We present here a case of a patient with a narcissistic personality disorder. We must take narcissism, like the rest of the personality patterns, as the response of an individual to a context, as the result of a relational matrix (Mitchell). The origin of pathological narcissism is to be found in caregivers who emotionally neglected the child, victim of isolation, on the one hand, and who share and promote narcissistic fantasies of the child, confused with their own fantasies. Dysregulation of narcissism occurs when the child's needs have been ignored, causing severe disturbances in self-esteem or the creation of a great defensive shield (Morrison). At first, our patient could not accept any fault in himself, assuming that the therapist would not accept his faults either. The challenge as therapists is to assume the disability that the patient attributes to us, the incompetence that the patient pursues, without us falling into disaster or in the most absolute hell, which is ultimately what he fears the most. Accepting the faults that the patient displaces in the therapist is a surprise for the patient, it was even a corrective experience in the encounter with himself.
Intersect between self-esteem and emotion regulation in narcissistic personality disorder - implications for alliance building and treatment