Metacognitive Interpersonal Therapy for Narcissistic Personality Disorder and Associated Perfectionism
ABSTRACT Treating narcissistic personality disorder (NPD) successfully is possible but requires a thorough understanding of the pathology and appropriate clinical procedures. Perfectionism is one prominent feature often associated with narcissistic difficulties. Metacognitive Interpersonal Therapy (MIT) for NPD adopts manualized step-by-step procedures aimed at progressively dismantling narcissistic processes by first stimulating an autobiographical mode of thinking and then improving access to inner states and awareness of dysfunctional patterns. Finally, adaptive patterns of thinking, feeling, and acting are promoted, together with a sense of autonomy and agency and a reduction of perfectionistic regulatory strategies. Throughout, there needs to be constant attention to regulation of the therapy relationship to avoid ruptures and maximize cooperation. We describe here a successful case of MIT applied to a man in his early 20's with narcissism, perfectionism, and significant co-occurrence of Axis I and Axis II disorders.
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ABSTRACT: Narcissistic perfectionism is frequently described in theory, but there are no empirically tested models of this construct. Our study tested a model of narcissistic perfectionism, and differentiated this construct from self-critical perfectionism. Data from two samples of undergraduates, including a 28-day daily diary study, were used to test the factorial validity of narcissistic perfectionism and its unique indirect pathways to aversive social behavior. Results supported the factorial validity of narcissistic perfectionism as distinct from self-critical perfectionism, and each perfectionism construct predicted negative social behaviors through overlapping but distinct forms of perfectionistic discrepancies. Our study suggests narcissistic perfectionism is a distinct personality construct that predicts aversive social behavior, thereby supporting theoretical descriptions of this oft-discussed, but rarely studied, personality construct.Journal of Research in Personality 03/2015; 57. DOI:10.1016/j.jrp.2015.02.006 · 2.00 Impact Factor
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ABSTRACT: This article explores the psychological profile and treatment of young people who present clinically with features of borderline and avoidant personality disorder, along with vulnerable narcissistic traits. Self-harm in these youngsters is often used to regulate internal storms. It is argued that the adolescent phase of development is a trigger point for collapse in these vulnerable young people. In therapy, these patients are difficult to connect with emotionally and treatment can be fraught with strong countertransference reactions. A case study is used to illustrate the use of mentalization-based treatment for adolescents for such individuals.Journal of Clinical Psychology 01/2015; 71(2). DOI:10.1002/jclp.22153 · 2.12 Impact Factor
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ABSTRACT: Motive-oriented therapeutic relationship (MOTHER), a prescriptive concept based on an integrative form of case formulation, the Plan Analysis (PA) method (Caspar, in: Eells (ed.), Handbook of psychotherapy case formulations, 2007), has shown to be of particular relevance for the treatment of patients presenting with personality disorders, in particular contributing to better therapeutic outcome and to a more constructive development of the therapeutic alliance over time (Kramer et al., J Nerv Ment Dis 199:244–250, 2011). Several therapy models refer to MOTHER as intervention principle with regard to borderline and Narcissistic Personality Disorder (NPD) (Sachse et al., Clarification-oriented psychotherapy of narcissistic personality disorder, 2011; Caspar and Berger, in: Dulz et al. (eds.), Handbuch der Borderline-Störungen, 2011). The present case study discusses the case of Mark, a 40-year-old patient presenting with NPD, along with anxious, depressive and anger problems. This patient underwent a seven-session long pre-therapy process, based on psychiatric and psychotherapeutic principles complemented with PA and MOTHER, in preparation for further treatment. MOTHER will be illustrated with patient–therapist verbatim from session 4 and the links between MOTHER and confrontation techniques will be discussed in the context of process-outcome hypotheses, in particular the effect of MOTHER on symptom reduction.Journal of Contemporary Psychotherapy 06/2014; 44(2):71-82. DOI:10.1007/s10879-013-9249-5