“…It is also possible that certain types of interventions might be less vulnerable to the deleterious effects of client narcissism than others, and future research in this area would be very useful. In addition, given the detailed theoretical and empirical literature on the interpersonal impact of pathological narcissism (Dickinson & Pincus, 2003;Friedman, Oltmanns, Gleason, & Turkheimer, 2006;Lukowitsky & Pincus, in press), research is needed to elucidate the mechanisms by which narcissism relates to service utilization and psychotherapy outcome. For example, client narcissism might lead to a harmful activation of narcissistic elements of the therapist's personality (Luchner, Mirsalimi, Moser, & Jones, 2008), leading to disengagement with the therapeutic process (Diamond, Yeomans, & Levy, 2011;Stern, Yeomans, Diamond, & Kernberg, 2013), or narcissism might cause a heightened sensitivity to shame on the part of the client (Gramzow & Tangney, 1992) and a tendency to respond with hostility to narcissistic injury (South, Oltmanns, & Turkheimer, 2003).…”