Narcissistic Personality Disorder



Treatment Summary: Narcissistic Personality Disorder is difficult to treat because the narcissistic person does not think they have a problem. What brings most people with narcissistic personality disorder into treatment is substance abuse issues, martial problems, lose of a job or when aging and illness threatens their sense of superiority. Psychotherapy can uncover defense mechanisms and trace their origins to emotional conflicts early in life. An important part of this process is transference, the re- emergence of childhood feelings for parents in the relationship with the therapist. Group therapy can also be effective in treating this disorder but the challenge is getting the person with NPD to stop talking about themselves and realize how their behavior effects the others in the group.

  • Reference: (2004). Narcissism and self-esteem. (cover story). Harvard Mental Health Letter, 20 (8), 1. Retrieved from MasterFILE Premier database.
  • Submitter: Ron Beltz

Transference-focused psychotherapy (TFP)

Treatment Summary: This object relations approach harnesses the transference reactions of the client to the therapist in order to enhance the client's emotional, affective, and behavioral self-regulation, as well as his or her self-efficacy, intimacy, and relationship quality. Treatment occurs twice per week for a period of at least one year. The client and counselor devise and adhere to a specific treatment contract with defined and measurable goals. The client's projections and the way he or she treats the counselor are interpreted as reflections of the relationship dynamics outside of the therapeutic setting.

  • Reference: Clarkin, J.F., Levy, K.N., & Schiavi, J.M. (2005). Transference focused psychotherapy: Development of a psychodynamic treatment for severe personality disorders. Clinical Neuroscience Research, 4, 379-386. Diamond, D., & Meehan, K. (2013). Attachment and Object Relations in Patients With Narcissistic Personality Disorder: Implications for Therapeutic Process and Outcome.Journal of Clinical Psychology, 69(11), 1148-1159.
  • Submitter: Daniela L. Galvez Nelson


Treatment Summary: Self-psychology, a form of psychoanalysis, is a theory developed by Heinz Kohut. The theory is based on the crucial component of establishing an empathetic relationship with the client in order to build trust. Negligent parenting during early childhood may lead to insecure attachment, which is believed to be one of the factors related to NPD. Kohut's theory proposes that healthy self-development in children stems from nurturing relationships with caregivers in which the child's emotional needs are met through proper interaction in three areas: mirroring response, idealizing response, and twinship response. Within these responses, children's needs of being understood and appreciated, need for a strong emotional attachment to others, and the need to feel a sense of closeness with others like themselves are met. During treatment, the client with NPD may experience transference with the therapist which mimics these same needs that were unmet in childhood. Using the self-psychology approach in treatment helps the therapist to interact with rather than react to the client. The goal of this form of treatment of NPD is to assist the client in reaching a more mature and healthier self-development.

  • Reference: Bennett, C. S. (2005). Attachment theory and research applied to the conceptualization and treatment of pathological narcissism. Clinical Social Work Journal, 34(1), 45-59. Retrieved March 17, 2010, from the Academic Search Complete database. Czuchta Romano, D. M. (2004). A self-psychology approach to narcissistic personality disorder: a nursing reflection. Perspectives on Psychiatric Care, 40(1), 20-28. Retrieved March 15, 2010, from the Academic Search Complete database.
  • Submitter: Jill Guerin
Virtual Advisor