A mentalizing approach for narcissistic personality disorder: Moving from “me-mode” to “we-mode
Open accessAbstract
Narcissistic personality disorder (NPD) is a prevalent condition that frequently co-occurs with other diagnoses that bring patients into treatment. Narcissistic disturbances are not often the chief complaint, but they complicate the development of an adequate therapeutic alliance. Typical countertransference challenges, combined with stigma related to NPD, result in difficulty for the therapist to relate to these patients empathically. Mentalization-based treatment provides a means for therapists to reach these patients by taking a "not-knowing" stance with interest and curiosity in clarifying and expanding a shared awareness of the patient's emotional experiences. By understanding the attachment functions, mentalizing imbalances, and problems of epistemic disregard among patients with NPD, therapists can break through the self-centered "me-mode" of the therapeutic dyad, where the typical lack of engagement or power struggles prevail, to a "we-mode," where the patient and therapist are joined in attention to what happens in the patient's mind and in interactions with others.
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Individuals with PN struggle to acknowledge and process distressing emotions including shame, humiliation, rage, and envy.
“These individuals struggle to acknowledge and process distressing emotions including shame, humiliation, rage, and envy (128, 132, 146).”
From Psychoanalytically informed MDMA-assisted therapy for pathological narcissism: a novel theoretical approach (2025) · cites this paper as [132]
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References 23 · Cited by 26
- Authors
- Choi-Kain, L. W., Simonsen, S., & Euler, S.
- Affiliations
- Harvard University (US)
- Venue
- American Journal of Psychotherapy
- Published
- 2022-03-23
- Volume
- 75
- Issue
- 1
- Pages
- 38-43
- ISSN
- 0002-9564 (ISSN-L)
- 2575-6559
- OpenAlex
- W4206563734
- Cited by
- 26
- References
- 23
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 4 · 2023: 5 · 2022: 1
- FWCI
- 4.33
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- American Journal of Psychotherapy (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich)
- 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, mentalization-based treatment, therapeutic relationship, countertransference, attachment functions, therapist empathy, stigma, power struggles
- MeSH terms
- Mentalization, Therapeutic Alliance, Countertransference, Emotions, Humans, Personality Disorders
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