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Therapy for Clients with Personality Disorders

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Therapy for Clients with Personality Disorders

Narcissistic Personality Disorder: Description and Diagnostic Criteria

Narcissistic personality disorder (NPD) is characterized by a grandiose sense of self, excessive need for praise, and a lack of empathy toward others (Mitra et al., 2024). According to the DSM-5-TR, the diagnostic criteria establish a consistent and exaggerated sense of self-esteem, a fixation with fantasies that center around being successful or powerful, self-perception as being special or different, an inordinate desire for admiration, feelings of entitlement, taking advantage of others in relationships, lack of concern about others’ feelings, jealousy of others or feeling that others are jealous of them, and disdainful behaviors and attitude: Therapy for Clients with Personality Disorders.

Therapeutic Approach and Modality

Based on recent evidence, the use of a Mentalization-Based Treatment (MBT) approach with NPD clients in individual therapy settings is commendable. Notably, Choi-Kain et al. (2022) note that MBT assists clients in transitioning from an egocentric “me-mode” to a more social “we-mode” through enhancement in one’s skills to appreciate the mental states of self and other beings. The individual modality is particularly appropriate as it allows for focused attention on the client’s specific manifestations of narcissistic traits while building a strong therapeutic alliance.

Furthermore, the well-established techniques of MBT, emphasizing “not knowing” and understanding one’s emotions, pose no threats to clients, which can ultimately enhance the treatment effectiveness since narcissists do not respond well to aggressive forms of treatment. The approach helps address both grandiose and vulnerable aspects of narcissism while working within the client’s defenses rather than in opposition to them.

The Therapeutic Relationship and Diagnosis Sharing

Therapeutic relations in psychiatry constitute a practitioner and patient partnership based on the trust and the empathic orientation of the clinician to the patient with the aim of treatment. As noted by Nook et al. (2022), this bond is especially important with regard to patients with NPD since they are easily hurt by what they perceive as criticism, and they have a weak self-image.

When sharing the NPD diagnosis, the approach differs across settings. In the individual setting, I would focus on and discuss the diagnosis in terms of the patterns the client noticed and the difficulties they relate to those symptoms. For example, one could say, “The challenges you’ve described with relationships and self-image align with what we call narcissistic personality traits. Understanding this can help us work together more effectively.”

In the family setting, I would describe the effects of narcissistic traits on family interactions without passing blame. I would suggest the diagnosis in the context of the possibility of better understanding and communication within the family as well as promote the idea that family members should assist in predicting support methods. Lastly, in a group setting, I would focus the discussion of the diagnosis on highlighting past experiences and how they can be beneficial during growth. I would help the group members identify and appreciate themselves as having something in common with others in the group but respect their uniqueness and avoid open conflict.

Supporting Research

Three peer-reviewed sources support this discussion. First, Nook et al. (2022) present evidence on the cognitive-behavioral perspective of the dysregulation of narcissistic self-esteem and highlight the need to correct dysfunctional beliefs and interpretations. Second, Choi-Kain et al. (2022) showcase the use of mentalization-based activity as an effective treatment of NPD, specifically in fostering feelings of empathy and minimizing self-centered attitudes. Lastly, Mitra et al. (2024) describe the tolerance of the disorder as it pertains to biological and environmental factors, hence calling for agglomerative treatment by addressing various dimensions of the disorder.

Notably, these sources are scholarly as they appear in peer-reviewed academic journals, present original research or systematic reviews, include comprehensive citations and references, follow standardized academic writing formats, and are authored by qualified researchers in the field. This approach takes into account the diverse nature of NPD while providing functional techniques to help manage the therapeutic alliance and the sharing of diagnosis over several different treatment modalities.

References

Choi-Kain, L. W., Simonsen, S., & Euler, S. (2022). A mentalizing approach for narcissistic personality disorder: Moving from “me-mode” to “we-mode.” American Journal of Psychotherapy, 75(1), 38–43. https://doi.org/10.1176/appi.psychotherapy.20210017

Mitra, P., Torrico, T. J., & Fluyau, D. (2024, March 1). Narcissistic personality disorder. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK556001/

Nook, E. C., Jaroszewski, A. C., Finch, E. F., & Choi-Kain, L. W. (2022). A cognitive-behavioral formulation of narcissistic self-esteem dysregulation. FOCUS, 20(4), 378–388. https://doi.org/10.1176/appi.focus.20220055

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Question

Week 10: Assignment

THERAPY FOR CLIENTS WITH PERSONALITY DISORDERS

Individuals with personality disorders often find it difficult to overcome the enduring patterns of thought and behavior that they have thus far experienced and functioned with in daily life. Even when patients are aware that personality-related issues are causing significant distress and functional impairment and are open to counseling, treatment can be challenging for both the patient and the therapist. For this Assignment, you examine specific personality disorders and consider therapeutic approaches you might use with clients.

RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

To prepare:

THE ASSIGNMENT
Succinctly, in 1–2 pages, address the following:

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.

BY DAY 7
Submit your Assignment. Also attach and submit PDFs of the sources you used.

SUBMISSION INFORMATION
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1. To submit your completed assignment, save your Assignment as WK10Assgn_LastName_Firstinitial
2. Then, click on Start Assignment near the top of the page.
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Therapy for Clients with Personality Disorders

Therapy for Clients with Personality Disorders

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