Vulnerable narcissism as beneficial factor for the therapeutic alliance in borderline personality disorder

Abstract

Evidence suggests that narcissism and borderline personality disorder are associated with each other. This naturalistic study investigated the predictive value of grandiose and vulnerable narcissism on the development of the therapeutic alliance in short‐term psychodynamic treatment across 12 weeks. The sample consisted of 99 patients with borderline personality disorder. Narcissism was assessed with the Pathological Narcissism Inventory at treatment onset. The therapeutic alliance was rated with the Scale to Assess Therapeutic Relationships by both patient and therapist at four time points during treatment. Results showed a significant predictive value of vulnerable narcissism on the therapeutic alliance, revealing a more beneficial progression for patients with higher vulnerable narcissism. Grandiose narcissism had no predictive value on the therapeutic alliance. The study strengthens the clinical utility of the concept of vulnerable narcissism towards the evaluation of treatment processes in borderline personality disorder.

The peaks and valleys of narcissism: The factor structure of narcissistic states and their relations to trait measures.

“…Such an image may explain the clinical claim that narcissistic individuals in grandiose states do not usually seek help (E. F. Ronningstam, 2005) and the reasons why building and maintaining a therapeutic alliance with them is challenging (E. Ronningstam, 2012). In fact, clinical observations (E. F. Ronningstam, 2005) and empirical evidence (Ellison et al, 2013) suggest that narcissistic individuals are not only more prone to seeking help but also to displaying affection and sympathy toward the therapist and building a therapeutic alliance (Busmann et al, 2021;Kealy et al, 2017;E. Ronningstam, 2012) when they are in vulnerable states, as in such states narcissistic individuals experience discomforting feelings and subjective psychological distress .…”

“…In fact, clinical observations (E. F. Ronningstam, 2005) and empirical evidence (Ellison et al, 2013) suggest that narcissistic individuals are not only more prone to seeking help but also to displaying affection and sympathy toward the therapist and building a therapeutic alliance (Busmann et al, 2021; Kealy et al, 2017; E. Ronningstam, 2012) when they are in vulnerable states, as in such states narcissistic individuals experience discomforting feelings and subjective psychological distress (Pincus & Lukowitsky, 2010).…”

Mentalizing Mediates the Association between Narcissism and Psychotherapeutic Treatment Outcome in a Mixed Clinical Sample

“…For instance, the grandiose features of pathological narcissism were associated with less treatment utilization and premature termination [16, 21-23]. In contrast, narcissistic vulnerability had a positive impact on the development of the therapeutic alliance in patients with borderline personality disorder [24]. Further studies revealed that pathological narcissism was associated with aversive countertransference reactions and a less positive therapist response [20, 25, 26].…”

Aliança de trabalho em aconselhamento de carreira: Fatores dos/as psicólogos/as e clientes

“…A investigação também tem identificado fatores dos/as clientes relacionados com a qualidade da aliança de trabalho: características da personalidade (Vasco, Silva, & Chambel, 2001), como a extroversão e amabilidade, conscienciosidade (Covali et al, 2011), vulnerabilidade narcísica (Busmann et al, 2021), distress (e.g., Milot-Lapointe et al, 2020;Zilcha-Mano et al, 2018) e baixa escolaridade. Por sua vez, variáveis do cliente relativas ao comportamento vocacional, como a maturidade vocacional e a indecisão vocacional, têm emergido como preditores da aliança de trabalho (e.g., Cattani et al, 2016;Covali et al, 2011;Whiston et al, 2016).…”