This study examined clinician emotional responses and therapeutic alliance in psychotherapy with adolescent patients with specific subtypes of narcissistic personality disorder (NPD). A national sample of therapists (N = 58) completed the Therapist Response Questionnaire for Adolescents to identify patterns of clinician response, the Working Alliance Inventory to evaluate the quality of alliance, and the Shedler-Westen Assessment Procedure-II for Adolescents to assess the personality pathology of a patient in their care. The results showed that the grandiose narcissistic subtype was positively related to angry/criticized and disengaged/hopeless therapist responses and negatively related to warm/attuned response. The fragile subtype was positively related to overinvolved/worried therapist response. The high-functioning/exhibitionistic subtype was negatively related to angry/criticized response. Lower quality of therapeutic alliance was positively associated with the grandiose subtype. Moreover, the empirically founded prototypes of therapist responses to adolescent patients with NPD subtypes strongly resemble theoretical-clinical accounts. The clinical implications are addressed.

中文翻译：

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临床医生在治疗患有自恋型人格障碍亚型的青少年患者时的情绪反应和治疗联盟：一项具有临床意义的实证调查

本研究检查了临床医生的情绪反应和治疗联盟，对患有特定自恋型人格障碍 (NPD) 特定亚型的青少年患者进行心理治疗。一个全国性的治疗师样本（N = 58）完成了青少年治疗师反应问卷，以确定临床医生反应的模式，评估联盟质量的工作联盟清单，以及评估青少年性格的 Shedler-Westen 评估程序-II病人在他们护理中的病理。结果表明，夸大自恋亚型与愤怒/批评和脱离/绝望的治疗师反应呈正相关，与温暖/调和反应呈负相关。脆弱亚型与过度参与/担心的治疗师反应呈正相关。高功能/表现主义亚型与愤怒/批评反应呈负相关。较低质量的治疗联盟与宏伟亚型正相关。此外，治疗师对 NPD 亚型青少年患者反应的经验建立原型与理论-临床描述非常相似。解决了临床意义。