Principles of Psychodynamic Treatment for Patients With Narcissistic Personality Disorder

Abstract

Narcissistic personality disorder is a pleomorphic entity that requires the psychodynamically oriented therapist to tailor the approach to the characteristics of the individual patient. Psychodynamic principles encompass a broad range of interventions depending on the patient's specific characteristics. The therapist's interventions range from interpretation of the transference to supportive approaches that emphasize empathic validation and direct advice. In the absence of systematic data on these variations, this article attempts to offer clinically based principles. Several themes are emphasized: the experience of shame, the predictable transference-countertransference developments, the role of comorbidity with other personality disorders and traits, and the approach to resistances.

Pathological narcissism: An analysis of interpersonal dysfunction within intimate relationships

“…For instance, a treatment contract may include the fact that treatment progression is contingent on the client not acting out violent urges against intimate partners, or even the therapist, and rather treatment would involve exploring these impulses in therapy in a safe way, with specific consequences (e.g., contacting authorities, therapy termination) if the contract is significantly or repeatedly violated. Further, therapists need to be adequately prepared to tolerate strong countertransference reactions as related to patterns of idealization and devaluation that may occur in the therapeutic alliance (Crisp & Gabbard, 2020; Tanzilli et al, 2017; Tanzilli & Gualco, 2020).…”

Narcissistic Personality Disorder: Are Psychodynamic Theories and the Alternative DSM-5 Model for Personality Disorders Finally Going to Meet?

“…Choi-Kain (2020) advocates using General Psychiatric Management, while others propose modifications of existing evidence-based treatment models for BPD to treat pathological narcissism: Mentalization-Based Treatment (Drozek and Unruh, 2020), Transference Focused Psychotherapy Hersh, 2020), Dialectical Behavior Therapy (Reed-Knight andFischer, 2011), or Schema Focused Therapy (Young et al, 2003). Nevertheless, others focus on specific themes when treating pathological narcissism, for example in psychodynamic therapy (Crisp and Gabbard, 2020) or the client-centered Clarification-Oriented Psychotherapy (Maillard et al, 2020). Traditional highfrequency psychoanalysis-three to five weekly sessions on the couch-seems to have missed the boat in terms of establishing a position in the discussion.…”

Evaluation der Wirksamkeit der klärungsorientierten Psychotherapie bei Personen mit einer narzisstischen Persönlichkeitsstörung nach DSM-IV – eine naturalistische Längsschnittstudie mit prä-post Design

“…Der Testbatterie lag die deutsche Version der 32-Item Kurzversion (IIPD-32) [18] zugrunde. Aus den 8 definierten Subskalen wurden für die vorliegende Untersuchung 3 Subskalen benutzt 5 (zu ausnutzbar, zu fürsorglich, zu unterwürfig). Beck-Depressions-Inventar (BDI) [17] Das BDI ist ein Screening-Instrument zur Erfassung von Depressionssymptomen, die per 21 Items (z.…”

“…In verschiedenen Studien wurde bereits deutlich, dass die KOP von NPS auf Seiten des Therapeuten ein hohes Maß an Flexibilität für die spezifischen Bedürfnisse des Patienten bedarf und so die stärksten Effekte erzielt werden können [40]. Auch in psychodynamischen Therapien [5] wird der therapeutischen Beziehung in der Behandlung von NPS eine besondere Bedeutung zuteil. Ebenso betonen schematherapeutische Ansätze, die aus den Konzepten der Kognitiven Verhaltenstherapie hervorgingen, deren Bedeutung bei der NPS-Behandlung [9].…”