Clinician Emotional Responses and Therapeutic Alliance When Treating Adolescent Patients With Narcissistic Personality Disorder Subtypes: A Clinically Meaningful Empirical Investigation

Tanzilli, Annalisa; Gualco, Ivan

doi:10.1521/pedi.2020.34.supp.42

Cited by 29 publications

(26 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It should be also considered that both grandiose and vulnerable narcissistic traits can be present within the same person [ 6 , 68 ]. Research in adolescents has shown that NPD can be distinguished in three subtypes: predominantly grandiose/malignant, fragile and high-functioning/exhibitionistic [ 95 , 103 ]. However, feelings of grandiosity and vulnerability may still fluctuate on a state basis within the individual [ 104 ].…”

Section: Discussionmentioning

confidence: 99%

“…Fostering self-compassion in treatment, including with young people, may counter the disruptive effects of shame by allowing one’s needs and sense of self, including negative aspects of the self, to be experienced [ 26 , 109 ]. The challenge here is that feelings of shame may relate to less self-compassion or even fear thereof in adolescents with narcissistic traits [ 110 , 111 ] and that therapists may show less warm responses to adolescents presenting with pathological narcissistic traits [ 103 ]. In clinical practice, it is important to be aware of emotional reactions to clients with narcissistic traits to be able to foster self-compassion [ 103 ].…”

Section: Discussionmentioning

confidence: 99%

“…The challenge here is that feelings of shame may relate to less self-compassion or even fear thereof in adolescents with narcissistic traits [ 110 , 111 ] and that therapists may show less warm responses to adolescents presenting with pathological narcissistic traits [ 103 ]. In clinical practice, it is important to be aware of emotional reactions to clients with narcissistic traits to be able to foster self-compassion [ 103 ].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Narcissistic traits in young people and how experiencing shame relates to current attachment challenges

Schie

Jarman²,

Reis

et al. 2021

BMC Psychiatry

View full text Add to dashboard Cite

Background Young people with pathological narcissistic traits may have more maladaptive ways of relating to themselves and others. In this study, we investigated how the experience of shame may be a mechanism by which vulnerable and grandiose pathological narcissism relates to negative and positive internalised models of the self and others, manifested as attachment styles. Methods Participants (N = 348) were young people who reported on pathological narcissism, the experience of shame and their model of self and others (secure, dismissive, preoccupied and fearful attachment). Mediation of the experience of shame between vulnerable and grandiose narcissism on the one hand and secure, dismissive, preoccupied and fearful attachment on the other hand, was tested using a path model. Results Shame mediated the relationship between vulnerable narcissism and a more negative model of others and self (i.e. less secure, more fearful and more preoccupied in attachment). Higher grandiose narcissism traits were related to a more positive model of others and self (i.e. more secure attachment) and were unrelated to the experience of shame. Conclusions Young people with vulnerable narcissism traits tended to report more shame, and struggled to be close to others. It may be that shame experiences highlight a discrepancy between the ideal and actual self that may contribute to a more insecure attachment style. A good working alliance and fostering self-compassion may counter some negative effects of shame in those most vulnerable, but dismissal in those most grandiose presents a clinical conundrum requiring further research.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Narcissistic traits in young people and how experiencing shame relates to current attachment challenges

Schie

Jarman²,

Reis

et al. 2021

BMC Psychiatry

View full text Add to dashboard Cite

show abstract

“…The idea that grandiose individuals may have trouble expressing deeper emotional experience may also inform research around the negative effect grandiosity is thought to have on the therapeutic alliance (e.g., Zalman et al, 2019;Tanzilli and Gualco, 2020). Clients who are more grandiose in presentation may be less inclined to share their distress or divulge a need for help, placing strain on the alliance and leading to ruptures.…”

Section: Discussionmentioning

confidence: 99%

“…Vulnerable pathological narcissism tends to involve interpersonal problems associated with being too cold, avoidant and exploitable, in contrast to the grandiose presentation, which is characterized by problems with being too vindictive, domineering, intrusive and over-nurturant (Pincus et al, 2009). The clinical utility of differentiating these two dimensions has been well argued (Cain et al, 2008), with grandiosity linked to lower treatment utilization, poor therapeutic alliance, and therapist responses characterized by anger and hopelessness (Pincus et al, 2014;Ronningstam, 2017;Tanzilli and Gualco, 2020).…”

