On Tone, Play, and Healing: Commentary on Riordan's Case Studies

Abstract

The clinical work reported by Riordan (2012) is discussed, with attention to prosody (tone) and other subjectively inferred aspects of his therapeutic style with narcissistically troubled clients. Consideration is also given to cultural contexts relevant to understanding the reported increase in narcissistic problems in contemporary patients, the personality and genuineness of the therapist as factors in psychological healing, and the role of play and playfulness in reducing the suffering of clients who rely on narcissistic defenses to compensate for a fragile, erratic, or unrealistic sense of self-esteem. The focus throughout is on the less specifiable, more artistic elements of the psychotherapy process.

A Personal Perspective on the Treatment of Three Cases of Narcissistic Vulnerability

“…In commenting on my article, Nancy McWilliams (2012) and Kenneth Levy (2012) take different but complementary perspectives in critically evaluating the nature and implications of my work. Below I briefly comment on each commentary and then present some observations to expand the reader's understanding of what I individually brought to the treatment of Alex, Brian, and Candace.…”

“…Below I briefly comment on each commentary and then present some observations to expand the reader's understanding of what I individually brought to the treatment of Alex, Brian, and Candace. McWilliams (2012) offered comments on my work from a viewpoint that seems common to her writings (e.g., McWilliams, 2004); namely, she views the clinician's humanity as an integral part of the therapeutic enterprise. In this context, McWilliams considered, among other things, the "less specifiable, more artistic elements of the psychotherapy process" (2012, p. 203) with regard to my treatment of three individuals struggling with narcissistic vulnerability.…”

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ABSTRACTThis article is a response to the commentaries of Nancy McWilliams (2012) and Kenneth Levy (2012) concerning my treatment of three patients-Alex, Brian, and Candace-whose presenting difficulties included a narcissistic personality disturbance and who were treated using Mitchell's (1988) integrated treatment model. In addition to responding to particular points raised by McWilliams' more "artistic" and Levy's more "scientific" perspectives, I provide a more personal context and view of my experience in providing therapy to these three patients.

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