The Treatment of Trait and Narcissistic Personality Disturbances

Abstract

The treatment of narcissism and narcissistic personality disorders (NPD) is challenging for clinicians because of their complexity and limited empirical evidence to guide treatment. This chapter provides an overview of the state of the field of psychotherapeutics for NPD. Interest in the treatment of NPD was stimulated by Heinz Kohut who developed a theory of self-psychology and developed methods for treating what he termed disorders of the self. Kohut did not articulate a specific approach for treating NPD, so much as articulating principles for how to create a therapeutic relationship, using empathy and mirroring to mend structural deficits in the self-system. While there is substantial support demonstrating the efficacy of psychotherapy in general, and growing empirical evidence for the treatment of personality disorders, there is limited evidence for NPD. A review of the literature shows over 30 randomly controlled treatment studies evaluating the efficacy of treatment for personality disorders but most focused on borderline personality disorder and none specifically on NPD. There are a number of studies, which include NPD in their sample, but sample sizes are so small that specific implications cannot be generalized for NPD. While there is a dearth of empirical evidence demonstrating efficacy for any single approach for NPD, there are a number of treatment approaches, which have been suggested for narcissism and NPD. Currently, there is only one approach specifically for NPD, but no single approach has shown efficacy using randomly controlled treatment studies. However, there is substantial clinical case material and anecdotal evidence suggesting that integrative and unified approaches are the most suited for narcissistic trait and personality disorders.