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The ongoing rewriting of the therapeutic contract in Metacognitive Interpersonal Therapy for narcissistic personality disorder: The case of Mark
  • Giancarlo Dimaggio,
  • Virginia Valentino
Giancarlo Dimaggio

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Virginia Valentino
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In order to treat persons suffering from narcissistic personality disorder (NPD) it is necessary to agree on therapeutic goals and om tasks to undertake in order to meet them. This is difficult with NPD, as they have difficulties finding meaningful goals to strive for, other than the quest for status. Moreover, in order to change they need to expose themselves to experience painful feelings such as shame, guilt or fear, feelings that they automatically tend to keep at bay. Finally, they have problems forming a benevolent image of their therapists and to harken to it in order to cooperate towards mutually agreed goals and tasks. As a consequence, NPD patients ask for change but hardly engage themselves in the work necessary to achieve it. Therapists therefore need to pay the uttermost attention to drafting, negotiating and continuously updating a reasonable and realistic therapeutic contract. In this paper we describe the story of a man in his thirties with NPD who was ridden with depression, guilt, envy and anger and did not find ways to pursue the healthy and adaptive behaviors he would need to pursue in order to leave a richer social life. The therapist overcame ruptures in the therapeutic alliance and then involved the patient in a process where they set the steps to follow, making sure the patient was convinced they made sense. After a contract was reached progress became possible. Implications for the role of the therapeutic contract in NPD treatment are discussed.
15 Aug 2023Submitted to Journal of Clinical Psychology
16 Aug 2023Submission Checks Completed
16 Aug 2023Assigned to Editor
16 Aug 2023Review(s) Completed, Editorial Evaluation Pending
16 Aug 2023Reviewer(s) Assigned
29 Oct 2023Editorial Decision: Revise Minor
31 Oct 20231st Revision Received
31 Oct 2023Submission Checks Completed
31 Oct 2023Assigned to Editor
31 Oct 2023Review(s) Completed, Editorial Evaluation Pending
01 Nov 2023Editorial Decision: Accept