Therapist responses and therapeutic alliance in the psychotherapy of adolescent patients with narcissistic personality disorder: An empirical investigation
Aim: Although the clinical literature on countertransference reactions and
therapeutic alliance with adolescent patients with personality pathology is quite
extensive, the corresponding empirical literature is limited. This study examined
these relational variables in psychotherapy with adolescent patients with three
subtypes of the narcissistic personality disorder (NPD). Methods: Fifty-eight
clinicians completed the Psychodiagnostic Chart–Adolescent (PDC-A) of the
Psychodynamic Diagnostic Manual (PDM-2), the Shedler-Westen Assessment
Procedure-II for Adolescents (SWAP-II-A), the Therapist Response
Questionnaire for Adolescents (TRQ-A), and the Working Alliance Inventory
(WAI), to provide a comprehensive diagnostic assessment of adolescent
patients in their care as well as to evaluate countertransference patterns and
quality of alliance in their treatment. Results: The grandiose narcissistic subtype
was negatively associated with warm/attuned therapist response and positively
associated with angry/criticized and disengaged/hopeless responses. The fragile
subtype was positively associated with overinvolved/worried response. The
high-functioning/exhibitionistic subtype was negatively associated with
angry/criticized response. Moreover, the grandiose subtype was positively
related to lower quality of therapeutic alliance, that was negatively related to the
high-functioning/exhibitionistic subtypes. No significant association was found
between therapeutic alliance and the fragile subtype. Moreover, the empirically
founded prototypes of therapist responses to adolescent patients with NPD
subtypes strongly resembles theoretical-clinical accounts. Discussion: This
study provides a nuanced view of countertransference reactions evoked by
adolescent patients with specific NPD subtypes, and extends knowledge on
therapeutic alliance in their treatment. Therapists could use the information
derived from the therapeutic relationship to generate clinically meaningful
diagnosis of adolescent patients and promote therapies tailored on their core
psychological features