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Chapter 6 - Narcissistic Personality Disorder

from Part III - Application and Adaptations for Mental Health Presentations

Published online by Cambridge University Press:  18 May 2023

Anthony Bateman ,
Peter Fonagy ,
Chloe Campbell ,
Patrick Luyten  and
Martin Debbané
Anthony Bateman
Affiliation:
Anna Freud National Centre for Children and Families, London
Peter Fonagy
Affiliation:
University College London
Chloe Campbell
Affiliation:
University College London
Patrick Luyten
Affiliation:
University College London
Martin Debbané
Affiliation:
University College London
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Summary

A mentalizing framework for understanding narcissism is outlined, and the resulting modifications of basic mentalization-based treatment (MBT) for narcissistic personality disorder are discussed. Treatment of patients with pathological narcissism requires an emphasis on empathic validation and support of the vulnerable “I-mode.” The dangers of not recognizing low mentalizing in narcissistic functioning are also discussed, as both patient and clinician can fail to recognize pretend mode, which may masquerade as “we-mode.” Together the patient and the therapist may then set up a pretend therapy that can be interminable and that functions only to fuel the mental narcissistic structure. A clinical example of a patient in treatment is used to illustrate the process of treatment.

Keywords

affect focuscounter-relational mentalizinggrandiose narcissism“I-mode”“me-mode”narcissismpretend modethick-skinned narcissismthin-skinned narcissismvulnerable narcissism“we-mode”
Type
Chapter
Information
Cambridge Guide to Mentalization-Based Treatment (MBT) , pp. 155 - 173
Publisher: Cambridge University Press
Print publication year: 2023

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References

Skodol, AE, Bender, DS, Morey, LC et al. Personality disorder types proposed for DSM-5. J Pers Disord 2011; 25: 136–69.CrossRefGoogle ScholarPubMed
Tyrer, P, Crawford, M, Mulder, R et al. The rationale for the reclassification of personality disorder in the 11th revision of the International Classification of Diseases (ICD-11). Personal Ment Health 2011; 5: 246–59.CrossRefGoogle Scholar
Fonagy, P, Gergely, G, Jurist, E, Target, M. Affect Regulation, Mentalization, and the Development of the Self. New York, NY: Other Press LLC, 2002.Google Scholar
Robinson, EA. Robinson: Poems. Donaldson, S, ed. New York, NY: Everyman’s Library, 2007 (originally published 1897); 33.Google Scholar
James, W. Principles of Psychology. New York, NY: Henry Holt, 1890.Google Scholar

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