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Psychotherapy is a general term for treating mental health problems by talking with a psychiatrist, psychologist or other mental health provider.

During psychotherapy, you learn about your condition and your moods, feelings, thoughts and behaviors. Psychotherapy helps you learn how to take control of your life and respond to challenging situations with healthy coping skills.

There are many specific types of psychotherapy, each with its own approach. The type of psychotherapy that’s right for you depends on your individual situation. Psychotherapy is also known as talk therapy, counseling, psychosocial therapy or, simply, therapy.

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Mental health providers: Tips on finding one

Mental health providers: Credentials, services offered and what to expect.
By Mayo Clinic Staff

If you’ve never seen a mental health provider before, you may not know how to find one who suits your specific needs. Here are some points to keep in mind as you search for a mental health provider.

What type of mental health provider do you need?

Mental health providers are professionals who diagnose mental health conditions and provide treatment. Most have either a master’s degree or more advanced education and training. Be sure that the mental health provider you choose is licensed to provide mental health services. Services offered depend on the provider’s training and specialty area.

Below you’ll find some of the most common types of mental health providers. Some may specialize in certain areas, such as depression, substance misuse or family therapy. They may work in different settings, such as private practice, hospitals, community agencies or other facilities.

Psychiatrist

A psychiatrist is a physician — doctor of medicine (M.D.) or doctor of osteopathic medicine (D.O.) — who specializes in mental health. This type of doctor may further specialize in areas such as child and adolescent, geriatric, or addiction psychiatry. A psychiatrist can:
•Diagnose and treat mental health disorders
•Provide psychological counseling, also called psychotherapy
•Prescribe medication

Psychologist

A psychologist is trained in psychology — a science that deals with thoughts, emotions and behaviors. Typically, a psychologist holds a doctoral degree (Ph.D., Psy.D., Ed.D.). A psychologist:
•Can diagnose and treat a number of mental health disorders, providing psychological counseling, in one-on-one or group settings
•Cannot prescribe medication unless he or she is licensed to do so
•May work with another provider who can prescribe medication if needed

Psychiatric-mental health nurse

A psychiatric-mental health nurse (P.M.H.N.) is a registered nurse with training in mental health issues. A psychiatric-mental health advanced practice registered nurse (P.M.H.-A.P.R.N.) has at least a master’s degree in psychiatric-mental health nursing. Other types of advanced practice nurses able to provide mental health services include a clinical nurse specialist (C.N.S.), a certified nurse practitioner (C.N.P) or a doctorate of nursing practice (D.N.P.). Mental health nurses:
•Vary in the services they can offer, depending on their education, level of training, experience and state law
•Can assess, diagnose and treat mental illnesses, depending on their education, training and experience
•Can — if state law allows — prescribe medication if they’re an advanced practice nurse

Physician assistant

A certified physician assistant (P.A.-C.) practices medicine under the supervision of a physician. Physician assistants can specialize in psychiatry. These physician assistants can:
•Diagnose and treat mental health disorders
•Provide psychological counseling, also called psychotherapy
•Prescribe medication

Licensed clinical social worker

If you prefer a social worker, look for a licensed clinical social worker (L.C.S.W.) with training and experience specifically in mental health. A licensed clinical social worker must have a master’s degree in social work (M.S.W.), a Master of Science in social work (M.S.S.W.) or a doctorate in social work (D.S.W. or Ph.D.). These social workers:
•Provide assessment, psychological counseling and a range of other services, depending on their licensing and training
•Are not licensed to prescribe medication
•May work with another provider who can prescribe medication if needed

Licensed professional counselor

Training required for a licensed professional counselor (L.P.C.) may vary by state, but most have at least a master’s degree with clinical experience. These counselors:
•Provide diagnosis and psychological counseling (psychotherapy) for a range of concerns
•Are not licensed to prescribe medication
•May work with another provider who can prescribe medication if needed

What factors should you consider?

Consider these factors when choosing among the various types of mental health providers:
•Your concern or condition. Most mental health providers treat a range of conditions, but one with a specialized focus may be more suited to your needs. For example, if you have an eating disorder, you may need to see a psychologist who specializes in that area. If you’re having marital problems, you may want to consult a licensed marriage and family therapist. In general, the more severe your symptoms or complex your diagnosis, the more expertise and training you need to look for in a mental health provider.
•Whether you need medications, counseling or both. Some mental health providers are not licensed to prescribe medications. So your choice may depend, in part, on your concern and the severity of your symptoms. You may need to see more than one mental health provider. For example, you may need to see a psychiatrist to manage your medications and a psychologist or another mental health provider for counseling.
•Your health insurance coverage. Your insurance policy may have a list of specific mental health providers that are covered or only cover certain types of mental health providers. Check ahead of time with your insurance company, Medicare or Medicaid to find out what types of mental health services are covered and what your benefit limits are.

