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

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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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Authors and Affiliations

  1. Psychiatric Research Unit, Region Zealand, Copenhagen, Denmark

    Jane Fjermestad-Noll & Ole Jacob Storebø

  2. Harvard Medical School, Boston, USA

    Elsa Ronningstam

  3. McLean Hospital, Belmont, USA

    Elsa Ronningstam

  4. Psychiatric Research Unit, Region Zealand and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Bo Bach & Erik Simonsen

  5. Department of Psychology, University of Southern Denmark, Odense, Denmark

    Ole Jacob Storebø

  6. Institute of Psychology, University of Copenhagen, Copenhagen, Denmark

    Bent Rosenbaum

Authors
  1. Jane Fjermestad-Noll
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  2. Elsa Ronningstam
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  3. Bo Bach
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  4. Ole Jacob Storebø
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  5. Bent Rosenbaum
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  6. Erik Simonsen
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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

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