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In treating people with Cognitive-Behavioral Therapy:

  • Which people can't be helped by therapy?

  • How are some people more treatable than others?

Additional Info

In the comments of a blog post analyzing male seducers, a psychotherapist explained the effect of narcissistic mothers on their sons. She said that some people have a greater capacity for benefiting from therapy than others. Some people can't be helped by therapy.

What makes a person unable to benefit from therapy?

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It's an interesting question, but you'll probably need to refine your scope: (a) what kind of therapy are you talking about? (b) what class of symptoms or disorders are you covering? –  Jeromy Anglim Dec 7 '12 at 6:42
Some people can be stubborn and stick to noncompliance. If a patient isn't willing to "try" or "listen", therapy will not be beneficial... working with patients with BPD can be difficult (for example) but could you elaborate on what you mean by "more treatable"? I mean, you're right, CBT is not the befitting form/orientation of therapy for everyone, but do you want to focus on the mentioned narcissistic mothers? –  PheonixEnder Dec 8 '12 at 4:59
So people really need to want therapy. They must feel like cooperating for the therapy to be successful. Yes, PheonixEnder. I'd like to focus on people with narcissistic mothers for this question. If you can provide any additional info on psychological mental illness, instances where illness is not caused by phisiology such as chemical imbalances in the brain but rather is the result of experience or destructive thinking, I'd love to hear it. In cases where the illness is "purely mental," what makes a person more, or less, treatable? We can focus on narcissistic mothers if that keeps the –  Tyler Langan Dec 8 '12 at 5:07

2 Answers 2

Personality disorders in general are difficult to treat for a variety of reasons:

  • They are difficult to diagnose accurately.
  • By definition, personality disorders reflect enduring issues in multiple areas of functioning.
  • Patients often do not see themselves as having a problem.
  • Patients are difficult to get along with and form a constructive therapeutic relationship.
  • There are often no straightforward treatment courses (such as medication) due to lack of understanding of the disorder.

CBT represents a fairly diverse set of possible therapeutic strategies, and is known to be effective for personality disorders in general. For Narcissistic personality disorder, other treatment options are also common, such as integrated approaches, and group therapy.

I'm not aware of any studies looking at patient factors for the success of CBT in treating NPD specifically, but I would look at the factors that affect the success of CBT and PD treatment in general:

  • Is the diagnosis accurate (get a second opinion)?
  • How severe / persistent are the symptoms?
  • Are there complicating comorbidities (eg, anger, impatience)?
  • Is the patient interested in seeking therapy?
  • Is there a healthy relationship between the patient and the therapist (try other therapists if not)?
  • Is the patient committed to change, willing to pursue therapy consistently, and for a long period of time?
  • Is the patient in a supportive / accommodating environment at home?
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Generally, therapy is more successful, the more resources a patient brings to the therapy.

For example, a generally healthy person will recover quickly from a flu, while an old person with fragile health may even die from it. The same goes for psychotherapy.

The more "functional" a person was before he or she developed a psychological disorder, the more friends they have, the more functional their family was when they were children, the better educated that person is, and so on – the more likely it is that this person's psychological health can be restored through treatment.

Moderators of therapy success are the same as for the absence of a disorder in the first place. That is, the more likely it is for someone to develop a disorder, the less likely it is that treatment will be successful.

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