Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy.
Center for Individual and Couple Therapy, Genoa, Italy.
J Pers Disord. 2020 Mar;34(Suppl):42-62. doi: 10.1521/pedi.2020.34.supp.42.
This study examined clinician emotional responses and therapeutic alliance in psychotherapy with adolescent patients with specific subtypes of narcissistic personality disorder (NPD). A national sample of therapists ( = 58) completed the Therapist Response Questionnaire for Adolescents to identify patterns of clinician response, the Working Alliance Inventory to evaluate the quality of alliance, and the Shedler-Westen Assessment Procedure-II for Adolescents to assess the personality pathology of a patient in their care. The results showed that the grandiose narcissistic subtype was positively related to angry/criticized and disengaged/hopeless therapist responses and negatively related to warm/attuned response. The fragile subtype was positively related to overinvolved/worried therapist response. The high-functioning/exhibitionistic subtype was negatively related to angry/criticized response. Lower quality of therapeutic alliance was positively associated with the grandiose subtype. Moreover, the empirically founded prototypes of therapist responses to adolescent patients with NPD subtypes strongly resemble theoretical-clinical accounts. The clinical implications are addressed.
本研究考察了心理治疗师在治疗具有特定自恋型人格障碍（NPD）亚型的青少年患者时的情绪反应和治疗联盟。一个全国性的治疗师样本（n=58）完成了青少年治疗师反应问卷，以确定治疗师反应模式；工作联盟量表，以评估联盟的质量；和谢德勒-韦斯顿评估程序-II 评估患者的人格病理学。结果表明，浮夸自恋亚型与愤怒/批评和脱钩/绝望的治疗师反应呈正相关，与温暖/协调的反应呈负相关。脆弱亚型与过度卷入/担忧的治疗师反应呈正相关。高功能/表现型亚型与愤怒/批评反应呈负相关。治疗联盟质量较低与浮夸亚型呈正相关。此外，对具有 NPD 亚型的青少年患者的治疗师反应的实证基础原型与理论临床描述非常相似。探讨了临床意义。
