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Bird J, Caligor E. A case report of the treatment of narcissistic personality disorder with transference focused psychotherapy. J Clin Psychol 2024; 80:1177-1191. [PMID: 38170437 DOI: 10.1002/jclp.23637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/30/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024]
Abstract
The following case study provides a description of the transference-focused psychotherapy (TFP) treatment of a young man diagnosed with narcissistic personality disorder (NPD). TFP is an individual, psychodynamic therapy developed to treat a range of personality disorders. TFP is evidence-based for the treatment of borderline personality disorder and has been adapted for the treatment of NPD. This case illustrates the application of the strategies and techniques of TFP to treatment of NPD as well as challenges clinicians may face in arriving at timely diagnosis of the disorder. Although no specific treatment for NPD has been empirically validated, TFP utilizes the therapeutic techniques identified across modalities for successful treatment of pathological narcissism. This report describes how treatment interventions such as goal setting, developing a therapeutic alliance, using a treatment contract and addressing treatment interfering behaviors contributed to this patient's improvement in self-reflection, formation of healthier and more flexible ideas about self and other, increased self-agency, tolerance of normative disillusionments and increase in empathy.
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Affiliation(s)
- Joanna Bird
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Eve Caligor
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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2
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Hinz LD. Filling the form: Expressive Therapies Continuum-guided treatment of narcissistic personality disorder. J Clin Psychol 2024; 80:1192-1206. [PMID: 38178697 DOI: 10.1002/jclp.23635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 11/08/2023] [Accepted: 12/08/2023] [Indexed: 01/06/2024]
Abstract
Sara was a 65-year-old Caucasian woman who requested art therapy after the death of her partner. She had experienced incest by her father and verbal abuse by her mother until she left home at 21. Her life was characterized by broken relationships due to alienating anger outbursts and an interrupted work history; she met three criteria for narcissistic personality disorder. Sara initially was socially isolated and intellectualizing. She desired recognition but was fearful of exposure. The Expressive Therapies Continuum (ETC) theoretical framework, which consisted of a gradual progression from cognitively-dominated sessions to more emotionally focused processing, guided the therapeutic work. The ETC theory encourages transparency and collaboration between therapist and client regarding therapeutic tasks and goals, and provides a framework for addressing and repairing ruptures in the therapeutic alliance. Art therapy began with the cognitive tasks which Sara completed relatively comfortably, then encouraged integration of emotion via expressive writing, diagrams, and body mapping. Through careful attention to repair of ruptures by directly discussing and adapting the direction and tasks of therapy, Sara slowly was able to experience emotions other than anger. She integrated cognitive and emotional insights about her life and developed empathy for her childhood self. At termination Sara had cultivated two friendships and met only one criterion of NPD. Limitations of this case study include a lack of research evidence for ETC-guided art therapy with NPD clients and by the retrospective approach. Future research efforts could provide this support by encouraging clinicians to conduct prospective case study research.
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Affiliation(s)
- Lisa D Hinz
- Department of Art Therapy Psychology, Dominiacan University of California, San Rafael, California, USA
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Dimaggio G, Valentino V. The ongoing rewriting of the therapeutic contract in Metacognitive Interpersonal Therapy for narcissistic personality disorder: The case of Mark. J Clin Psychol 2024; 80:776-794. [PMID: 37965788 DOI: 10.1002/jclp.23621] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/16/2023]
Abstract
In order to effectively treat individuals suffering from Narcissistic Personality Disorder (NPD), it is crucial to establish therapeutic goals and identify tasks to achieve them. However, this is a challenging process with NPD patients because they often struggle to find meaningful goals beyond the pursuit of status. Moreover, in order to change Furthermore, to promote change, they must confront painful emotions such as shame, guilt, or fear, which they habitually try to avoid. Additionally, they face difficulties in forming a positive perception of their therapists and cooperating towards mutually agreed-upon goals and tasks. As a consequence, NPD patients ask for change but hardly engage themselves in the work necessary to achieve it. Therapists therefore need to pay the uttermost attention to drafting, negotiating and continuously updating a reasonable and realistic therapeutic contract. In this paper we describe the story of a man in his thirties with NPD who was ridden with depression, guilt, envy and anger and did not find ways to pursue the healthy and adaptive behaviors he would need to pursue in order to leave a richer social life. The therapist overcame ruptures in the therapeutic alliance and then involved the patient in a process where they set the steps to follow, making sure the patient was convinced they made sense. After a contract was reached progress became possible. Implications for the role of the therapeutic contract in NPD treatment are discussed.
