Gunderson Personality Disorders Institute, McLean Hospital, Belmont, Massachusetts, (Choi-Kain); Department of Psychiatry, Harvard Medical School, Boston (Choi-Kain); Stolpegaard Psychotherapy Center, Mental Health Services, Capital Region, Gentofte, Denmark (Simonsen); University Psychiatric Clinics Basel, Basel, Switzerland (Euler).
Am J Psychother. 2022 Jan 1;75(1):38-43. doi: 10.1176/appi.psychotherapy.20210017. Epub 2022 Jan 12.
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.
自恋型人格障碍（NPD）是一种普遍存在的病症，常与其他诊断同时发生，这些诊断使患者需要接受治疗。自恋障碍通常不是主要诉求，但它们会使建立充分的治疗联盟变得复杂。典型的反移情挑战，加上与 NPD 相关的污名，导致治疗师难以对这些患者产生共情。基于心理化的治疗为治疗师提供了一种方法，可以通过采取“不知道”的立场，对澄清和扩展患者情感体验的共同意识表现出兴趣和好奇心，从而接触到这些患者。通过了解 NPD 患者的依恋功能、心理化失衡以及知识忽视问题，治疗师可以打破治疗性对偶的以自我为中心的“我模式”，在这种模式中，典型的缺乏参与或权力斗争占主导地位，进入“我们模式”，在这种模式中，患者和治疗师共同关注患者思维中的发生的事情以及与他人的互动。
