Experiential techniques and therapeutic relationship in the treatment of narcissistic personality disorder: The case of Laura

Abstract

Experiential techniques can be used to address maladaptive interpersonal patterns in patients with personality disorders (PDs) as long as they are delivered minding about the therapeutic relationship. We present the case study of Laura, a 38-year-old woman presenting with covert narcissism, generalized anxiety disorder, depression, and complicated grief treated with metacognitive interpersonal therapy. Laura initially refused to engage in any experiential work out of fear of being judged and abandoned by her therapist. To navigate this therapeutic obstacle, the therapist focused on exploring and eventually repairing early alliance ruptures. Thereafter, Laura engaged in experiential work, which helped her address her narcissistic interpersonal patterns. After 2 years, Laura's symptoms and narcissistic problematic behaviors decreased. This case study can help us understand how experiential techniques can be successfully used in PD psychotherapy as long as attention to the therapy relationship is paid.

The interplay between therapeutic relationship and therapeutic technique: “It takes two to tango”

“…In the fourth paper “Experiential techniques and therapeutic relationship in the treatment of narcissistic personality disorder: The case of Laura,” Centonze and colleagues (2023) discuss the benefits of using experiential techniques to rewrite maladaptive interpersonal patterns in patients with personality disorders and present the case of a 38‐year‐old woman suffering from covert narcissism with generalised anxiety disorder, depression, and complicated bereavement. In this clinical case, the use of guided imagery and body work to help address the patient's loneliness and anxiety was met with resistance and generated a therapeutic rupture.…”

“…Conversely, they need to monitor their inner pressure to deliver, to focus only on symptom reduction and be preoccupied if that does not quickly happen. When patients are reluctant to accept a technique (see Centonze et al, 2023) or it does not bring immediate results, therapists can feel guilty, ineffective or conversely, blame the patients and put pressure on them. To avoid falling into both ends of (a) overprotection and (b) putting too much pressure on themselves and/or on their patients, therapists need to be aware of their own vulnerabilities.…”

The interplay between therapeutic relationship and therapeutic technique: The whole is more than the sum of its parts

“…Pathway 2 involves “expectations,” and with respect to the case studies, this relates to the patient's belief that the rationale, formulation, and treatment plans and techniques will be helpful. Centonze and collaborators (2023) and Matos and collaborators (2022) demonstrate this effectively. In the case of Centonze and collaborators, upon hearing the therapeutic technique, the patient became contemptuous and spiteful.…”

“…Fourth, Centonze and collaborators (2023) present the case of a 38‐year‐old woman suffering from covert narcissism with generalized anxiety disorder, depression, and complicated bereavement who was treated with metacognitive interpersonal therapy (Dimaggio et al, 2020). The qualitative difference, in this case, was that, using guided imagery and bodywork to help the patient overcome loneliness and anxiety, the patient responded with contempt for these practices and a therapeutic rupture was created.…”

Homework assignments in relational psychoanalytic treatment of personality disorders: A case study of a patient with narcissistic personality disorder

“…If so, how? These new tasks can be helpful and encourage creativity (Centonze et al, 2023), while at other times cause strain in the therapeutic relationship or alliance ruptures (Muran et al, 2021;Safran & Muran, 2000). Due to the various possible outcomes, it is important for the relational psychoanalyst to continuously pay attention to the impact that homework assignments have on the therapeutic relationship.…”