Metacognitive Interpersonal Therapy for Narcissistic Personality Disorder and Associated Perfectionism

Center for Metacognitive Interpersonal Therapy, Rome, Italy.
Journal of Clinical Psychology (Impact Factor: 2.12). 08/2012; 68(8):922-34. DOI: 10.1002/jclp.21896
Source: PubMed

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.

  • [Show abstract] [Hide abstract]
    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
  • [Show abstract] [Hide abstract]
    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
  • [Show abstract] [Hide abstract]
    ABSTRACT: Narcissistic personality disorder is a relatively uncommon diagnosis in clinical settings; however, these patients are frequently in need of and referred for long-term psychotherapy. Such patients may not seek therapy willingly but do so at a time when they experience sufficient vulnerability to accept therapy. Given these and other characteristics, the narcissistic patient can be challenging for therapists. This paper suggests some strategic approaches that may be employed with patients with narcissistic pathology. Partly, these approaches incorporate more contemporary understandings of narcissistic pathology such as appreciating that these patients can present both the grandiose and vulnerable elements of narcissistic pathology and that a gender focus using theories of masculinity may enlighten our approach to these patients. Specifically the strategies reviewed are: starting therapy by assessing for the patient’s vulnerable characteristics and offering some gratification for their need for acknowledgement; monitoring and managing the risk of suicide and comorbid disorder in patients with narcissistic pathology and in the working through phase of therapy, recognizing the need for patients to developed increased self-cohesion and the importance of supervision/consultation in the working through process of therapy.
    Journal of Contemporary Psychotherapy 06/2014; 44(2). DOI:10.1007/s10879-013-9258-4