Mentalizing Mediates the Association between Narcissism and Psychotherapeutic Treatment Outcome in a Mixed Clinical Sample

Abstract

<b><i>Introduction:</i></b> Pathological narcissism has been a challenge for the success of psychological treatment, whereas mentalizing has turned out to be an important mechanism of change in psychotherapy. This study focused on the classic narcissistic self (CNS) (i.e., narcissistic grandiosity) as predictor of the outcome. It further investigated whether mentalizing mediates this relation. <b><i>Methods:</i></b> A mixed clinical sample of 205 patients was investigated. The CNS scale of the Narcissism Inventory and the Mentalization Questionnaire was used to measure the features of narcissistic grandiosity and the capacity to mentalize, respectively. The symptom outcome was assessed with the Hamburg Modules for the Assessment of Psychosocial Health. <b><i>Results:</i></b> Contrary to our expectations, we did not find a direct association between narcissistic grandiosity and a decrease in symptoms. However, mentalizing was found to mediate the association between the CNS as well as between the narcissistic furor and outcome. <b><i>Conclusion:</i></b> Our results confirm the ambiguity concerning the clinical significance of narcissistic grandiosity. However, in order to improve the treatment outcome in patients with narcissistic features, especially narcissistic furor, individualized treatment plans might consider introducing interventions that enhance the capacity to mentalize.

Pathological narcissism’s impact on psychodynamic group therapy for perfectionism.

“…In the largest study to date, Daig et al (2009) found in a sample of 1,442 psychosomatic inpatients undergoing group and individual psychodynamic psychotherapy that greater levels of narcissistic vulnerability at baseline were associated with smaller improvements in mood and interpersonal functioning from admission to discharge. In contrast, Euler et al (2022) did not find, in 205 psychosomatic inpatients undergoing psychodynamic-based group and individual psychotherapy, a direct association between baseline PN and treatment outcome. However, the authors did find that higher levels of PN were indirectly associated with smaller reductions in psychological and somatoform symptoms through impairments in patients' mentalization capacity.…”

“…Second, this study adds to an accumulating body of research suggesting that pretreatment PN does not interfere with outcome in psychodynamic psychotherapies (Cheek et al, 2018; Euler et al, 2022; Ogrodniczuk et al, 2009; Richter et al, 2023). For instance, a recent study found that PN did not have an impact on treatment outcome for patients undergoing psychodynamic therapy but that it did have a significant impact on treatment outcome for patients undergoing cognitive behavioural therapy (Richter et al, 2023).…”

“…First, extant studies are naturalistic and thus do not account for differences in treatment duration and/or treatment type, which can obscure PN’s true impact on psychotherapy outcome. Second, none of the past studies that included group psychotherapy data in their investigation (i.e., Cheek et al, 2018; Daig et al, 2009; Ellison et al, 2013; Euler et al, 2022; Ogrodniczuk et al, 2009) accounted for the possibility of group-level dependence within their data, which can lead to inflated Type I error rates and inaccurate model parameter estimates (Tasca et al, 2009).…”