Object Relations-Focused Psychoanalytic Psychotherapy in the Treatment of Narcissistic Personality Disorder

Abstract

The current study examines the psychotherapeutic treatment of an early-20s Caucasian male diagnosed with narcissistic personality disorder. The patient was treated with 56 sessions of psychoanalytic psychotherapy utilizing an object relations approach. Treatment aimed at decreasing the patient’s anger, anxiety, depression, and improving emotion regulation. Another focus of this patient’s treatment was helping him gain insight into the nature of his unconscious predictions and interpretations of others’ behavior in the hope that he may begin to experience relationships with greater emotional connection and less conflict. Treatment outcomes were measured using Reliable Change Index analyses, which indicated a significant reduction in anxiety, depression, anger, and emotion regulation difficulty between the beginning of treatment and the most recent session. The patient also demonstrated increased mentalization abilities and fewer anger outbursts throughout the course of treatment. During the sessions surrounding a therapeutic rupture, the patient’s emotion regulation abilities worsened temporarily; therapy shifted during this time to a more supportive analytic framework. An object relations-focused theoretical background and clinical treatment implications are discussed in relation to this case.