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Cited by 10Psychoanalysis and Psychopathology ResearchPersonality Disorders and PsychopathologyPersonality Traits and Psychology

The Management of Narcissistic Vulnerability: Three Case Studies Guided by Stephen Mitchell's Integrated Treatment Model

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Riordan, Robert W.·2012·Pragmatic Case Studies in Psychotherapy
DOI 10.14713/pcsp.v8i3.1771
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Abstract

The psychological literature pertaining to the treatment of the patient with a narcissistic personality disturbance is dominated by the divergent theories of Otto Kernberg and Heinz Kohut. In this context, Stephen Mitchell’s theory of narcissistic illusion, which integrates Kernberg’s view of narcissism as a defensive phenomenon and Kohut’s view of narcissism as a growth-enhancing opportunity, is first reviewed. The current study then seeks to assess, through the application of Mitchell’s integrated treatment model to three long-term psychotherapy cases, the efficacy of Mitchell’s model. Efficacy is assessed through (a) a comparison of pre-treatment and post-treatment scores on two standardized, self-report measures, Raskin and Terry's Narcissistic Personality Inventory and the Millon Clinical Multiaxial Inventory-III; (b) DSM diagnostic appraisals before and after therapy; and (c) behavioral comparisons indicating initial psychopathology versus improvement over the course of therapy. In interpreting the findings of the case studies, I argue that the goal of treatment of patients with a narcissistic personality disturbance is to help them (a) acknowledge their narcissistic orientation, and (b) ultimately understand the function of their narcissistic illusion. I conclude that Mitchell’s theory successfully guides the clinician to such an outcome. The strengths and limitations of Mitchell’s model are critically reviewed. Finally, adjunctive interventions to aid the clinician in the management of the patient’s ongoing narcissistic vulnerability are proposed.

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  • A few pre-post studies have documented clinically significant change, including symptom reduction and improved functioning, among patients with narcissistic personality disorder.

    “A few pre-post studies have documented clinically significant change, including symptom reduction and improved functioning among patients (95–97) (Weinberg et al., 2019, unpublished manuscript)”

    From Narcissistic Personality Disorder: Progress in Understanding and Treatment (2022) · cites this paper as [96]

    The Conclusion and Qualitative Behavioral Outcome Measures report symptom relief and improvements in relationships and daily functioning after treatment. But the paper describes the changes as modest, and its DSM Indicators section says both patients who initially met criteria for narcissistic personality disorder still met those criteria at the end of treatment. It reports statistically significant overall progress, not clinically significant change as claimed (pp. 150–203; passage page numbers unavailable). (LLM, conf=0.85)

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Research works printed but not linked: 6

  1. Ehrenberg, M.F. (1991). Shared parenting agreements after marital separation: The role of narcissism and child-centeredness. Unpublished doctoral dissertation.
  2. Holmes, J. (2001). Ideas in psychoanalysis: Narcissism. Cambridge, UK: Icon Books Ltd.
  3. Kohut, H. (1984). How does analysis cure? Chicago: University of Chicago Press. Guided By Stephen Mitchell's Integrated Treatment Model R.W. Riordan Pragmatic Case Studies in Psychotherapy, http://pcsp.libraries.rutgers.edu Volume 8, Module 3, Article 1, pp. 150-203, 09-30-12
  4. Messer, S. B. & Warren C. S. (1995). Models of brief psychodynamic therapy: A comparative approach. New York: The Guilford Press.
  5. Riordan, R.W. (2011). The management of narcissistic vulnerability: Three cases studies guided by Stephen Mitchell's integrated treatment model Combining expressive writing with an affect- Guided By Stephen Mitchell's Integrated Treatment Model R.W. Riordan Pragmatic Case Studies in Psychotherapy, http://pcsp.libraries.rutgers.edu Volume 8, Module 3, Article 1, pp. 150-203, 09-30-12 [copyright by author] and attachment-focused psychotherapeutic approach in the treatment of a single-incident trauma survivor. Unpublished doctoral dissertation, Rutgers University, Piscataway, NJ.
  6. Siegel, S. (1956). Nonparametric statistics for the social sciences. New York: McGraw-Hill.

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Authors
Riordan, R. W.
Affiliations
Rutgers, The State University of New Jersey (US)
Corresponding author
Riordan, Robert W.
Venue
Pragmatic Case Studies in Psychotherapy
Publisher
National Register of Health Service Psychologists
Published
2012-10-04
Volume
8
Issue
3
Pages
150-203
ISSN
1553-0124 (ISSN-L)
DOI
10.14713/pcsp.v8i3.1771
OpenAlex
W2077671010
Cited by
10
References
55
Citations by year
2024: 1 · 2023: 1 · 2022: 2 · 2018: 2 · 2015: 1 · 2012: 3
FWCI
1.45
Type
journal article
Language
en
Open access
Licence
cc-by-nc-sa
Locations
  • Pragmatic Case Studies in Psychotherapy (publishedVersion, cc-by-nc-sa)
  • Rutgers University Community Repository (Rutgers University) (submittedVersion)
  • Rutgers University Community Repository (Rutgers University)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
Keywords
narcissistic personality disorder, Stephen Mitchell, integrated treatment model, narcissistic vulnerability, Otto Kernberg, Heinz Kohut, long-term psychotherapy, treatment efficacy, Narcissistic Personality Inventory, MCMI-III, adjunctive intervention

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