Clinically, we observe that patients whose self-esteem is especially brittle require certain considerations in formulating a treatment plan (e.g., Gold & Stricker, 2011). We refer to such patients as narcissistically vulnerable, but we are not using the term narcissistic pejoratively or as an equivalent to the Diagnostic and Statistical Manual of Mental Disorders (DSM) category of Narcissistic Personality Disorder. In contemporary psychoanalysis, as informed by self psychology (Kohut, 1977, 1984) and relational theory (e.g., Mitchell, 1986), narcissism is appreciated as a normal part of being human, and healthy self-love has its own developmental course intertwined with that of developing love for others. Regulating self-love and self-worth-that is, self-esteem-through life's inevitable failures, successes, losses, accomplishments, disapproval, and praise is a universal challenge requiring multiple adjustments, calibrations, and stabilizations daily. Some people, however, because of developmental setbacks and insufficiencies, struggle significantly with restoring a realistic, positive, and integrated sense of themselves through the upturns and downturns of fortune and misfortune. 7 EXPERIENCE OF SELF AND OTHER: NARCISSISTIC VULNERABILITIES

Applying the Social Cognition and Object Relations Scale-Global (SCORS-G; Stein, Hilsenroth, Slavin-Mumford, & Pinsker, 2011; Westen, 1995) rating method to Thematic Apperception Test (TAT; Murray, 1943) narratives, this study of undergraduates aimed to (a) assess the component structure and construct validity of the SCORS-G in a nonclinical sample and (b) contribute to the development of a set of norms to guide clinical interpretation of this method. A 2-component solution for the SCORS-G entailed cognitive and affective components. Support for construct validity came from known-groups analyses in which this nonclinical sample was healthier on all 8 scales of the SCORS-G compared with a composite of previously published clinical samples. The cognitive scales (complexity of representations of people, understanding of social causality) were particularly strong in differentiating between the nonclinical and clinical groups. Additionally, in the overall sample the affective component of the SCORS-G was positively, significantly, and meaningfully related to a self-report measure of interpersonal functioning. This association was stronger among male participants; among females, the affective component was more strongly and negatively correlated with self-reported physical symptoms. Unexpectedly, the affective component did not correlate with a self-report measure of mental health, but its correlation with a performance-based measure of mental health involved a small effect in the predicted direction. Addressing a gap in the literature, this study also contributes a set of nonclinical norms that can be used to guide clinical interpretation of the TAT SCORS-G with some patients. Theoretical and clinical implications, as well as limitations, are discussed.

When a therapist becomes gravely ill, not only is the vital therapeutic frame disrupted, but the therapist's preoccupation with personal vulnerability-as well as defenses against such feelings-may preclude acting in the best interests of clients. Although theAPA (1992) provides ethical guidelines that apply to therapists in such situations, the clinical literature more tellingly captures the nature and difficulty of the specific dilemmas that arise. Three such dilemmas for therapists involve (a) self-disclosure to clients about the illness, (b) precautions against the abandonment of clients, and (c) decisions concerning return to practice following a period of absence. The explicit focus in the literature has been on clinical, rather than ethical, implications of various approaches to these dilemmas. A goal of this article is not only to review these clinical perspectives, but also to elucidate the particular ethical values that are embedded within them.One conceptualization of psychotherapy is that of a process whereby the therapist lends his/her ego strength to the client while the client tries to develop or internalize such resources (Gold,The author wishes to thank Annette Stanton, Ph.D., for her suggestions regarding preparation of the article.

BackgroundConceptualizations of personality disorders (PD) are increasingly moving towards dimensional approaches. The definition and assessment of borderline personality disorder (BPD) in regard to changes in nosology are of great importance to theory and practice as well as consumers. We studied empirical connections between the traditional DSM-5 diagnostic criteria for BPD and Criteria A and B of the Alternative Model for Personality Disorders (AMPD).MethodRaters of varied professional backgrounds possessing substantial knowledge of PDs (N = 20) characterized BPD criteria with the four domains of the Level of Personality Functioning Scale (LPFS) and 25 pathological personality trait facets. Mean AMPD values of each BPD criterion were used to support a nosological cross-walk of the individual BPD criteria and study various combinations of BPD criteria in their AMPD translation. The grand mean AMPD profile generated from the experts was compared to published BPD prototypes that used AMPD trait ratings and the DSM-5-III hybrid categorical-dimensional algorithm for BPD. Divergent comparisons with DSM-5-III algorithms for other PDs and other published PD prototypes were also examined.ResultsInter-rater reliability analyses showed generally robust agreement. The AMPD profile for BPD criteria rated by individual BPD criteria was not isomorphic with whole-person ratings of BPD, although they were highly correlated. Various AMPD profiles for BPD were generated from theoretically relevant but differing configurations of BPD criteria. These AMPD profiles were highly correlated and showed meaningful divergence from non-BPD DSM-5-III algorithms and other PD prototypes.ConclusionsResults show that traditional DSM BPD diagnosis reflects a common core of PD severity, largely composed of LPFS and the pathological traits of anxiousness, depressively, emotional lability, and impulsivity. Results confirm the traditional DSM criterion-based BPD diagnosis can be reliably cross-walked with the full AMPD scheme, and both approaches share substantial construct overlap. This relative equivalence suggests the vast clinical and research literatures associated with BPD may be brought forward with DSM-5-III diagnosis of BPD.

No abstract