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Richter M, Mota S, Hater L, Bratek R, Goltermann J, Barkhau C, Gruber M, Repple J, Storck M, Blitz R, Grotegerd D, Masuhr O, Jaeger U, Baune BT, Dugas M, Walter M, Dannlowski U, Buhlmann U, Back M, Opel N. Narcissistic dimensions and depressive symptoms in patients across mental disorders in cognitive behavioural therapy and in psychoanalytic interactional therapy in Germany: a prospective cohort study. Lancet Psychiatry 2023; 10:955-965. [PMID: 37844592 DOI: 10.1016/s2215-0366(23)00293-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Narcissistic personality traits have been theorised to negatively affect depressive symptoms, therapeutic alliance, and treatment outcome, even in the absence of narcissistic personality disorder. We aimed to examine how the dimensional narcissistic facets of admiration and rivalry affect depressive symptoms across treatment modalities in two transdiagnostic samples. METHODS We did a naturalistic, observational prospective cohort study in two independent adult samples in Germany: one sample pooled from an inpatient psychiatric clinic and an outpatient treatment service offering cognitive behavioural treatment (CBT), and one sample from an inpatient clinic providing psychoanalytic interactional therapy (PIT). Inpatients treated with CBT had an affective or psychotic disorder. For the other two sites, data from all service users were collected. We examined the effect of core narcissism and its facets admiration and rivalry, measured by Narcissistic Admiration and Rivalry Questionnaire-short version, on depressive symptoms, measured by Beck's Depression Inventory and Patient Health Questionnaire-Depression Scale, at baseline and after treatment in patients treated with CBT and PIT. Primary analyses were regression models, predicting baseline and post-treatment depression severity from core narcissism and its facets. Mediation analysis was done in the outpatient CBT group for the effect of the therapeutic alliance on the association between narcissism and depression severity after treatment. FINDINGS The sample included 2371 patients (1423 [60·0%] female and 948 [40·0%] male; mean age 33·13 years [SD 13·19; range 18-81), with 517 inpatients and 1052 outpatients in the CBT group, and 802 inpatients in the PIT group. Ethnicity data were not collected. Mean treatment duration was 300 days (SD 319) for CBT and 67 days (SD 26) for PIT. Core narcissism did not predict depression severity before treatment in either group, but narcissistic rivalry was associated with higher depressive symptom load at baseline (β 2·47 [95% CI 1·78 to 3·12] for CBT and 1·05 [0·54 to 1·55] for PIT) and narcissistic admiration showed the opposite effect (-2·02 [-2·62 to -1·41] for CBT and -0·64 [-1·11 to -0·17] for PIT). Poorer treatment response was predicted by core narcissism (β 0·79 [0·10 to 1·47]) and narcissistic rivalry (0·89 [0·19 to 1·58]) in CBT, whereas admiration showed no effect. No effect of narcissism on treatment outcome was discernible in PIT. Therapeutic alliance mediated the effect of narcissism on post-treatment depression severity in the outpatient CBT sample. INTERPRETATION As narcissism affects depression severity before and after treatment with CBT across psychiatric disorders, even in the absence of narcissistic personality disorder, the inclusion of dimensional assessments of narcissism should be considered in future research and clinical routines. The relevance of the therapeutic alliance and therapeutic strategy could be used to guide treatment approaches. FUNDING IZKF Münster. TRANSLATION For the German translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Maike Richter
- Institute for Translational Psychiatry, University of Münster, Münster, Germany; Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.
