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A young woman sits on her couch visibly upset. Her partner is sitting with her. She is in need of therapy that will actually help her heal from narcissistic abuse.

Therapy That Will Actually Help You Heal From Narcissistic Abuse

8 min.

If you’ve survived narcissistic abuse, healing is possible with the right kind of help. Learn more about the best therapy for narcissistic abuse.

By: Ashley Laderer

Clinically Reviewed By: Don Gasparini Ph.D., M.A., CASAC

October 11, 2023


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Table of Contents

If you were or are a victim of narcissistic abuse, you may experience lasting effects on your well-being. Narcissists may abuse people with manipulative and controlling behavior that aims to demean or belittle victims. Emotional abuse inflicted by narcissists (such as a narcissistic parent) can leave you with long-lasting emotional scars, including self-doubt, poor self-esteem, and, of course, trauma.

Although people use the term “narcissist” colloquially, narcissistic abuse refers to a specific cycle of abuse perpetrated by someone with narcissistic personality disorder (NPD) or narcissistic traits if they aren’t diagnosed. This harmful cycle of abuse may result in what’s referred to as narcissistic abuse syndrome or narcissistic victim syndrome. These are not formal mental health diagnoses or medical terms, but they are used to identify the long-lasting impacts that narcissistic abuse can have on its victims. 

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Recovery from abuse and the associated trauma is a challenging journey, but with the right therapy and support, survivors can heal, move forward, and feel empowered. Here’s what you need to know about how to heal from narcissistic abuse with the help of therapy. 

What is the best therapy for narcissistic abuse?

Seeking help as a survivor of narcissistic abuse can be life-changing. The emotional abuse inflicted by people with narcissistic personality disorder is traumatizing –– and you, as a victim, deserve the help to feel your best after being hurt repeatedly.

“When someone is impacted by trauma, it changes both the mind and body,” says licensed clinical social worker Claudia Goldstein. “The nervous system can stay stuck in a state of ‘fight-or-flight,’ or it may enter the ‘freeze’ state where it completely shuts off, making it easy to be constantly re-triggered and make the individual prone to further mental health decline.” 

Furthermore, childhood trauma from narcissism and emotional abuse can increase your risk of mental health struggles such as depression, anxiety, panic attacks, and post-traumatic stress disorder (PTSD), especially complex PTSD, says licensed clinical social worker Kimberly Perlin.

If the impacts of trauma on your nervous system and overall well-being are impacting your quality of life and functioning, it’s time to seek treatment. When determining what therapy is used for narcissistic abuse recovery, it will come down to the individual’s circumstances and symptoms. However, here are some commonly used types of therapy that can help you heal from narcissistic abuse.

Cognitive behavioral therapy (CBT)

CBT addresses the thoughts, feelings, and behaviors that have taken shape as a result of the narcissistic relationship,” Goldstein says.

This therapy empowers survivors of trauma to recognize and challenge negative self-perceptions, anxiety, and self-doubt, which are all common outcomes of narcissistic abuse. Survivors learn how their feelings, thoughts, and behaviors are connected, ultimately allowing them to regain control, self-worth, and emotional well-being. 

CBT addresses cognitive distortions (unhealthy, unhelpful thought patterns) that may have taken root due to abuse. Therapists trained in CBT will also likely teach relaxation techniques and coping skills that you can use in times of high anxiety or when you’re triggered. Ultimately, you’ll develop a healthy relationship with your thoughts and feelings. 

“CBT encourages survivors to cease seeking external reassurance and, instead, embark on a journey of self-trust and self-empowerment,” Goldstein says. “This approach offers a solid foundation for building a life that’s no longer defined by past trauma.” Where appropriate, exposure therapy is an aspect of CBT that therapists might use in this case, too.

Cognitive behavioral therapy (CBT)

Trauma-focused CBT (TF-CBT)

Prolonged exposure therapy (PE)

Eye movement desensitization and reprocessing therapy (EMDR)

Dialectical behavior therapy (DBT)

CBT empowers survivors to recognize and challenge cognitive distortions resulting from narcissistic abuse to address negative self-perceptions, anxiety, and self-doubt.

TF-CBT educates survivors of narcissistic abuse about trauma, helps them develop relaxation and coping skills, understand the connections between thoughts, feelings, and behaviors, and process traumatic memories.

PE gradually exposes survivors of narcissistic abuse to traumatic memories and emotions, helping them confront and process the abuse-related experiences safely.

EMDR helps survivors of narcissistic abuse reprocess traumatic memories and reduce distressing physiological responses through eye movement work.

DBT helps survivors of narcissistic abuse cope with intense emotions by teaching mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness skills.

Trauma-focused CBT (TF-CBT)

TF-CBT is a special type of CBT specifically designed for kids and teens who are trauma survivors alongside their parent/caregiver –– as long as the caregiver is not the abuser, in this instance, the narcissistic parent or caregiver with narcissistic personality disorder.  

The main aspects of this trauma therapy follow the “PRACTICE” acronym, which stands for the following:

P – Psychoeducation/parenting skills

The therapist teaches you and your caregiver about trauma, triggers, and mental health impacts of trauma. You will learn how a therapist can help you heal from narcissistic abuse in this case, and parents will learn skills to best help children who are trauma survivors. 

R – Relaxation skills

Since traumatic memories and triggers can evoke strong responses, it’s important to learn relaxation skills to use in the heat of the moment, such as breathing exercises or visualization. 

A – Affect modulation skills

You will learn healthy ways to express your emotions and positive, helpful ways to cope with difficult emotions.

