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
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.
Available from: Elsa Ronningstam
- "Efforts to conceptualize and understand NPD in terms of traits and psychodynamic formulation of self and interpersonal functioning encouraged treatment strategies that focused specifically on pathological narcissism. Several different documented and applied treatment approaches now attend to disordered narcissism in alliance building and treatment[13,151617181920. Studies of diagnostic stability have shown that although narcissistic traits and the categorical NPD diagnosiscan be changeable over time with moderate remission (about 50 %), measures of dimensional personality pathology, which attend to motivational and self-regulatory functioning of pathological narcissistic traits, have shown more temporal stability[22,23]. "
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ABSTRACT: This review is focused on integrating recent research on emotion regulation and empathic functioning with specific relevance for agency, control, and decision-making in narcissistic personality disorder (NPD, conceptualized as self direction in DSM 5 Section III). The neuroscientific studies of emotion regulation and empathic capability can provide some significant information regarding the neurological/neuropsychological underpinnings to narcissistic personality functioning. Deficiencies in emotion processing, compromised empathic functioning, and motivation can influence narcissistic self-regulation and agential direction and competence in social interactions and interpersonal intimate relationships. The aim is to expand our understanding of pathological narcissism and NPD and suggest relevant implications for building a collaborative treatment alliance.
- "We may add that for patients with PD, it seems particularly helpful when working towards the emergence of core fear or shame. Because such emotions are central to several PDs (Dimaggio & Attina, 2012;Sachse et al., 2011), their facilitation may actually be important for any treatment of PDs. The quality of a therapist's understanding of the patient's core issues and conveying this to the patient, as well as therapist's use of process direction, again predicted the patient's disclosing of core negative self-evaluations. "
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ABSTRACT: It is important to understand the change processes involved in psychotherapies for patients with personality disorders (PDs). One patient process that promises to be useful in relation to the outcome of psychotherapy is emotional processing. In the present process-outcome analysis, we examine this question by using a sequential model of emotional processing and by additionally taking into account a therapist's appropriate responsiveness to a patient's presentation in clarification-oriented psychotherapy (COP), a humanistic-experiential form of therapy. The present study involved 39 patients with a range of PDs undergoing COP. Session 25 was assessed as part of the working phase of each therapy by external raters in terms of emotional processing using the Classification of Affective-Meaning States (CAMS) and in terms of the overall quality of therapist-patient interaction using the Process-Content-Relationship Scale (BIBS). Treatment outcome was assessed pre- and post-therapy using the Global Severity Index (GSI) of the SCL-90-R and the BDI. Results indicate that the good outcome cases showed more self-compassion, more rejecting anger, and a higher quality of therapist-patient interaction compared to poorer outcome cases. For good outcome cases, emotional processing predicted 18% of symptom change at the end of treatment, which was not found for poor outcome cases. These results are discussed within the framework of an integrative understanding of emotional processing as an underlying mechanism of change in COP, and perhaps in other effective therapy approaches for PDs.
Available from: Sherry H Stewart
- "Using a 28-day daily diary design, we also sought to test a mediation model wherein narcissistic perfectionism and self-critical perfectionism predict conflict with others and derogation of others, but through different pathways. According to theory, narcissistic perfectionists derogate others and experience conflict with others because people do not live up to their grand expectations (Dimaggio & Attinà, 2012; Ellis, 1997). In contrast, research suggests self-critical perfectionists derogate others and experience conflict with others because they believe others expect too much of them (Mushquash & Sherry, 2012). "
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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.
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