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Quaderni di Psicoterapia Cognitiva - Open Access

Clinical cases

No. 51 (2022)

Assessing and treating guilt in narcissism personality disorder with Metacognitive Interpersonal Therapy

DOI
https://doi.org/10.3280/qpc51-2022oa15185
Submitted
gennaio 9, 2023
Published
2023-01-18

Abstract

Patients with pathological narcissism experience guilt and implement specific coping strategies to manage emotion. The strategies most commonly found in functioning in narcissistic personality disorder are atonement, externalization of anger on others and the renunciation of pursuing one’s own desires, supported by the blocking of action. In this paper, we first describe the different types of guilt, in particular deontological and altruistic and then, under the lenses of Metacognitive Interpersonal Therapy, we describe the interactions between guilt, narcissistic functioning and interpersonal maladaptive schemas. These schemas guide patients from negative, rigid and embodied representations of himself and others. We provide the description of a clinical case of a man with narcissistic personality disorder (NPD and show how assessing the role of guilt in his functioning helped reducing guilt and how this was beneficial in treating narcissism.

References

  1. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Washington DC: American Psychiatric Publishing. DOI: 10.1176/appi.books.9780890425596.
  2. Baldwin, M.W. (1992). Relational schemas and the processing of social information. Psychological bulletin, 112(3): 461. DOI: 10.1037/0033-2909.112.3.461.
  3. Bush, M. (1989). The role of incounscious guilt in psichopatology and psychotherapy. Bulletin of the Menninger Clinic, 53(2): 97-107.
  4. Bushman, B.J. & Baumeister, R.F. (2002). Threatened egotism, narcissism, self-esteem and direct and displaced aggression. Do self-love or self-hate lead to violence? Journal of Personality and Social Psychology, 75(1): 219-29. DOI: 10.1037/e552692012-026.
  5. Castelfranchi, C. (1994). Colpevol-mente: alcuni punti (interrogativi) sui sensi di colpa. In C. Castelfranchi, R. D’amico & I. Poggi (a cura di), Sensi di colpa. Firenze: Giunti.
  6. Crits-Christoph, P. & Luborsky, L. (1990). Understanding transference: The CCRT method. New York: Basic Books.
  7. Dimaggio, G. (2016). L’illusione del narcisista: La malattia della grande vita. Milano: Baldini & Castoldi.
  8. Dimaggio, G. (2021). Treatment principles for pathological narcissism and narcissistic personality disorder. Journal of Psychotherapy Integration 32(4): 408-425. DOI: 10.1037/int0000263.
  9. Dimaggio, G. & Semerari, A. (eds.). (2003). I disturbi di personalità: modelli e trattamento: stati mentali, metarappresentazione, cicli interpersonali. Roma-Bari: Laterza.
  10. Dimaggio, G., Montano, A., Popolo, R. & Salvatore, G. (2013). Terapia metacognitiva interpersonale. Milano: Raffaello Cortina.
  11. Dimaggio, G., Ottavi, P., Popolo, R. & Salvatore, G. (2019). Corpo, immaginazione e cambiamento. Milano: Raffaello Cortina.
  12. Gazzillo, F. (2018). Il senso di colpa: tra valutazione delle proprie azioni e valutazioni della propria natura. Giornale italiano di psicologia, 45(3): 555-560. DOI: 10.1421/92808.
  13. Gazzillo, F. (2021). Fidarsi dei pazienti: introduzione alla Control Mastery Theory. Nuova edizione. Milano: Raffaello Cortina.
  14. Hewitt, P.L., Flett, G.L., Mikail, S.F. (2020). Perfezionismo. Un approccio relazionale alla comprensione, valutazione e al trattamento. Roma: Fioriti.
  15. Kohut, H. (1971). Narcisismo e analisi del sé. Torino: Bollati Boringhieri, 1976.
  16. Kohut, H. (1977). La guarigione del sé. Torino: Bollati Boringhieri, 1980.
  17. Leonardi, J., Fimiani, R., Faccini, F., Gorman, B.S., Bush, M. & Gazzillo, F. (2020). An Empirical Investigation into Pathological Worry and Rumination: Guilt, Shame, Depression, and Anxiety. Psychology Hub, 37(3): 31-42. DOI: 10.13133/2724-2943/17229.
  18. Liotti, G.& Monticelli, F. (2008). I sistemi motivazionali nel dialogo clinico. Il manuale AIMIT. Milano: Raffaello Cortina.
  19. Mancini, F. (1997). Il senso di colpa: un’analisi cognitiva. Psicoterapia, 9: 31-46.
  20. Mancini, F. (2008). I sensi di colpa altruistico e deontologico. Cognitivismo clinico, 5(2): 123-144.
  21. Mancini, F. & Gangemi, A. (2018). Senso di colpa deontologico e senso di colpa altruistico: una tesi dualista. Giornale italiano di psicologia, 45(3): 483-510. DOI: 10.1421/92800.
  22. Mancioppi, S., Dimaggio, G., Petrilli, D. & Fiore, D. (2004). Il senso di colpa nel disturbo narcisistico di personalità. Psicobiettivo: rivista quadrimestrale di psicoterapie a confronto, 3: 95-113.
  23. Modell, A.H. (1965). Sul diritto a una vita. In A.H. Modell (1984). Psicoanalisi in un nuovo contesto. Milano: Raffaello Cortina, 1992.
  24. Modell, A.H. (1984). Psicoanalisi in un nuovo contesto. Milano: Raffaello Cortina.
  25. Ronningstam, E. (2017). Intersect between self-esteem and emotion regulation in narcissistic personality disorder-implications for alliance building and treatment. Borderline personality disorder and emotion dysregulation, 4(1): 1-13. DOI: 10.1186/s40479-017-0054-8.
  26. Sampson, H. (1983). Pathogenetic beliefs and unconscious guilt in the therapeutic process: clinical observation and research evidence. In Symposium on Narcissism, Masochism, and the Sense of Guilt in Relation to the Therapeutic Process. Letterman General Hospital, San Francisco.
  27. Thomaes, S., Bushman, B.J., Orobio de Castro, B., Cohen, G.L. & Denissen, J.J.A. (2010). Reducing narcissistic aggression by buttressing self-esteem. Psychological Science 20(12): 1536-1542. DOI: 10.1111%2Fj.1467-9280.2009.02478.x.
  28. Weinberg, I. & Ronningstam, E. (2020). Dos and don’ts in treatments of patients with narcissistic personality disorder. Journal of personality disorders, 34(Supplement): 122-142. DOI: 10.1521/pedi.2020.34.supp.122.
  29. Weiss, J. (1983). Notes on unconscious guilt, pathogenic beliefs, and the treatment process. Bulletin #6. The psychotherapy research, Group Department of Psychiatry, Mount Zion Hospital and Medical Center.
  30. Weiss J. (1986). Unconscious guilt in J. Weiss & H. Sampson & Mount Zion Psychoterapy Research Group The psychoanalytic process: theory, clinical observation and empirical research. New York: Guilford Press.
  31. Weiss, J. (1993). How Psychotherapy works: process and tecnique. New York: Guilford Press.
  32. Weiss, J. (2002). Control-mastery theory. Encyclopedia of psychotherapy, 1: 545-549.
  33. Yakeley, J. (2018). Current understanding of narcissism and narcissistic personality disorder. BJPsych advances, 24(5): 305-315. DOI: 10.1192/bja.2018.20.

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