TY - JOUR

T1 - Psychotherapeutic Treatment of Depressive Symptoms in Patients with Narcissistic Disturbances

T2 - A Review

AU - Fjermestad-Noll, Jane

AU - Ronningstam, Elsa

AU - Bach, Bo

AU - Storebø, Ole Jacob

AU - Rosenbaum, Bent

AU - Simonsen, Erik

PY - 2020

Y1 - 2020

N2 - This review sought to outline the common complicating and facilitating factors during treatment of depressive symptoms in patients with narcissistic pathology, including various specific treatment approaches. A systematic literature search was performed to identify literature describing the co-occurrence of depressive symptoms and narcissistic pathology along with psychotherapeutic considerations and methods used to treat depressive symptoms in such patients. Theory and research suggest that depressive symptoms often co-occur with narcissistic disturbances because depression may emerge when narcissistic defenses fail. Narcissistic disturbances are thought to oscillate between grandiose and vulnerable features, and patients often seek treatment when they are in the vulnerable state. Psychological factors that are frequently dysregulated in these patients are shame, perfectionism and aggression. These factors must therefore be recognized as a part of the narcissistic pathology, and should particularly be considered in order to build a psychotherapeutic alliance with the patient, to avoid premature termination of treatment, and to achieve a positive treatment response. Psychotherapy must primarily target the underlying narcissistic disturbance, and not the depressive symptoms per se. The review aims at outlining treatment approaches that may be useful for clinicians.

AB - This review sought to outline the common complicating and facilitating factors during treatment of depressive symptoms in patients with narcissistic pathology, including various specific treatment approaches. A systematic literature search was performed to identify literature describing the co-occurrence of depressive symptoms and narcissistic pathology along with psychotherapeutic considerations and methods used to treat depressive symptoms in such patients. Theory and research suggest that depressive symptoms often co-occur with narcissistic disturbances because depression may emerge when narcissistic defenses fail. Narcissistic disturbances are thought to oscillate between grandiose and vulnerable features, and patients often seek treatment when they are in the vulnerable state. Psychological factors that are frequently dysregulated in these patients are shame, perfectionism and aggression. These factors must therefore be recognized as a part of the narcissistic pathology, and should particularly be considered in order to build a psychotherapeutic alliance with the patient, to avoid premature termination of treatment, and to achieve a positive treatment response. Psychotherapy must primarily target the underlying narcissistic disturbance, and not the depressive symptoms per se. The review aims at outlining treatment approaches that may be useful for clinicians.

KW - Depression

KW - Depressive symptoms

KW - Narcissistic disturbances

KW - Narcissistic pathology

KW - Psychotherapeutic treatment

KW - Therapeutic treatment

U2 - 10.1007/s10879-019-09437-4

DO - 10.1007/s10879-019-09437-4

M3 - Review

AN - SCOPUS:85068863462

VL - 50

SP - 21

EP - 28

JO - Journal of Contemporary Psychotherapy

JF - Journal of Contemporary Psychotherapy

SN - 0022-0116

ER -