Interpersonal perceptions in treatment sessions: Pathological narcissism predicts self‐rater discrepancies

Abstract

Objective Evidence suggests that pathological narcissism impacts psychotherapy process and outcome. This study investigates whether traits of pathological narcissism account for distinctiveness (construal) of patients' interpersonal perceptions in treatment settings. Methods Patients enrolled in psychological/psychotherapeutic treatment (N = 150) described a segment of a session in a written format and subsequently assessed both self‐ and clinician's behavior on the dimensions of dominance and hostility (patient‐reported ratings), along with their pathological narcissistic traits. Three independent raters also assessed interpersonal behaviors (observer‐reported ratings) based on the written session descriptions. Indices of construal were defined by the residuals of self‐reported (net of observer‐reported) ratings and were regressed onto pathological narcissistic traits. Results No association emerged between pathological narcissism and construal in patients' perceptions of their clinicians. However, grandiose traits of pathological narcissism were related to distinctively perceiving oneself as more dominant, while vulnerable traits were related to distinctively perceiving oneself as more hostile. The former association (but not the latter) also held after incorporating additional observer ratings to investigate the robustness of the results. Conclusion Findings are discussed in light of treatment‐related self‐enhancement and self‐concealment processes.

Narcissistic personality disorder in the ICD‐11: Severity and trait profiles of grandiosity and vulnerability

“…While negative affectivity was virtually unanimously identified in the vulnerable narcissism vignette (94%), detachment was also regularly endorsed (72%) indicating this may also be a relevant trait. The grandiose narcissism vignette was predominately marked by trait dissociality (91%) but not the vulnerable vignette (12%), which is interesting to consider as interpersonal dysfunction is a salient feature of pathological narcissism (Cheek et al, 2018) with evidence of trait antagonism being present irrespective of subtype expression (Di Sarno et al, 2023). As such it may be that the depressive elements of the vulnerable presentation overshadowed the antagonistic ones in clinician initial ratings.…”

Pathological narcissism’s impact on psychodynamic group therapy for perfectionism.

“…In line with past theory, research provides evidence for the difficulties PN poses in therapy. Specifically, higher PN has been associated with perceiving oneself as more dominant and hostile during psychotherapy sessions (Di Sarno et al, 2023), having lower commitment to personal growth and diminished expectations for resolving one's own mental health difficulties (Kealy, Sandhu, & Ogrodniczuk, 2017) as well as increased likelihood of early treatment termination (e.g., Ellison et al, 2013;Ogrodniczuk et al, 2009). Furthermore, research has found that individuals high in PN tend to evoke more negative countertransference responses in their therapists, including feelings of being criticized/devalued, feelings of hostility/ anger, helplessness/inadequacy, and disengagement, as well as less positive countertransference reactions (Tanzilli et al, 2017).…”