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Abstract
The subjective experience of patients suffering from narcissistic personality disorder (NPD) has been studied using various methods. However, there has not been an analysis of psychotherapy session transcripts. It is much more likely that the facets of experience surface in this context than during a single interview or in a self-administered questionnaire. Using the Grid of Problematic States, designed to assess contents emerging in patients’ transcripts, the authors analyzed the first 18 psychotherapy sessions with three female patients suffering from NPD and treated by therapists of the cognitive–constructivist school specializing in personality disorders. The three patients’ dominant states of mind were characterized by anger, feeling excluded from groups, feelings of being harmed, and distrust toward others. The authors discuss the results and their implications for future research and for the definition of NPD in future editions of the Diagnostic and Statistical Manual of Mental Disorders.
Notes
1. The patients’ personal data have been significantly altered to avoid the possibility of their being identified. All three were informed and provided written consent to the use of the data.
2. Carmen's low number of markable constructs should be considered an indirect indicator both of her poor metacognition and of a withdrawal from the therapeutic relationship (Safran & Muran, 2000). Carmen kept her therapist at a distance, made no requests for help, and displayed hostility and detachment (Dimaggio et al., Citation2006, Citation2007). This is a further sign of a limited activation of the care-seeking system.
3. The two states of mind, anger and fear, merge in TP1, probably because the patient has only just started therapy and narrates things in a confused way, as she is under the pressure of her malaise and has not yet created any communicational codes with her therapist.