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Narcissism and Its Discontents

Diagnostic Dilemmas and Treatment Strategies With Narcissistic Patients

Glen O. Gabbard, M.D., and Holly Crisp-Han, M.D.

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  • ISBN 978-1-61537-277-5
  • Item #37277

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The definition of narcissism can be a moving target. Is it an excess of self-love? Profound insecurity? Low self-esteem? Too much self-esteem? Because of the multifaceted nature of narcissistic personality disorder (NPD), treating this disorder presents clinicians with a range of wholly unique challenges.

Narcissism and Its Discontents recognizes the variable nature of NPD and provides a template for adjusting treatment to the patient rather than shoehorning the patient into a manualized treatment that may prove to be less effectual.

This guide offers clinicians strategies, including transference and countertransference, to deal with the complex situations that often arise when treating narcissistic patients, among them, patient entitlement, disengagement, and envy. The authors provide a skillful integration of research and psychoanalytic theory while also addressing psychotherapeutic strategies that are less intensive but also useful—being cognizant of the fact that a majority of patients do not have access to psychoanalysis proper.

A chapter on the cultural aspects of narcissism addresses the recent societal fascination with NPD in the discourse on politics and celebrity, particularly in the age of social media. Regardless of the treatment setting—psychoanalysis, psychotherapy, pharmacotherapy, partial hospital, or inpatient—clinicians will find a wealth of approaches to treating a diverse and challenging patient population in Narcissism and Its Discontents.


  • About the Authors
  • Preface
  • Part I: Diagnostic Dilemmas
  • Chapter 1. Narcissism and Its Discontents
  • Chapter 2. The Cultural Context of Narcissism
  • Chapter 3. Modes of Relatedness
  • Part II: Treatment Strategies
  • Chapter 4. Beginning the Treatment
  • Chapter 5. Transference and Countertransference
  • Chapter 6. Tailoring the Treatment to the Patient
  • Chapter 7. Specific Treatment Strategies
  • Chapter 8. Termination
  • Index

About the Authors

Glen O. Gabbard, M.D., is Clinical Professor of Psychiatry at Baylor College of Medicine in Houston, Texas. He is also Training and Supervising Analyst at the Center for Psychoanalytic Studies in Houston. He is in the full-time private practice of psychiatry, psychoanalysis, and psychotherapy.

Holly Crisp, M.D., is Clinical Associate Professor at Baylor College of Medicine in Houston, Texas. She is on the faculty at the Center for Psychoanalytic Studies in Houston. She is in the full-time private practice of psychiatry, psychoanalysis, and psychotherapy.

This is an excellent, comprehensive, and timely contribution that can help clinicians integrate the accumulated scholarly, clinical, and empirical accounts on narcissism and its pathology. In this masterfully organized and written book, Drs. Gabbard and Crisp present a balanced summary of intersubjective psychodynamic and psychoanalytic treatment of narcissistic patients, with uniquely thoughtful and guiding descriptions and clinical illustrations of numerous specific challenges that psychotherapists can face. Informative and educational, it is a remarkably engaging resource for clinicians and psychotherapists in all stages of their careers.—Elsa Ronningstam, Ph.D., Associate Professor (PT), Harvard Medical School, Boston, Massachusetts, and Clinical Psychologist, McLean Hospital, Belmont, Massachusetts

In this marvelous new book, Narcissism and Its Discontents, Gabbard and Crisp help us understand the many faces of narcissism in the context of an upheaval of social change. Then they invite us to sit at their sides while they, master clinicians, show us how to reach and help those whose narcissism has led them from success to great peril. And how to do so with compassion, even when the going gets rough. Take a seat. You won't regret it.—John M. Oldham, M.D., Professor of Psychiatry, Barbara and Corbin Robertson Jr. Endowed Chair for Personality Disorders, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas

Compassionate, clear, and wise, this book reflects perspectives that can come only from extensive clinical experience, combined with both illustrative vignettes and elegant prose. Clinicians will find it as absorbing to read as it is instructive to their practices.—John G. Gunderson, M.D., Professor of Psychiatry, Harvard Medical School, Boston, Massachusetts, and Director, BPD Center for Treatment, Research and Training, McLean Hospital, Belmont, Massachusetts

This book is a gift to the profession; it should be the template for all clinical monographs. It's a great read, hard to put down, while at the same time comprehensive, authoritative, and miraculously concise. The book is as wise as it is practical, from a general appreciation of narcissistic concerns to the bruising interactions of the clinical moment. Above all, Gabbard and Crisp offer vignettes previewing what the therapist is likely to meet and feel at every stage of the treatment and what responses may be helpful, always based on an understanding of what is at stake for the patient. The clinical section is a tour de force of expert supervision-by-text. This book will strengthen the hand of the experienced therapist, and its clear, phenomenological explanations and striking clinical vignettes will instill resilience in the beginner.—Lawrence Friedman, M.D., Clinical Professor of Psychiatry at the Weill-Cornell Medical College and member of the Faculty of the Institute for Psychoanalytic Education affiliated with the New York University Medical Center

NPD is a difficult entity to diagnose and treat. Even defining narcissism can be a daunting task, given its many faces, its continuity with healthy self-interest and confidence, and its changing nature both throughout development and in the same patient faced with different environmental stressors. Thus, the authors' ability to cover all these topics and to create a multifaceted image of a narcissistic patient in only 150 pages is truly impressive. Most importantly, the book teaches how to think about NPD conceptually, taking into account each patient's unique character traits and circumstances. With that said, it would be impossible to cover everything related to NPD in a short book, and interested readers may want to look elsewhere to deepen their understanding of the topics this book covers. The authors provide plentiful references to encourage further exploration. It is important to note that, however broad, the focus is still primarily on psychoanalytically-oriented theories. While the role of other treatment modalities, such as group and couple therapies, is briefly discussed, other therapeutic techniques, including CBT and DBT, appear to be beyond the scope of this book. However, this is a comprehensive overview of NPD from multiple vantage points that is short, easy to read, and full of memorable examples that most clinicians can relate to.—Marina Bayeva, M.D., Ph.D., Doody's Book Review

This is a very timely and helpful contribution for clinicians and psychotherapists independent of the stage of their careers. It is also a most instructive and needed educational guide on the range of narcissistic pathology and its treatment.—Elsa Ronningstam, Ph.D., Journal of Psychiatric Practice May 2019

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