At work, in the family, or at the last night’s party, you know a narcissist, someone who is so much in love with himself or herself. This self-love can sometimes reach pathological levels resulting in a personality disorder called narcissistic personality disorder or NPD. Characterized by grandiose delusions about oneself, a constant need for attention and admiration, a lack of empathy, NPD may actually take you to career heights (who doesn’t get impressed by confidence?) but interpersonal relationships are a different matter altogether. Who would want to live with people who are too busy admiring themselves?
Can NPD Be Treated?
Like all personality disorders, NPD too can be managed even though a complete cure may not be achievable. Some NPD cases could be genetic but a lot many are found to have stemmed from inadequate parenting. You can read about the various causes here
Keeping that in mind, psychiatrists from Sigmund Freud to Heinz Kohut and Otto F. Kernberg have developed various treatment methods to help people with the disorder. Freud believed that narcissist were incapable of transference (a psychiatric term for unconscious redirection of feelings from one person to the other) because of their inability to establish sound object relations. This was refuted by Kohut and Kernberg through their intense research on the subject. They came up with three broad groups of individual treatments–psychoanalysis, psychoanalytic/dynamic psychotherapy/casework, and supportive psychotherapy/casework.1
What Are The Challenges In The Treatment?
Kernberg has admitted that treating patients of NPD is full of challenges and there are narcissists who are “almost untreatable”.2
Some NPD patients don’t trust their therapist and find going to a therapist shameful or humiliating. A fear of dependency makes them want to control the treatment by “self-analysing” their problems. Some narcissists, on the other hand, show a defensive idealization of the therapist and term the therapist as the greatest. This idealization often get shattered and lead to contempt for the therapist. They could also “steal” the therapist’s language and use it on others. With their narcissistic entitlement and incorporation, they would sometimes try to seduce the therapist as a part of their ploy to destroy the efforts of the therapist. He notes that it could be very difficult to cure such extreme cases of the disorder.
Treatments For Severe Cases
People with NPD could have difficulties acknowledging problems and vulnerabilities which can make any kind of therapy difficult. Equally difficult are the NPD cases that occur alongside other psychiatric disorders which can increase the likelihood of treatment dropout.3 In severe cases, the treatments used in other personality disorders like borderline personality disorders are being used to treat NPD as well. Some of the effective treatments include:
Mentalization-based Therapy
For normal people with no mental disorders, mentalization is a pretty simple process of understanding oneself and other people which include making sense of each other’s mental processes and states of mind. But not for people with personality disorders. This results in serious complications in their interpersonal relationships. Mentalization-based therapy focuses on this aspect and use various interventions to develop mentalizing in patients.4
Transference-focused Psychotherapy
This involve exploring the secret, inner world of the patients to gauge their identity crises. The therapy tries to promote identity integration, so the patient is able to lead a better, normal life.5
Schema-focused Psychotherapy
This form of therapy focuses more on the basic needs of the patient and in activating emotions. The therapy borrows heavily from cognitive-behavioral, experiential, interpersonal and psychoanalytical approaches to treatment.6
Functional Analytic Behavior Therapy
Traditional psychodynamic approaches to NPD focus heavily on transference and the problem behaviors of the patient in the therapist’s clinic are treated in isolation as part of transference. Functional analytic psychotherapy differs here. Here, in-session client behaviors are assumed to be examples of the same interpersonal problem behaviors that occur in other relationships. So, the therapist’s task is to respond to them as they occur, shaping more effective client interpersonal behaviors.7
Dialectical Behavioral Therapy or DBT
DBT focuses on acceptance and change in patients. The treatment strategies draw from various principles like cognitive-behavioral principles for change of behavior, client-centered and emotion-focused therapy strategies for helping the therapist convey his or her acceptance of the patient, and Zen Buddhist principles to help the patient develop greater acceptance of self, of others, and of life in general.8
No matter what treatment method is being used, both the patient and the therapist should bare in mind that psychotherapy takes time to show results. Personality disorders are particularly difficult with a good chance of patients dropping out from therapy out of frustration. Effective therapy demands patience and empathy from the therapist.
References
