Narcissistic Personality Disorder (NPD) is categorized as an emotional, erratic, or dramatic personality disorder. Typically, NPD is a mental illness linked with an excessive preoccupation with prestige, power, adequacy, and vanity (Yakeley, 2018). NPD patients have a strong desire for recognition and praise. Moreover, they appear arrogant since they lack empathy and the ability to appreciate the views of others. NPD is caused by childhood traumas (I.e., sexual, verbal, and physical abuse), genetics (i.e., family history), abusive relationships, and other environmental factors. According to a study done by Gawda & Czubak (2017), NPD is a more prevalent personality disorder among men than women. According to DSM-5 criteria, individuals with NPD have inflated self-appraisal.
Moreover, they have unreasonable personal standards. NPD clients have impaired interpersonal functioning arising from their lack of empathy, whereby they have an impaired ability to identify or recognize the needs and feelings of others. In addition, their intimate relationships are largely superficial and based on gaining personal interests and serving self-esteem needs. NPD patients have amplified antagonism characterized by attention-seeking (i.e., admiration-seeking) and grandiosity (i.e., self-centeredness, condescending toward others, and an increased sense of entitlement). Moreover, persons with NPD have ultra-confidence lies and fragile self-esteem. Lastly, they are interpersonally exploitative. In other words, they like benefiting or taking advantage of others (Schalkwijk et al., 2021).
Selected therapeutic approach: Psychodynamic therapy
Psychodynamic therapy is a highly preferred therapeutic approach for treating patients with NPD. It helps NPD patients examine their thoughts, beliefs, and emotions mainly to gain insights into their current selves (Steinert et al., 2017). Sessions in psychodynamic therapy are open-ended and intense, which are highly determined by the patient’s free association. In this view, psychodynamic therapy is not based on an agenda and schedule (Steinert et al., 2017). Therapists administering psychodynamic therapy draw their formulations from the client’s reactions. For instance, a grandiose person responds with anger when his/her ego is threatened; others may react by expressing sadness or shame. Vulnerable NPD patients constantly protect their views against those who criticize, ridicule or disagree with them. Therefore, therapists help NPD patients become self-aware of their problems, which marks the start of their subsequent treatments.
The therapeutic relationship in psychiatry
A therapeutic relationship strongly predicts patient outcomes (Nienhuis et al., 2018). These relationships are not necessarily established through face-to-face contact but also can be created through telephone, web, or other means of communication. Therapeutic relationships are core in psychiatry practices since they give the means to engage patients. Generally, a therapeutic relationship refers to the alliance between a therapist and a patient throughout a therapeutic process (Nienhuis et al., 2018). The relationship is centered on therapeutical goals and agreed on treatment plans. Effective therapeutic relationships are based on congruence, respect, and trust. Therapists have to show genuineness and empathy with their clients when handling clients. Therefore, creating and maintaining therapeutic relationships plays a huge role in psychotherapy.
Sharing diagnoses with patients is a sensitive area that requires therapists to be careful. In this regard, when sharing a diagnosis with an individual, I will first begin by acknowledging the effort and commitment made by the patient in seeking help. Secondly, I will provide a brief overview of NPD and its treatment. Doing so alleviates any anxieties from the client. Lastly, I will inform the client about his/her condition and guide him/her in finding the right treatment plan. In the family case, I will begin by appreciating each member’s willingness to cooperate during diagnosis. Then, I will proceed with a brief discussion about mental health issues and their effect on the family. I will let the family know they need to treat mental health illnesses because they may lead to misunderstanding or breaking family relationships. Then, I will share the diagnosis and suggest the best treatment for members identified with NPD. In a group sharing similar experiences, I will consider sharing diagnoses with each member separately because some may want their state of health to remain private. This would require individual visits, upon which I will briefly describe the diagnosis and share the results. After completing this exercise, I will organize a group meeting for subsequent treatment.
Supporting Sources
The sources selected are scholarly written by experts or professionals affiliated with a specific field. Each source has the names of the authors and their credentials. Moreover, each article has in-text citations and a list of scholarly sources. The articles selected use a specific structure for scholarly sources comprising an abstract, an introduction, background, literature, method, findings, discussion, and conclusion. The language used in the articles is highly technical and specialized.
Gawda, B., & Czubak, K. (2017). Prevalence of personality disorders in a general population among men and women. Psychological Reports, 120(3), 503-519. https://doi.org/10.1177/0033294117692807
Nienhuis, J. B., Owen, J., Valentine, J. C., Winkeljohn Black, S., Halford, T. C., Parazak, S. E., … & Hilsenroth, M. (2018). Therapeutic alliance, empathy, and genuineness in individual adult psychotherapy: A meta-analytic review. Psychotherapy Research, 28(4), 593-605. https://doi.org/10.1080/10503307.2016.1204023
Schalkwijk, F., Luyten, P., Ingenhoven, T., & Dekker, J. (2021). Narcissistic Personality Disorder: Are Psychodynamic Theories and the Alternative DSM-5 Model for Personality Disorders Finally Going to Meet? Frontiers in psychology, 2389. https://doi.org/10.3389/fpsyg.2021.676733
Steinert, C., Munder, T., Rabung, S., Hoyer, J., & Leichsenring, F. (2017). Psychodynamic therapy: as efficacious as other empirically supported treatments? A meta-analysis testing equivalence of outcomes. American Journal of Psychiatry, 174(10), 943-953. https://doi.org/10.1176/appi.ajp.2017.17010057
Yakeley, J. (2018). Current understanding of narcissism and narcissistic personality disorder. BJPsych Advances, 24(5), 305-315. doi:10.1192/bja.2018.20
