Treatment Principles for Pathological Narcissism and Narcissistic Personality Disorder

Pathological Narcissism (PN) is a challenge to clinicians, who have difficulties dealing with clients relationally and forming and agreeing on a therapy contract. PN sufferers easily fuel relational conflict or withdraw from relationships. In spite of its severity and prevalence, there is no empirically supported treatment for this condition. Given this, integrative therapists need to be offered a series of principles of good clinical practice, that they can adopt irrespective of their preferred orientation. This article focuses on 5 domains of PN, that is: (a) maladaptive self-other schemas, (b) poor self-reflection and intellectualizing, (c) disturbed agency, (d) maladaptive coping and defenses, and (e) poor theory of mind and empathy. With this background, I offer specific treatment suggestions that can be applied in an integrative spirit and are formulated in a way that lends them to empirical investigation. With this and other recent efforts, the hope is to increase clinicians' and researchers' awareness of how PN can be treated and possibly increase the amount of empirical studies aimed at showing what principles of change are actually effective. Pathological Narcissism and narcissistic personality disorder are prevalent and present with significant comorbidity and create problems to self and others, but there is no empirically supported treatment to date for these conditions. This article presents treatment suggestions that may pave the way for addressing them and paving the way for empirical studies.