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The definition of narcissism can be a moving target. Is it an excess of self-love? Profound insecurity? Low self-esteem? Too much self-esteem? Because of the multifaceted nature of narcissistic personality disorder (NPD), treating this disorder presents clinicians with a range of wholly unique challenges.
Narcissism and Its Discontents recognizes the variable nature of NPD and provides a template for adjusting treatment to the patient rather than shoehorning the patient into a manualized treatment that may prove to be less effectual.
This guide offers clinicians strategies, including transference and countertransference, to deal with the complex situations that often arise when treating narcissistic patients, among them, patient entitlement, disengagement, and envy. The authors provide a skillful integration of research and psychoanalytic theory while also addressing psychotherapeutic strategies that are less intensive but also useful—being cognizant of the fact that a majority of patients do not have access to psychoanalysis proper.
A chapter on the cultural aspects of narcissism addresses the recent societal fascination with NPD in the discourse on politics and celebrity, particularly in the age of social media. Regardless of the treatment setting—psychoanalysis, psychotherapy, pharmacotherapy, partial hospital, or inpatient—clinicians will find a wealth of approaches to treating a diverse and challenging patient population in Narcissism and Its Discontents.
NPD is a difficult entity to diagnose and treat. Even defining narcissism can be a daunting task, given its many "faces," its continuity with healthy self-interest and confidence, and its changing nature both throughout development and in the same patient faced with different environmental stressors. Thus, the authors' ability to cover all these topics and to create a multifaceted image of a narcissistic patient in only 150 pages is truly impressive. Most importantly, the book teaches how to think about NPD conceptually, taking into account each patient's unique character traits and circumstances. With that said, it would be impossible to cover everything related to NPD in a short book, and interested readers may want to look elsewhere to deepen their understanding of the topics this book covers. The authors provide plentiful references to encourage further exploration. It is important to note that, however broad, the focus is still primarily on psychoanalytically-oriented theories. While the role of other treatment modalities, such as group and couple therapies, is briefly discussed, other therapeutic techniques, including CBT and DBT, appear to be beyond the scope of this book. However, this is a comprehensive overview of NPD from multiple vantage points that is short, easy to read, and full of memorable examples that most clinicians can relate to.
— Marina Bayeva, M.D., Ph.D.
Glen O. Gabbard, M.D., is Clinical Professor of Psychiatry at Baylor College of Medicine in Houston, Texas. He is also Training and Supervising Analyst at the Center for Psychoanalytic Studies in Houston. He is in the full-time private practice of psychiatry, psychoanalysis, and psychotherapy.
Holly Crisp, M.D., is Clinical Associate Professor at Baylor College of Medicine in Houston, Texas. She is on the faculty at the Center for Psychoanalytic Studies in Houston. She is in the full-time private practice of psychiatry, psychoanalysis, and psychotherapy.
About the Authors
Preface
Part I: Diagnostic Dilemmas
Chapter 1. Narcissism and Its Discontents
Chapter 2. The Cultural Context of Narcissism
Chapter 3. Modes of Relatedness
Part II: Treatment Strategies
Chapter 4. Beginning the Treatment
Chapter 5. Transference and Countertransference
Chapter 6. Tailoring the Treatment to the Patient
Chapter 7. Specific Treatment Strategies
Chapter 8. Termination
Index