Therapy for Clients with Narcissistic Personality Disorder
A narcissistic personality disorder is a mental disorder whereby an individual believes they are better than others. The individual cannot also understand other people’s emotions (Yakeley, 2018). According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), an individual is diagnosed with a narcissistic personality disorder if they exhibit five or more of the following symptoms:
They have an over-the-top feeling of self-admiration. Expects to be seen as superior despite lack of accomplishments. Exaggerates their victories and abilities,
Obsessed with fantasies of unlimited power, success, knowledge, beauty, and perfect love,
Believes that they are special and unique and should only be associated with other special and unique people. They also believe that they should associate with high-status people or institutions,
Requires exaggerated approval,
Unrealistic expectations of compliance to their wishes or preferential treatment,
Uses other people to achieve their own goals,
Lacks understanding of the emotions and needs of others,
Is jealous of others and believes that others are jealous of them,
Shows self-important, contemptuous attitude.
Therapeutic Approach and Modality
The therapeutic approach of choice for an individual with a narcissistic personality disorder is long-term continuous psychotherapy in the psychiatric outpatient clinic. Long-term psychotherapy exceeds the standard treatment length for most psychological conditions. According to Lind et al. (2019), long-term psychotherapy is very effective in the management of patients with personality disorders. Long-term psychotherapy gives patients an in-depth understanding of the conditions that they are suffering from. A good understanding of their conditions enables them to heal quickly. Additionally, in long-term psychotherapy, patients can learn where the symptoms of their disease are coming from. For instance, childhood trauma could have affected their psychological development. If this is discovered in therapy, then some closure can be achieved.
The modality of choice for the treatment of narcissistic personality disorder would be cognitive behavioral therapy. In cognitive-behavioral therapy, patients are taught how to identify impractical thoughts and replace them with sensible thoughts. They are also taught how to identify destructive behaviors and how to replace them with healthy behaviors. Furthermore, they are taught about their psychological condition, how it affects their thoughts and behavior, and how it affects the people living with them (Yakeley, 2018). Individuals who have narcissistic personality disorder suffer from distorted self-image and would, therefore, benefit greatly from cognitive behavioral therapy.
The Therapeutic Relationship and Sharing of Diagnosis
A therapeutic relationship in psychiatry is an alliance between a mental health care professional and an individual receiving mental health treatment. A therapeutic relationship is based on trust, understanding, positivity, setting healthy boundaries, and honest communication (Bolsinger et al., 2020). When sharing the diagnosis of the disorder with a client, I would give accurate information, avoid the use of medical terms, listen, and be empathetic to the patient’s situation. When sharing during a group session, I would be straightforward and give group members time to ask questions and advise on issues that need to be sorted.
The supporting articles by Yakeley J. (2018), Lind et al. (2019), and Bolsinger et al. (2020) are considered scholarly because they are current and can be found on Google Scholar. The articles clearly state the names of the authors and their credentials. Furthermore, the article by Bolsinger et al. (2020) is part of BJPsych Advances, an international peer-reviewed journal owned by The Royal College of Psychiatrists.
Bolsinger, J., Jaeger, M., Hoff, P., & Theodoridou, A. (2020). Challenges and opportunities in building and maintaining a good therapeutic relationship in acute psychiatric settings: A narrative review. Frontiers in psychiatry, 10, 965. https://doi.org/10.3389/fpsyt.2019.00965
Lind, M., Jørgensen, C. R., Heinskou, T., Simonsen, S., Bøye, R., & Thomsen, D. K. (2019). Patients with borderline personality disorder show increased agency in life stories after 12 months of psychotherapy. Psychotherapy, 56(2), 274. https://doi.org/10.1037/pst0000184
Yakeley, J. (2018). Current understanding of narcissism and narcissistic personality disorder. BJPsych Advances, 24(5), 305-315. https://doi.org/10.1192/bja.2018.20
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Review this week’s Learning Resources and reflect on the insights they provide about treating clients with personality disorders.
Select one of the personality disorders from the DSM-5 (e.g., paranoid, antisocial, narcissistic). Then, select a therapy modality (individual, family, or group) that you might use to treat a client with the disorder you selected.
Succinctly, in 1–2 pages, address the following:
Briefly describe the personality disorder you selected, including the DSM-5 diagnostic criteria.
Explain a therapeutic approach and a modality you might use to treat a client presenting with this disorder. Explain why you selected the approach and modality, justifying their appropriateness.
Next, briefly explain what a therapeutic relationship is in psychiatry. Explain how you would share your diagnosis of this disorder with the client in order to avoid damaging the therapeutic relationship. Compare the differences in how you would share your diagnosis with an individual, a family, and in a group session.
Support your response with specific examples from this week’s Learning Resources and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.
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