Therapy or the relational healing emphasis of psychodynamic approaches.
How This Research Is Used in the Book
Narcissus and the Child draws on this landmark review to provide hope and direction for both survivors and their supporters. The research helps readers understand that healing from narcissistic abuse involves addressing personality-level wounds that require specialized attention and extended care.
“The evidence is clear: the deepest psychological wounds can heal with the right treatment approach and sufficient time. This research teaches us that what feels like permanent damage to your sense of self, your ability to trust, or your emotional stability is actually a treatable response to trauma. The same therapeutic innovations helping people with personality disorders can transform the lives of narcissistic abuse survivors who commit to the healing process with skilled professional support.”
Historical Context
This comprehensive review was published during a transformative period in mental health treatment when personality disorders were finally being recognized as treatable rather than permanent conditions. The research helped shift clinical culture away from therapeutic pessimism toward evidence-based hope, influencing how both personality disorders and complex trauma are understood and treated in contemporary practice.
Further Reading
• Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema Therapy: A Practitioner’s Guide. Guilford Press.
• Linehan, M. M. (2014). DBT Skills Training Manual (2nd ed.). Guilford Press.
• Bateman, A., & Fonagy, P. (2016). Mentalization-Based Treatment for Personality Disorders: A Practical Guide. Oxford University Press.
About the Author
Arnoud Arntz is a leading researcher in personality disorders and Schema Therapy, serving as Professor of Clinical Psychology at the University of Amsterdam. His groundbreaking work has advanced understanding of how early childhood experiences contribute to personality pathology.
Gitta Jacob is a prominent Schema Therapist and researcher specializing in personality disorders and trauma treatment. She has contributed extensively to the development of Schema Therapy techniques for complex psychological conditions.
Christopher W. Lee is a clinical psychologist and researcher known for his work in trauma therapy and EMDR, contributing valuable insights into treating personality-related trauma responses.
Historical Context
Published during a pivotal period when personality disorders were gaining recognition as treatable conditions rather than permanent character flaws, this review helped establish evidence-based hope for complex psychological healing in both clinical and survivor communities.
Frequently Asked Questions
Yes, research shows that specialized therapies like Schema Therapy and psychodynamic approaches can effectively treat personality disorders, including NPD, though treatment requires long-term commitment and skilled clinicians.
Schema Therapy, Dialectical Behavior Therapy (DBT), and specialized psychodynamic therapies show the strongest evidence for treating personality disorders effectively.
Treatment for personality disorders typically requires 2-4 years of consistent therapy, as these conditions involve deeply ingrained patterns that take time to change.
Yes, many therapeutic approaches developed for personality disorders are highly effective for treating complex trauma and emotional wounds caused by narcissistic abuse.
Yes, personality disorder therapy uses specialized techniques designed to address deeply rooted patterns, schemas, and attachment wounds that regular therapy may not target effectively.
Schema Therapy addresses early maladaptive schemas formed in childhood, helping people understand and heal the root causes of their personality-related difficulties.
While some growth is possible, research shows that specialized professional treatment is typically necessary for significant, lasting change in personality disorder patterns.
If you experience persistent patterns of relationship difficulties, emotional dysregulation, or identity issues following narcissistic abuse, specialized therapy assessment can help determine appropriate treatment.