Section: Introductionmentioning

confidence: 99%

Pathological Narcissism and Emotional Responses to Rejection: The Impact of Adult Attachment

et al. 2021

View full text Add to dashboard Cite

Background: Aspects of pathological narcissism, such as grandiosity, vulnerability and entitlement, tend be enacted in therapeutic settings, negatively influencing outcome and alliance between the clients and therapist. This research took an experimental approach to understanding the interplay between the emotional reactions of individuals with a pathological narcissistic presentation, and adult attachment style. We predicted that participants reporting narcissistic vulnerability would report greater insecurity in attachment (fearful and preoccupied styles), greater trait emotional reactivity, and also experience more intense and negative responses to simulated rejectionMethods: 269 participants (75.84% female, median age = 21) completed baseline and rejection trials of a virtual ball-tossing game, following the assessment of grandiose and vulnerable pathological narcissism, entitlement, adult attachment, trait emotional reactivity (measured prior to the rejection) and in-situ affective response (measured both before and after the rejection). Change in affect from baseline was calculated to capture affective responses to the manipulation.Results: Vulnerable narcissism was positively associated with both fearful and preoccupied attachment, and negatively associated with secure and dismissive attachment, whilst grandiose narcissism was significantly related to preoccupied attachment only. Multiple hierarchical regression analyses showed vulnerable narcissism predicted both (1) more negative trait emotional reactivity and (2) a significant increase in negative affect following the rejection trial. Grandiose narcissism was associated with (1) higher positive trait emotional reactivity, and (2) significant reductions in positive affect following rejection.Conclusion: Results indicated that those high in pathological narcissistic vulnerability reported greater insecurity in attachment, negative trait emotional reactivity and experienced a more negative and intense emotional reaction to rejection. Grandiose narcissism was related to a more deactivated pattern of emotional reactivity, and less positive (rather than more negative) emotional reactions. Findings have important implications for therapy, particularly regarding communication of emotions for individuals high in vulnerable and grandiose narcissism.

show abstract

Patient personality dimensions, relational patterns and therapeutic alliance in clinical practice: An empirical investigation

Tanzilli

Boldrini

Carone

et al. 2022

Clin Psychology and Psychoth

Self Cite

View full text Add to dashboard Cite

Introduction Transference (meant in this context, as the patient relational patterns expressed towards the clinician) and therapeutic alliance play a crucial role in the treatment of personality pathology. To date, no empirical study examined the association between these two dimensions of the clinical relationship and patients' personality maladaptive traits in psychotherapy. Methods A national sample of therapists (N = 100) of different theoretical orientations assessed dysfunctional personality features of a patient in their care using a comprehensive and empirically grounded dimensional diagnostic approach from the Shedler–Westen Assessment Procedure‐200 (SWAP‐200). Moreover, they filled in the Psychotherapy Relationship Questionnaire (PRQ) to identify interpersonal patterns expressed early in treatment by the patients and the Working Alliance Inventory (WAI‐T) to evaluate quality of therapeutic alliance. Results Overall, the most severe and maladaptive dimensions of patients' personality were associated with more negative clinician–patient dynamics and poorer levels of therapeutic alliance in statistically significant and clinically relevant ways. Notably, the hostile transference was predicted by both SWAP Hostility and Psychopathy, whereas the SWAP Narcissism was the strongest predictor of the special/entitled transference. The latter was also predicted by SWAP Emotional Dysregulation; conversely, the SWAP Dysphoria was the most robust predictor of anxious/preoccupied pattern. The SWAP Schizoid Orientation and Psychopathy predicted avoidant/dismissing attachment pattern; moreover, they were strongly and negatively related to the SWAP Psychological Health that was the best predictor of positive transference and alliance. Conclusions Findings support that therapists' careful understanding of patients' interpersonal ways during early treatment stages may meaningfully inform diagnostic and therapeutic processes.

show abstract

Clinician Emotional Responses and Therapeutic Alliance When Treating Adolescent Patients With Narcissistic Personality Disorder Subtypes: A Clinically Meaningful Empirical Investigation

Cited by 29 publications

References 50 publications

Narcissistic traits in young people and how experiencing shame relates to current attachment challenges

Narcissistic traits in young people and how experiencing shame relates to current attachment challenges

Pathological Narcissism and Emotional Responses to Rejection: The Impact of Adult Attachment

Patient personality dimensions, relational patterns and therapeutic alliance in clinical practice: An empirical investigation

Contact Info

Product

Resources

About