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Psychotherapeutic Treatment of Depressive Symptoms in Patients with Narcissistic Disturbances: A Review

Abstract

This review sought to outline the common complicating and facilitating factors during treatment of depressive symptoms in patients with narcissistic pathology, including various specific treatment approaches. A systematic literature search was performed to identify literature describing the co-occurrence of depressive symptoms and narcissistic pathology along with psychotherapeutic considerations and methods used to treat depressive symptoms in such patients. Theory and research suggest that depressive symptoms often co-occur with narcissistic disturbances because depression may emerge when narcissistic defenses fail. Narcissistic disturbances are thought to oscillate between grandiose and vulnerable features, and patients often seek treatment when they are in the vulnerable state. Psychological factors that are frequently dysregulated in these patients are shame, perfectionism and aggression. These factors must therefore be recognized as a part of the narcissistic pathology, and should particularly be considered in order to build a psychotherapeutic alliance with the patient, to avoid premature termination of treatment, and to achieve a positive treatment response. Psychotherapy must primarily target the underlying narcissistic disturbance, and not the depressive symptoms per se. The review aims at outlining treatment approaches that may be useful for clinicians.

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Acknowledgement

The study was partially made possible by funding granted to the first author from the Health Scientific Research Fund of Region Zealand.

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Correspondence to Jane Fjermestad-Noll.

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Fjermestad-Noll, J., Ronningstam, E., Bach, B. et al. Psychotherapeutic Treatment of Depressive Symptoms in Patients with Narcissistic Disturbances: A Review. J Contemp Psychother 50, 21–28 (2020). https://doi.org/10.1007/s10879-019-09437-4

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  • DOI: https://doi.org/10.1007/s10879-019-09437-4

Keywords

  • Narcissistic disturbances
  • Narcissistic pathology
  • Depression
  • Depressive symptoms
  • Psychotherapeutic treatment
  • Therapeutic treatment