This episode continues the Heal NPD Seminar Series with Dr. Mark Ettensohn and associate Deanna Young, Psy.D.
In this session, the group discusses the article “A Mentalizing Approach for Narcissistic Personality Disorder: Moving From ‘Me-Mode’ to ‘We-Mode’” (Choi-Kain, Simonsen, & Euler, 2022), which explores how Mentalization-Based Treatment (MBT) can be applied to the treatment of narcissistic personality disorder.
The paper argues that many of the challenges clinicians encounter when working with narcissistic patients can be understood through the lens of attachment, mentalization, and epistemic trust. Rather than viewing narcissistic pathology primarily as a problem of entitlement, grandiosity, or lack of empathy, the authors conceptualize it as a disturbance in the capacity to understand oneself and others in psychological terms and to learn from emotionally meaningful relationships.
The discussion explores the article’s central proposal that treatment involves helping patients move from a self-focused “me-mode” toward a more collaborative “we-mode,” in which multiple perspectives can be held in mind simultaneously. Particular attention is given to the ways in which narcissistic adaptations interfere with trust, intimacy, and therapeutic engagement.
Along the way, the conversation examines several key MBT concepts, including:
* Epistemic trust and distrust
* Nonmentalizing modes, including pretend mode, psychic equivalence, and teleological thinking
* Marked contingent mirroring
* The therapeutic alliance as a vehicle for psychological change
* Why confrontation and pressure for change can sometimes reinforce narcissistic defenses rather than weaken them
The discussion also considers the broader cultural discourse surrounding narcissism and contrasts popular approaches that emphasize accountability, confrontation, and labeling with psychodynamic and attachment-based approaches that emphasize understanding, curiosity, and the gradual development of trust.
Finally, the group reflects on the practical realities of psychotherapy with narcissistic patients, including the pressures created by partners and family members seeking rapid change, the tendency for therapists to become caught in power struggles, and the challenge of maintaining a mentalizing stance in the face of difficult interpersonal dynamics.
Key themes include:
* Mentalization-Based Treatment (MBT) and narcissistic personality disorder
* Attachment theory and personality pathology
* Epistemic trust as a foundation for psychological growth
* The relationship between vulnerability and grandiosity
* Nonmentalizing modes of experience
* The role of empathy, curiosity, and validation in treatment
* Clinical challenges in working with narcissistic patients
This series is intended for clinicians, trainees, and viewers seeking a nuanced, clinically grounded understanding of narcissism beyond popular discourse.
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Citation:
Choi-Kain, L. W., Simonsen, S., & Euler, S. (2022). A Mentalizing Approach for Narcissistic Personality Disorder: Moving From “Me-Mode” to “We-Mode.” American Journal of Psychotherapy, 75(1), 38–43.
Full text link: https://www.psychiatryonline.org/doi/epdf/10.1176/appi.psychotherapy.20210017