| | - Simon Mota
- Department of Psychology, University of Münster, Münster, Germany
| | - Leonie Hater
- Department of Psychology, University of Münster, Münster, Germany
| | - Rebecca Bratek
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Janik Goltermann
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Carlotta Barkhau
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Marius Gruber
- Institute for Translational Psychiatry, University of Münster, Münster, Germany; Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Jonathan Repple
- Institute for Translational Psychiatry, University of Münster, Münster, Germany; Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Michael Storck
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Rogério Blitz
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Dominik Grotegerd
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | | | | | - Bernhard T Baune
- Department of Psychiatry, University of Münster, Münster, Germany; Department of Psychiatry, Melbourne Medical School, University of Melbourne Parkville, VIC, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne Parkville, VIC, Australia; Joint Institute for Individualisation in a Changing Environment (JICE), University of Münster and Bielefeld University, Münster, Germany
| | - Martin Dugas
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany; Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Jena-Magdeburg-Halle, Germany; German Center for Mental Health (DZPG), Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany; Joint Institute for Individualisation in a Changing Environment (JICE), University of Münster and Bielefeld University, Münster, Germany
| | - Ulrike Buhlmann
- Department of Psychology, University of Münster, Münster, Germany
| | - Mitja Back
- Department of Psychology, University of Münster, Münster, Germany; Joint Institute for Individualisation in a Changing Environment (JICE), University of Münster and Bielefeld University, Münster, Germany
| | - Nils Opel
- Institute for Translational Psychiatry, University of Münster, Münster, Germany; Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany; Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Jena-Magdeburg-Halle, Germany; German Center for Mental Health (DZPG), Germany
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Marmarosh CL, Sandage S, Wade N, Captari LE, Crabtree S. New horizons in group psychotherapy research and practice from third wave positive psychology: a practice-friendly review. RESEARCH IN PSYCHOTHERAPY (MILANO) 2022; 25:643. [PMID: 36373391 PMCID: PMC9893048 DOI: 10.4081/ripppo.2022.643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/19/2022] [Indexed: 11/09/2022]
Abstract
Group psychotherapy has been shown to be equivalent to individual therapy for many disorders, including anxiety, depression, grief, eating disorders, and schizophrenia (Burlingame & Strauss, 2021). In addition to effectiveness in reducing symptoms, group offers members a sense of belonging, purpose, hope, altruism, and meaning throughout treatment (Yalom & Leszcz, 2020). These additional outcomes are especially important considering the COVID-19 pandemic and national/international conflicts, given the trauma, disruptions, and losses people have experienced. Applying recent developments in positive psychology to group therapy can enhance treatment. A practice-friendly review examined recent advances in the positive psychology literature, demonstrating how group therapy offers members unique growth opportunities in addition to reducing symptoms. Key findings from studies applying positive psychological constructs to group therapy outcomes are synthesized. Our review sheds light on the relevance of third wave positive psychology to enrich group therapy (Lomas et al., 2021). Specifically, group therapy can facilitate the development of vitalizing psychological virtues, and these can be used to assess treatment outcome: humanity, wisdom, transcendence, courage, temperance, and justice. Interrelatedly, we present support for including attachment theory and mentalization within a positive psychological group framework. Implications are explored for group therapy research, clinical work, and training.
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Affiliation(s)
- Cheri L. Marmarosh
- Divine Mercy University, Sterling, VA, USA,Director of the Center for the International Study of Spirituality and Mental Health, Divine Mercy University, 4554 Underwood Lane, Sterling, VA 20166, USA. ;
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Reis T, Gekker M, Land MGP, Mendlowicz MV, Berger W, Luz MP, Vilete L, Figueira I, Araújo AXG. The growth and development of research on personality disorders: A bibliometric study. Personal Ment Health 2022; 16:290-299. [PMID: 35182026 DOI: 10.1002/pmh.1540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/19/2022] [Accepted: 02/08/2022] [Indexed: 01/31/2023]
Abstract
This study objective was to investigate publication trends on personality disorders (PD) and to identify patterns of historical development. Publication rates were determined using the Results by Year Timeline feature of PubMed. Time series autoregressive integrated moving average models were used to analyse the publication rates for PDs in quinquennial periods beginning in 1980 and ending in 2019 and to predict the number of publications in the 2024-2029 period. More than 300 articles on antisocial and borderline PD are being published each year, and the models suggest an accelerating growth rate. Approximately 100 articles are being published on average every year on schizotypal PD, and the regression model indicates linear growth in the near future. The mean number of publications per year for obsessive-compulsive, narcissistic and avoidant PDs is in the range of 10-30 with the corresponding models indicating linear growth. Fewer than 10 articles are being published each year on dependent, paranoid, histrionic and schizoid PD, whereas dependent PD shows modest growth and paranoid PD rates tended to stability, histrionic and schizoid PD exhibit declining rates. Personality disorders are a group of conditions with diverse etiological, prognostic, therapeutic, legal, research, social and cultural implications that influence publication rates.
