TREATING NARCISSISTIC PERSONALITY DISORDER WITH SCHEMA THERAPY – A CASE STUDY
TREATING NARCISSISTIC PERSONALITY DISORDER WITH SCHEMA THERAPY – A CASE STUDY

Summary/Abstract: Objectives. This case study endeavors to provide an in-depth understanding of the schema and mode structure of narcissistic personality disorder (NPD) and to illustrate a possible therapeutic approach using schema therapy (ST). Material and methods. The recorded material from a 2-year therapeutic journey of a 38-year-old female client diagnosed with NPD was transcribed and systematically analyzed, together with the results of questionnaires that were given to the client at the start of therapy and at the end of the process. Results. The Millon Clinical Multiaxial Inventory (MCMI-III) was initially used to confirm the presence of NPD in the client. Concurrently, the Young Schema Questionnaire (YSQ) and Schema Mode Inventory (SMI) were employed to measure changes across the course of treatment. The MCMI-III confirmed the existence of NPD. The YSQ revealed a high presence of schemas in the domains of disconnection and rejection, as well as schemas of subjugation, entitlement, and approval seeking. The SMI indicated elevated scores on Vulnerable and Angry Child Modes, Detached Self-Soother and Self-Aggrandizer, Punitive and Demanding Parent. The scores for Happy Child and Healthy Adult were medium. Upon completion of therapy, a reevaluation of the questionnaire’s scores demonstrated a reduction in narcissism on MCMI-III from 89 to 78, indicating that the client no longer met the criteria for NPD but only for narcissistic personality traits. The scores for YSQ and SMI also decreased significantly. Conclusions. The use of schema therapy was an adaptive and successful approach to addressing the narcissistic personality pathology of the client. The utilization of a limited reparenting stance allowed empathic confrontation of the main narcissistic modes. The utilization of mode conceptualization and schema understanding reduced feelings of shame and promoted participation of the client’s Healthy Adult Mode in the therapeutic process.

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