The Management of Narcissistic Vulnerability: Three Case Studies Guided by Stephen Mitchell's Integrated Treatment Model

Abstract

The psychological literature pertaining to the treatment of the patient with a narcissistic personality disturbance is dominated by the divergent theories of Otto Kernberg and Heinz Kohut.  In this context, Stephen Mitchell’s theory of narcissistic illusion, which integrates Kernberg’s view of narcissism as a defensive phenomenon and Kohut’s view of narcissism as a growth-enhancing opportunity, is first reviewed. The current study then seeks to assess, through the application of Mitchell’s integrated treatment model to three long-term psychotherapy cases, the efficacy of Mitchell’s model. Efficacy is assessed through (a) a comparison of pre-treatment and post-treatment scores on two standardized, self-report measures, Raskin and Terry's Narcissistic Personality Inventory and the Millon Clinical Multiaxial Inventory-III; (b) DSM diagnostic appraisals before and after therapy; and (c) behavioral comparisons indicating initial psychopathology versus improvement over the course of therapy. In interpreting the findings of the case studies, I argue that the goal of treatment of patients with a narcissistic personality disturbance is to help them (a) acknowledge their narcissistic orientation, and (b) ultimately understand the function of their narcissistic illusion. I conclude that Mitchell’s theory successfully guides the clinician to such an outcome. The strengths and limitations of Mitchell’s model are critically reviewed.  Finally, adjunctive interventions to aid the clinician in the management of the patient’s ongoing narcissistic vulnerability are proposed.