Clinicians emotional response toward narcissistic patients: An empirical investigation

Objectives: Patients with narcissistic personality disorder (NPD) are among the most difficult to treat in psychotherapy, especially due to their strong resistance to treatment and other difficulties in establishing a therapeutic relationship characterized by intimacy, safety, and trust. Moreover, therapists’ emotional responses to these patients can be particularly intense and frustrating, as often reported in the clinical literature; however, they have rarely been investigated empirically. The aims of this study are 1) to examine the specific associations between patients diagnosed as NPD and therapists’ emotional response patterns; 2) to verify whether clinicians’ reactions were influenced by their theoretical orientation, as well as other variables (as gender, age, experience, ecc.); and 3) to provide an empirically derived portrait of clinicians’ emotional responses with NPD patients. Method: A national sample of psychiatrists and clinical psychologists (N = 70) completed the Therapist Response Questionnaire (TRQ) to identify patterns of therapist emotional response, and the Shedler-Westen Assessment Procedure-200 (SWAP-200) to assess personality disorder and level of psychological functioning in patients currently in their care. Results: Results show that NPD is positively associated with hostile/angry, criticized/devalued and disengaged therapist emotional responses, and negatively associated with positive response. Moreover, the relationship between patients’ NPD and therapists’ emotional responses is not dependent on clinicians’ theoretical approach and other variables. Finally, the portrait of therapist emotional responses with NPD patients provide a clinically nuanced and empirically founded description that strongly resembles theoretical and clinical accounts. Conclusions: Therapists’ recognition of their emotional responses to NPD patients can be crucial for better understanding the core psychopathological dynamics of these patients, as well as implementing effective and patient-tailored therapeutic interventions in clinical practice.