States of minds in narcissistic personality disorder: three psychotherapies analyzed using the grid of problematic states

The subjective experience of patients suffering from narcissistic personality disorder (NPD) has been studied using various methods. However, there has not been an analysis of psychotherapy session transcripts. It is much more likely that the facets of experience surface in this context than during a single interview or in a self-administered questionnaire. Using the Grid of Problematic States, designed to assess contents emerging in patients’ transcripts, the authors analyzed the first 18 psychotherapy sessions with three female patients suffering from NPD and treated by therapists of the cognitive constructivist school specializing in personality disorders. The three patients’ dominant states of mind were characterized by anger, feeling excluded from groups, feelings of being harmed, and distrust toward others. The authors discuss the results and their implications for future research and for the definition of NPD in future editions of the Diagnostic and Statistical Manual of Mental Disorders