A Mentalizing Approach for Narcissistic Personality Disorder: Moving From “Me-Mode” to “We-Mode”

In this article, we provide an overview of transference-focused psychotherapy for patients with pathological narcissism and narcissistic personality disorder (TFP-N). In TFP-N we have modified and refined the tactics and techniques of TFP, an evidence-based treatment for borderline personality disorder, to meet the specific challenges of working with patients with narcissistic personality pathology whose retreat from reality into an illusory grandiosity makes them particularly difficult to engage in treatment. We first describe a model of narcissistic pathology based on considerations of psychological structure stemming from object relations theory. This model provides a unifying understanding of the core structure of narcissistic pathology, the pathological grandiose self, that underlies the impairments in self and interpersonal functioning of those with narcissistic pathology across the levels of personality organization (from high functioning to borderline to malignant). We then delineate the clinical process of working with patients with pathological narcissism and narcissistic personality disorder. Starting with the assessment process, using a detailed clinical example, we guide the reader through the progression of TFP-N as it helps the patient move from the distorted, unintegrated sense of self underlying the narcissistic presentation to the more integrated, realistic sense of self that characterizes healthier personality functioning. In TFP-N the focus on the disturbed interpersonal patterns of relating in the here and now of the therapeutic interaction is the vehicle to diminish grandiosity and improve relatedness, thereby effecting enduring changes in mental representation and real-world functioning.

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The Narcissistic Personality Disorder and Addiction

Treatment of Personality Disorders ◽

10.1007/978-1-4757-6876-3_17 ◽

1999 ◽

pp. 241-253 ◽

Cited By ~ 1

Author(s):

Per Vaglum

Keyword(s):

Personality Disorder ◽

Narcissistic Personality Disorder ◽

Narcissistic Personality

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Clinician Emotional Response Toward Narcissistic Patients: A Preliminary Report

Research in Psychotherapy Psychopathology Process and Outcome ◽

10.4081/ripppo.2015.174 ◽

2015 ◽

Vol 18 (1) ◽

Cited By ~ 5

Author(s):

Annalisa Tanzilli ◽

Antonello Colli ◽

Laura Muzi ◽

Vittorio Lingiardi

Keyword(s):

Personality Disorder ◽

Psychological Functioning ◽

Emotional Response ◽

Theoretical Orientation ◽

Emotional Responses ◽

Emotional Reactions ◽

Narcissistic Personality Disorder ◽

Assessment Procedure ◽

Narcissistic Personality ◽

Therapist Response

Patients with narcissistic personality disorder are among the most difficult to treat in therapy, especially for their strong resistance to treatment and several difficulties in establishing a therapeutic relationship characterized by intimacy, safety, and trust. In particular, therapists’ emotional responses to these patients can be particularly intense and frustrating, as reported in the clinical literature but rarely investigated empirically.The aims of this preliminary study were: 1) to examine the associations between patients’ narcissistic personality disorder and distinct therapists’ countertransference patterns; and 2) to verify whether these clinicians’ emotional reactions were influenced by their theoretical orientation (as well as gender and age).A national sample of psychiatrists and clinical psychologists (N = 250) completed the Therapist Response Questionnaire (TRQ) to identify patterns of therapist emotional response, and the Shedler-Westen Assessment Procedure-200 (SWAP-200) to assess personality disorder and level of psychological functioning in a patient currently in their care and with whom they had worked for a minimum of eight sessions and a maximum of 6 months (one session per week).From the complete therapist sample, we identified a subgroup (N = 35) of patients with narcissistic personality disorder, and we found that this personality pathology was positively associated with criticized/mistreated and disengaged countertransference, but negatively associated with positive therapist response. Moreover, our results confirmed that the relationship between patients’ narcissistic personality disorder and therapists’ emotional responses was not dependent on clinicians’ theoretical approach (as well as their age and gender).These findings are consistent with clinical observations, as well as some empirical contributions, and have meaningful implications for clinical practice of patients suffering from this challenging pathology.

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