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Cited by 78Personality Disorders and PsychopathologyPsychoanalysis and Psychopathology ResearchPsychotherapy Techniques and Applications

Countertransference when working with narcissistic personality disorder: An empirical investigation.

Tanzilli, Annalisa, Muzi, Laura, Ronningstam, Elsa, Lingiardi, Vittorio·2017·Psychotherapy
DOI 10.1037/pst0000111
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Abstract

Narcissistic personality disorder (NPD) is one of the most challenging clinical syndromes to treat in psychotherapy, especially due to the difficulties of establishing a good enough therapist-patient relationship. Countertransference responses to NPD can be particularly intense, frustrating, and difficult to manage, as is often reported in the clinical literature though not clearly supported empirically. The aims of this study were to (a) investigate the relationship between patients' NPD and therapists' responses; (b) examine the associations between patient, clinician, therapy variables and clinicians' reactions during treatment of NPD patients; and (c) provide an empirically derived portrait of countertransference with NPD. A sample of psychiatrists and clinical psychologists (N = 67) completed the Therapist Response Questionnaire to identify patterns of countertransference, the Shedler-Westen Assessment Procedure-200, and the Global Assessment of Functioning Scale to assess the personality pathology and psychosocial functioning of a patient in their care. The results showed that NPD was positively associated with hostile/angry, criticized/devalued, helpless/inadequate, and disengaged countertransference and negatively associated with therapists' positive response, regardless of patients' personality and psychosocial functioning. NPD patients with stronger traits of cluster B personality pathology tended to elicit more negative and heterogeneous countertransference reactions than NPD patients without these features. The countertransference patterns with NPD patients were not strongly influenced by the variables of clinicians and therapy, with the exception of clinical experience. Overall, the portrait of therapists' reactions to NPD provided a clinically nuanced and empirically founded description strongly resembling theoretical-clinical accounts. The therapeutic implications of these findings were discussed. (PsycINFO Database Record

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  • Patients diagnosed with narcissistic personality disorder tend to provoke powerful feelings in their therapist.

    “Patients diagnosed with NPD tend to provoke powerful feelings in their therapist (94)”

    From Narcissistic Personality Disorder: Progress in Understanding and Treatment (2022) · cites this paper as [94]

  • Individuals with pathological narcissism are known to evoke strong, negative reactions from those with whom they are in a relationship.

    “Individuals with pathological narcissism are known to evoke strong, negative, reactions from those with whom they are in a relationship (Tanzilli et al., 2017).”

    From Pathological narcissism: An analysis of interpersonal dysfunction within intimate relationships (2022) · cites this paper as Tanzilli et al., 2017

  • Treatment for individuals with narcissistic personalities can inspire intense countertransference responses in clinicians and often result in stigmatisation.

    “Third, treatment for individuals with narcissistic personalities can inspire intense countertransference responses in clinicians [80] and often result in stigmatisation [81].”

    From Living with pathological narcissism: a qualitative study (2020) · cites this paper as [80]

  • Therapists frequently report hostile, criticized, and helpless countertransference reactions when working with NPD patients, often feeling devalued, disconnected, or ineffective.

    “Therapists frequently report experiencing hostile, criticized, and helpless countertransference reactions when working with NPD patients, often feeling devalued, disconnected, or ineffective in treatment (71, 186).”

    From Psychoanalytically informed MDMA-assisted therapy for pathological narcissism: a novel theoretical approach (2025) · cites this paper as [186]

  • Countertransference reactions are prevalent regardless of theoretical orientation.

    “Countertransference reactions are prevalent regardless of theoretical orientation (186).”

    From Psychoanalytically informed MDMA-assisted therapy for pathological narcissism: a novel theoretical approach (2025) · cites this paper as [186]

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Authors
Tanzilli, A., Muzi, L., Ronningstam, E., & Lingiardi, V.
Affiliations
  • Sapienza University of Rome (IT)
  • Harvard University (US)
ORCID
Venue
Psychotherapy
Publisher
American Psychological Association (APA)
Published
2017-06
Volume
54
Issue
2
Pages
184-194
ISSN
  • 0033-3204 (ISSN-L)
  • 1939-1536
DOI
10.1037/pst0000111
OpenAlex
W2624603322
Cited by
73
References
67
Citations by year
2026: 5 · 2025: 9 · 2024: 7 · 2023: 10 · 2022: 10 · 2021: 10 · 2020: 10 · 2019: 5 · 2018: 5 · 2017: 2
FWCI
7.46
Type
journal article
Language
en
Open access
closed
Locations
  • Psychotherapy (publishedVersion)
  • PubMed (publishedVersion)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
narcissistic personality disorder, countertransference, therapist reactions, therapeutic relationship, clinical experience, personality pathology, psychosocial functioning
MeSH terms
Adolescent, Adult, Countertransference, Female, Humans, Male, Middle Aged, Personality Disorders, Professional-Patient Relations, Psychometrics, Psychotherapy, Surveys and Questionnaires, Young Adult

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