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Affiliation(s)
- Taylor Reis
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Márcio Gekker
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Marcelo Gerardin Poirot Land
- Clinical Medicine Graduate Medical Program I Maternal and Child Health Graduate Program, Universidade Federal do Rio de Janeiro (UFRJ), 225 Rodolpho Paulo Rocco Avenue, building F, suite 5. University City, Fundão Island, Rio de Janeiro, Rio de Janeiro, 21941-905, Brazil
| | - Mauro Vitor Mendlowicz
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil.,Department of Psychiatry and Mental Health, Universidade Federal Fluminense (UFF), 303 Marquês de Paraná Street, second floor, Niteroi, Rio de Janeiro, 24220-000, Brazil
| | - William Berger
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Mariana Pires Luz
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Liliane Vilete
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Ivan Figueira
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Alexandre Xavier Gomes Araújo
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil.,Department of Psychiatry and Mental Health, Universidade Federal Fluminense (UFF), 303 Marquês de Paraná Street, second floor, Niteroi, Rio de Janeiro, 24220-000, Brazil
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Abstract
Research indicates that narcissistic personality disorder and subclinical narcissism may be reaching epidemic proportions within American society. It is thus probable that nursing administrators will encounter narcissistic behavior among their staff, supervisors, and/or patients and patient family members. It is therefore crucial that nurse leaders understand the causes of narcissism and how narcissistic behaviors might be addressed within health care settings. An awareness of these issues can help decrease the damage that narcissistic behaviors can have on individuals and institutions.
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Affiliation(s)
- Susan Mortell
- School of Nursing and Health Professions, University of San Francisco, San Francisco, California
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Reis S, Huxley E, Eng Yong Feng B, Grenyer BFS. Pathological Narcissism and Emotional Responses to Rejection: The Impact of Adult Attachment. Front Psychol 2021; 12:679168. [PMID: 34335393 PMCID: PMC8319504 DOI: 10.3389/fpsyg.2021.679168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/22/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Aspects of pathological narcissism, such as grandiosity, vulnerability and entitlement, tend be enacted in therapeutic settings, negatively influencing outcome and alliance between the clients and therapist. This research took an experimental approach to understanding the interplay between the emotional reactions of individuals with a pathological narcissistic presentation, and adult attachment style. We predicted that participants reporting narcissistic vulnerability would report greater insecurity in attachment (fearful and preoccupied styles), greater trait emotional reactivity, and also experience more intense and negative responses to simulated rejection Methods: 269 participants (75.84% female, median age = 21) completed baseline and rejection trials of a virtual ball-tossing game, following the assessment of grandiose and vulnerable pathological narcissism, entitlement, adult attachment, trait emotional reactivity (measured prior to the rejection) and in-situ affective response (measured both before and after the rejection). Change in affect from baseline was calculated to capture affective responses to the manipulation. Results: Vulnerable narcissism was positively associated with both fearful and preoccupied attachment, and negatively associated with secure and dismissive attachment, whilst grandiose narcissism was significantly related to preoccupied attachment only. Multiple hierarchical regression analyses showed vulnerable narcissism predicted both (1) more negative trait emotional reactivity and (2) a significant increase in negative affect following the rejection trial. Grandiose narcissism was associated with (1) higher positive trait emotional reactivity, and (2) significant reductions in positive affect following rejection. Conclusion: Results indicated that those high in pathological narcissistic vulnerability reported greater insecurity in attachment, negative trait emotional reactivity and experienced a more negative and intense emotional reaction to rejection. Grandiose narcissism was related to a more deactivated pattern of emotional reactivity, and less positive (rather than more negative) emotional reactions. Findings have important implications for therapy, particularly regarding communication of emotions for individuals high in vulnerable and grandiose narcissism.