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prevention

Because the cause of narcissistic personality disorder is unknown, there’s no known way to prevent the condition with any certainty. Getting treatment as soon as possible for childhood mental health problems may help. Family therapy may help families learn healthy ways to communicate or to cope with conflicts or emotional distress. Parents with personality disorders may benefit from parenting classes and guidance from therapists or social workers.

lifestyle and home remedies

Whether you decide to seek treatment on your own or are encouraged by loved ones or a concerned employer, you may feel defensive about treatment or think it’s unnecessary. The nature of narcissistic personality disorder can also leave you feeling that the therapy or the therapist is not worth your time and attention, and you may be tempted to quit. Try to keep an open mind, though, and to focus on the rewards of treatment.

Also, it’s important to:
•Stick to your treatment plan. Attend scheduled therapy sessions and take any medications as directed. Remember that it can be hard work and that you may have occasional setbacks.
•Learn about it. Educate yourself about narcissistic personality disorder so that you can better understand symptoms, risk factors and treatments.
•Get treatment for substance abuse or other mental health problems. Your addictions, depression, anxiety and stress can feed off each other, leading to a cycle of emotional pain and unhealthy behavior.
•Learn relaxation and stress management. Try such stress-reduction techniques as meditation, yoga or tai chi. These can be soothing and calming.
•Stay focused on your goal. Recovery from narcissistic personality disorder can take time. Keep motivated by keeping your recovery goals in mind and reminding yourself that you can work to repair damaged relationships and become happier with your life.

treatment and drugs

Narcissistic personality disorder treatment is centered around psychotherapy. There are no medications specifically used to treat narcissistic personality disorder. However, if you have symptoms of depression, anxiety or other conditions, medications such as antidepressants or anti-anxiety medications may be helpful.

Types of therapy that may be helpful for narcissistic personality disorder include:
•Cognitive behavioral therapy. In general, cognitive behavioral therapy helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones.
•Family therapy. Family therapy typically brings the whole family together in therapy sessions. You and your family explore conflicts, communication and problem solving to help cope with relationship problems.
•Group therapy. Group therapy, in which you meet with a group of people with similar conditions, may be helpful by teaching you to relate better with others. This may be a good way to learn about truly listening to others, learning about their feelings and offering support.

Because personality traits can be difficult to change, therapy may take several years. The short-term goal of psychotherapy for narcissistic personality disorder is to address such issues as substance abuse, depression, low self-esteem or shame. The long-term goal is to reshape your personality, at least to some degree, so that you can change patterns of thinking that distort your self-image and create a realistic self-image.

Psychotherapy can also help you learn to relate better with others so that your relationships are more intimate, enjoyable and rewarding. It can help you understand the causes of your emotions and what drives you to compete, to distrust others, and perhaps to despise yourself and others.

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test and diagnosis

Narcissistic personality disorder is diagnosed based on signs and symptoms, as well as a thorough psychological evaluation that may include filling out questionnaires.

Although there’s no laboratory test to diagnose narcissistic personality disorder, you may also have a physical exam to make sure you don’t have a physical problem causing your symptoms.

Some features of narcissistic personality disorder are similar to those of other personality disorders. It’s possible to be diagnosed with more than one personality disorder at the same time.

To be diagnosed with narcissistic personality disorder, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

Criteria for narcissistic personality disorder to be diagnosed include:
•Having an exaggerated sense of self-importance
•Being preoccupied with fantasies about success, power or beauty
•Believing that you are special and can associate only with equally special people
•Requiring constant admiration
•Having a sense of entitlement
•Taking advantage of others
•Having an inability to recognize needs and feelings of others
•Being envious of others
•Behaving in an arrogant or haughty manner

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preparing for your appointment

People with narcissistic personality disorder are most likely to seek treatment when they develop symptoms of depression — often because of perceived criticisms or rejections. If you recognize that aspects of your personality are common to narcissistic personality disorder or you’re feeling overwhelmed by sadness, talk with your doctor. Whatever your diagnosis, your symptoms signal a need for medical care.

When you call to make an appointment, your doctor may immediately refer you to a mental health provider, such as a psychiatrist.

Use the information below to prepare for your first appointment and learn what to expect from the mental health provider.

What you can do
•Write down any symptoms you’re experiencing and for how long. It will help the mental health provider to know what kinds of events are likely to make you feel angry or defeated.
•Write down key personal information, including traumatic events in your past and any current, major stressors.
•Make a list of your medical information, including other physical or mental health conditions with which you’ve been diagnosed. Also write down the names of any medications or supplements you’re taking.
•Take a family member or friend along, if possible. Someone who has known you for a long time may be able to ask questions or share information with the mental health provider that you don’t mention.
•Write down questions to ask your mental health provider in advance so that you can make the most of your appointment.

