Reaching the covert, fragile side of patients: The case of narcissistic personality disorder

A multifaceted self allows selection of those sides that are most suited to a situation and an interpersonal context, thus improving adaptation. Patients suffering from personality disorders display a limited range of self‐aspects, and their relationships are stereotyped and maladaptive. Another problem is that some of these sides scarcely reach consciousness and usually remain in the background. In the case of narcissistic personality disorder (NPD) the self‐part that is fragile is unlikely to reach consciousness, so that people suffering from this disorder are impervious and detached. We present a case of a psychotherapist working with a woman suffering from NPD by facilitating the emergence of the fragile part of her self, hidden by angry and scornful characters. We demonstrate, moreover, how reaching such a self‐part is associated with an improvement in the patient's interpersonal relationships outside the consulting room. © 2007 Wiley Periodicals, Inc. J Clin Psychol: In Session 63: 141–152, 2007.