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Affiliation(s)
- Samantha Reis
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Elizabeth Huxley
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | | | - Brin F S Grenyer
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
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Mortell S. The Purported Increase in Social Narcissism: Nursing Implications. J Psychosoc Nurs Ment Health Serv 2021; 59:2-4. [PMID: 34039127 DOI: 10.3928/02793695-20210415-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Susan Mortell
- University of San Francisco School of Nursing and Health Professions, San Francisco, California
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Janusz B, Bergmann JR, Matusiak F, Peräkylä A. Practices of Claiming Control and Independence in Couple Therapy With Narcissism. Front Psychol 2021; 11:596842. [PMID: 33569022 PMCID: PMC7868443 DOI: 10.3389/fpsyg.2020.596842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/07/2020] [Indexed: 11/25/2022] Open
Abstract
Four couple therapy first consultations involving clients with diagnosed narcissistic problems were examined. A sociologically enriched and broadened concept of narcissistic disorder was worked out based on Goffman’s micro-sociology of the self. Conversation analytic methods were used to study in detail episodes in which clients resist to answer a therapist’s question, block or dominate the development of the conversation’s topic, or conspicuously display their interactional independence. These activities are interpreted as a pattern of controlling practices that were prompted by threats that the first couple therapy consultation imposes upon the clients’ self-image. The results were discussed in the light of contemporary psychiatric discussions of narcissism; the authors suggest that beyond its conceptualization as a personality disorder, narcissism should be understood as a pattern of interactional practices.
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Affiliation(s)
- Bernadetta Janusz
- Department of Family Therapy and Psychosomatics, Jagiellonian University, Medical College, Kraków, Poland
| | - Jörg R Bergmann
- Faculty of Sociology, Bielefeld University, Bielefeld, Germany
| | - Feliks Matusiak
- Department of Child and Adolescent Psychiatry, Medical Colleague Kraków, Poland
| | - Anssi Peräkylä
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
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Valashjardi A, MacLean R, Charles K. Recollections of parenting styles in the development of narcissism: The role of gender. PERSONALITY AND INDIVIDUAL DIFFERENCES 2020. [DOI: 10.1016/j.paid.2020.110246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Living with pathological narcissism: a qualitative study. Borderline Personal Disord Emot Dysregul 2020; 7:19. [PMID: 32817795 PMCID: PMC7427292 DOI: 10.1186/s40479-020-00132-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/24/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Research into the personality trait of narcissism have advanced further understanding of the pathological concomitants of grandiosity, vulnerability and interpersonal antagonism. Recent research has established some of the interpersonal impacts on others from being in a close relationship with someone having such traits of pathological narcissism, but no qualitative studies exist. Individuals with pathological narcissism express many of their difficulties of identity and emotion regulation within the context of significant interpersonal relationships thus studying these impacts on others is warranted. METHOD We asked the relatives of people high in narcissistic traits (indexed by scoring above a cut-off on a narcissism screening measure) to describe their relationships (N = 436; current romantic partners [56.2%]; former romantic partners [19.7%]; family members [21.3%]). Participants were asked to describe their relative and their interactions with them. Verbatim responses were thematically analysed. RESULTS Participants described 'grandiosity' in their relative: requiring admiration, showing arrogance, entitlement, envy, exploitativeness, grandiose fantasy, lack empathy, self-importance and interpersonal charm. Participants also described 'vulnerability' of the relative: contingent self-esteem, hypersensitivity and insecurity, affective instability, emptiness, rage, devaluation, hiding the self and victimhood. These grandiose and vulnerable characteristics were commonly reported together (69% of respondents). Participants also described perfectionistic (anankastic), vengeful (antisocial) and suspicious (paranoid) features. Instances of relatives childhood trauma, excessive religiosity and substance abuse were also described. CONCLUSIONS These findings lend support to the importance of assessing the whole dimension of the narcissistic personality, as well as associated personality patterns. On the findings reported here, the vulnerable aspect of pathological narcissism impacts others in an insidious way given the core deficits of feelings of emptiness and affective instability. These findings have clinical implications for diagnosis and treatment in that the initial spectrum of complaints may be misdiagnosed unless the complete picture is understood. Living with a person with pathological narcissism can be marked by experiencing a person who shows large fluctuations in affect, oscillating attitudes and contradictory needs.
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Hersh RG, McCommon B, Golkin EG. Sharing a Diagnosis of Narcissistic Personality: a Challenging Decision with Associated Risks and Benefits. Curr Behav Neurosci Rep 2019. [DOI: 10.1007/s40473-019-00193-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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