Principles of psychodynamic treatment for patients with narcissistic personality disorder

Abstract

Narcissistic personality disorder is a pleomorphic entity that requires the psychodynamically oriented therapist to tailor the approach to the characteristics of the individual patient. Psychodynamic principles encompass a broad range of interventions depending on the patient’s specific characteris-tics. The therapist’s interventions range from interpretation of the transference to supportive approaches that emphasize empathic validation and di-rect advice. In the absence of systematic data on these variations, this article attempts to offer clinically based principles. Several themes are emphasized: the experience of shame, the predictable transference–countertransference developments, the role of comorbidity with other personality disorders and traits, and the approach to resistances.