For narcissistic personality disorder, some basic questions to ask your mental health provider include:
•What exactly is narcissistic personality disorder?
•Could I have different mental health conditions?
•What is the goal of treatment in my case?
•What treatments are most likely to be effective for me?
•How much do you expect my quality of life may improve with treatment?
•How frequently will I need therapy sessions and for how long?
•Would family or group therapy be helpful in my case?
•Are there medications that can help?
•I have these other health conditions. How can I best manage them together?
•Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

In addition to the questions that you’ve prepared to ask your mental health provider, don’t hesitate to ask any additional questions that may come up during your appointment.

What to expect from your mental health provider

The mental health provider is likely to ask you a number of questions to gain an understanding of your symptoms and how they’re affecting your life. The mental health provider may ask:
•What are your symptoms?
•When do these symptoms occur, and how long do they last?
•How do you feel — and act — when others seem to criticize or reject you?
•Do you have any close personal relationships? If not, how do you explain that lack?
•What are your accomplishments?
•What do you plan to accomplish in the future?
•How do you feel when someone needs your help?
•How do you feel when someone expresses difficult feelings, such as fear or sadness, to you?
•How would you describe your childhood, including your relationship with your parents?
•How would you say your symptoms are affecting your life, including school, work and personal relationships?
•Have any of your close relatives been diagnosed with a mental health problem, including a personality disorder?
•Have you been treated for any other mental health problems? If yes, what treatments were most effective?
•Do you use alcohol or illegal drugs? How often?
•Are you currently being treated for any other medical conditions?

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COMPLICATIONS

Complications of narcissistic personality disorder, if left untreated, can include:
•Substance abuse
•Alcohol abuse
•Depression
•Suicidal thoughts or behavior
•Relationship difficulties
•Problems at work or school

RISK FACTORS

Narcissistic personality disorder is rare. It affects more men than women. Narcissistic personality disorder often begins in early adulthood. Although some adolescents may seem to have traits of narcissism, this may simply be typical of the age and doesn’t mean they’ll go on to develop narcissistic personality disorder.

Although the cause of narcissistic personality disorder isn’t known, some researchers think that extreme parenting behaviors, such as neglect or excessive indulgent praise, may be partially responsible.

Risk factors for narcissistic personality disorder may include:
•Parental disdain for fears and needs expressed during childhood
•Lack of affection and praise during childhood
•Neglect and emotional abuse in childhood
•Excessive praise and overindulgence
•Unpredictable or unreliable caregiving from parents
•Learning manipulative behaviors from parents

Children who learn from their parents that vulnerability is unacceptable may lose their ability to empathize with others’ needs. They may also mask their emotional needs with grandiose, egotistical behavior that’s calculated to make them seem emotionally “bulletproof.”

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Symptoms
By Mayo Clinic Staff

Narcissistic personality disorder is characterized by dramatic, emotional behavior, which is in the same category as antisocial and borderline personality disorders.

Narcissistic personality disorder symptoms may include:
•Believing that you’re better than others
•Fantasizing about power, success and attractiveness
•Exaggerating your achievements or talents
•Expecting constant praise and admiration
•Believing that you’re special and acting accordingly
•Failing to recognize other people’s emotions and feelings
•Expecting others to go along with your ideas and plans
•Taking advantage of others
•Expressing disdain for those you feel are inferior
•Being jealous of others
•Believing that others are jealous of you
•Trouble keeping healthy relationships
•Setting unrealistic goals
•Being easily hurt and rejected
•Having a fragile self-esteem
•Appearing as tough-minded or unemotional

Although some features of narcissistic personality disorder may seem like having confidence or strong self-esteem, it’s not the same. Narcissistic personality disorder crosses the border of healthy confidence and self-esteem into thinking so highly of yourself that you put yourself on a pedestal. In contrast, people who have healthy confidence and self-esteem don’t value themselves more than they value others.

When you have narcissistic personality disorder, you may come across as conceited, boastful or pretentious. You often monopolize conversations. You may belittle or look down on people you perceive as inferior. You may have a sense of entitlement. And when you don’t receive the special treatment to which you feel entitled, you may become very impatient or angry. You may insist on having “the best” of everything — the best car, athletic club, medical care or social circles, for instance.

But underneath all this behavior often lies a fragile self-esteem. You have trouble handling anything that may be perceived as criticism. You may have a sense of secret shame and humiliation. And in order to make yourself feel better, you may react with rage or contempt and efforts to belittle the other person to make yourself appear better.

When to see a doctor

When you have narcissistic personality disorder, you may not want to think that anything could be wrong — doing so wouldn’t fit with your self-image of power and perfection. But by definition, a narcissistic personality disorder causes problems in many areas of your life, such as relationships, work, school or your financial affairs. You may be generally unhappy and confused by a mix of seemingly contradictory emotions. Others may not enjoy being around you, and you may find your relationships unfulfilling.

If you notice any of these problems in your life, consider reaching out to a trusted doctor or mental health provider. Getting the right treatment can help make your life more rewarding and enjoyable.

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