Podcast Discussion: Narcissistic Personality Disorder & Mentalization-Based Therapy (MBT)

Introduction

• Discussion on Narcissistic Personality Disorder (NPD) and mentalization-based therapy.
• Key personalities involved:
  • Anthony Bateman: Co-founder of MBT.
  • Bob Drak: Clinical Director of MBT Clinic.
  • Brandon Unruh: Psychiatrist and psychotherapist.

Participants and Roles

Bob Drak

• Clinical social worker.
• Focused on treating NPD and Borderline Personality Disorder (BPD) using MBT.
• Runs individual and group therapy sessions.

Brandon Unruh

• Psychiatrist and psychotherapist at Mclean Hospital.
• Mentored by John Gunderson, influential in BPD diagnosis.
• Medical Director at Gunderson Residence.

Anthony Bateman

• Visiting professor at University College London.
• Focuses on clinical work and training in mentalizing, research on antisocial personality disorder.

Understanding Narcissism

Types of Narcissism

• Grandiose: High self-perception of greatness.
• Vulnerable: Contingent self-esteem, based on external validations such as accomplishments and appearance.
• Both types share entitlement and antagonism traits.

Relationship with Other Disorders

• Overlay with antisocial behaviors, particularly in grandiose narcissism, leading to social disruptions.

Mentalization-Based Therapy (MBT)

Core Concepts

• MBT focuses on the ability to reflect on mental states in oneself and others.
• Target is to enhance the affective vocabulary of patients, helping them identify emotions like sadness and shame.

Problems in Mentalizing for Narcissists

• Overconfidence in perspective-taking: Difficulty in seeing other perspectives.
• Impaired empathy: Harder to empathize when self-esteem is threatened.
• Externalization of blame: Tendency to blame external factors for personal failures.
• Black and white thinking: Difficulty in tolerating ambiguity.

Treatment Approaches

• Initial Alliance Formation: Critical in engaging NPD patients.
• Affect Elaboration Pathway: Enhancing inward reflection and emotional vocabulary.
• Empathy Development: Context-dependent deficits addressed by normalizing vulnerabilities.
• Formulation in MBT: Writing up a formulation that includes mentalizing problems, shared with patients, to guide treatment.

Challenges in Treatment

• High dropout rates due to lack of dependency-seeking behavior in NPD patients.
• Co-constructed therapeutic relationship, emphasizing empathy and engagement.

Key Takeaways

• MBT is effective in managing both narcissistic and borderline personality traits.
• Treatment success stories demonstrate recovery and improvement in self-esteem regulation.
• Emphasis on understanding narcissism as a continuum of normal human experience, not just as a disorder.
• Importance of addressing pathology in self-esteem regulation for therapeutic success.

Conclusion

• The discussion highlights the complexities and nuances in treating narcissistic traits using MBT.
• Encourages a broader understanding and empathy for individuals with narcissistic vulnerabilities as part of the human experience.