C – Cognitive processing skills

You will understand how your thoughts, feelings, and behaviors are intertwined, and how to change your thought patterns.

T – Trauma narrative and processing

You will recount the details of your trauma to process it and move forward healthily. 

I – In vivo mastery

This is not always used in TF-CBT, but exposure therapy is an aspect of treatment in some situations. In that case, you will work with your therapist to create a fear hierarchy and a course of action for exposure. 

C – Conjoint child-parent sessions

Your therapist will work with both you and your parent together to promote healthy communication and well-being.

E – Enhancing safety

The last step ensures safety and trust, creating a plan so that further trauma doesn’t ensue from the narcissistic abuser. 

Prolonged exposure therapy (PE)

Exposure therapy is an offshoot of CBT. For those who develop PTSD from narcissistic abuse, prolonged exposure (PE) therapy can help. Typically, trauma survivors avoid memories or situations that trigger them or remind them of the trauma and abuse they endured. However, this can reinforce to the brain that these things are, in fact, dangerous. PE, as a trauma therapy, aims to counteract this.

Prolonged exposure is designed to help survivors confront and process the distressing memories and emotions associated with their traumatic experiences, such as emotional or verbal abuse endured in a toxic relationship with a narcissist. A therapist helps you do this in a gradual way that feels safe, teaching you coping skills along the way. Ultimately, this will help promote healing and recovery. 

There are two types of exposures used in PE. The first is imaginal exposure, during which you vividly recount the details of your traumatic memories, usually in the present tense, with the guidance of a trauma-informed therapist. This process allows you to confront the distressing memories you might have been suppressing in a safe, controlled environment. You will work through the emotions and thoughts that arise with your therapist. The other type of exposure is called in vivo exposure. This method focuses on real-life situations or activities you might avoid due to trauma-related anxiety. You and your therapist will collaborate on a hierarchy of feared situations, starting with the least distressing scenarios and working your way up to more challenging ones. 

Eye movement desensitization and reprocessing therapy (EMDR)

EMDR helps survivors dive deep into their traumatic memories and the associated emotions, reprocessing them in a healthier way. It is a unique form of therapy that uses back-and-forth eye movements or another type of bilateral (side-to-side) stimulation to help you process distressing, triggering memories. 

A trained EMDR therapist can help you process trauma related to narcissistic abuse more quickly while also ensuring that these memories evoke less of a distressing physiological response when you think of them. “You will never say your trauma was ‘fine,’ but you will be able to stay regulated and not overwhelmed by the memory or experiences that remind you of the memory,” Perlin says. 

In a typical EMDR therapy session, your provider might have you recall a traumatic memory surrounding abusive behavior, whether that’s early childhood trauma or something more recent, while also focusing on the external bilateral stimulation, such as following your therapist’s hand move back and forth with your eyes. This helps you reprocess the traumatic memory in a less emotionally charged way. As sessions progress, the distressing emotions associated with the trauma lose intensity.

Essentially, EMDR aims to facilitate the brain’s ability to heal by integrating the traumatic memories, ultimately reducing trauma-related symptoms. “By reprocessing the memories, sensations, and emotions associated with these events, EMDR helps individuals forge healthier core beliefs,” Goldstein says. “This transformation paves the way for the emergence of newfound confidence, a regulated nervous system, and the creation of fresh neural connections.”

Dialectical behavior therapy (DBT) 

DBT is a form of therapy that aims to help people cope with difficult emotions by understanding them and learning how to regulate them. Therapists trained in DBT teach you different techniques in both individual and group therapy settings. 

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“Dialectical behavioral therapy is useful as it can help address the intense emotions and reactions which can be common in narcissistic abuse and recovery,” Perlin says. 

This therapy consists of four key components:

  1. Mindfulness: This practice helps you develop present-moment awareness and acceptance. With practice, through mindfulness exercises and meditation, you can learn how to observe and detach from your unhelpful thoughts and feelings without judgment. This will help you change your relationship with your thoughts for the better.  
  2. Emotional regulation: You’ll learn how to identify distressing emotions and, in turn, regulate them. “DBT helps individuals regain control by teaching them emotional regulation techniques. It empowers them to expand their emotional window of tolerance, allowing them to navigate the ebb and flow of emotions with resilience and grace,” Goldstein says. 
  3. Distress tolerance: Distress tolerance skills help you healthily navigate tough emotions so you don’t resort to unhealthy coping mechanisms, such as substance abuse or self-harming behaviors. These skills include muscle relaxation, paced breathing, and radical acceptance.
  4. Interpersonal effectiveness: This component addresses your relationships outside of therapy, whether that means relationships with family members, friends, or romantic partners. Interpersonal relationship skills will help you learn to communicate your needs better, work through conflicts, build self-respect, and more. 
A young woman sits on her bed arguing with her partner, who is folding clothes. She is looking for a therapy that will actually help her heal from narcissistic abuse.

How can Charlie Health help? 

If you’re a survivor of narcissistic abuse and want to heal with therapy, Charlie Health may be able to help you.

Our virtual Intensive Outpatient Program (IOP) provides personalized mental health services for teens, young adults, and families dealing with various struggles, including trauma and co-occurring conditions. All of Charlie Health’s clinicians are trauma-informed and well-equipped to help you process your trauma in a non-judgemental, safe space.

With trauma-informed care and a supportive community, you can start feeling better. Your narcissistic abuse recovery journey starts now. Fill out this short form to get started.

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