Mentalization-Based Treatment for Pathological Narcissism

Robert P. Drozek, LICSW, is a staff psychotherapist in the Personality Disorders Service and Division of Alcohol, Drugs, and Addiction at McLean Hospital. He serves as a supervisor in the Mentalization-based Treatment (MBT) Clinic at McLean; a teaching associate in the Department of Psychiatry at Harvard Medical School; and an MBT trainer and supervisor through the Anna Freud Centre in London. His publications examine the interface between psychotherapy and ethics, with an emphasis on the role of ethics in the patient's therapeutic change. He is author of the book Psychoanalysis as an Ethical Process (2019). He maintains a private practice in Belmont, Massachusetts. Brandon T. Unruh, MD, is the medical director of the Gunderson Residence and founding director of the Mentalization-based Treatment (MBT) Clinic at McLean Hospital. He is an instructor in psychiatry at Harvard Medical School, and an MBT trainer and supervisor through the Anna Freud Centre in London. His clinical approach is anchored in the practice of evidence-based treatments for personality disorders, including MBT, dialectical behavior therapy, transference-focused psychotherapy, and good psychiatric management. His core academic publications and interests are in the areas of personality disorders, suicidality, spirituality, and flourishing. He is co-editor of the book Borderline Personality Disorder: A Case-based Approach (2018). He has a private practice in Cambridge, Massachusetts. Anthony W. Bateman MA, FRCPsych, is a consultant psychiatrist, psychotherapist, and MBT Consultant to the Anna Freud National Centre for Children and Families; a Visiting Professor at University College, London; and an Honorary Professor in Psychotherapy at the University of Copenhagen. With Peter Fonagy, he developed mentalization-based treatment for borderline personality disorder, studying its effectiveness in research trials. He has authored, co-authored, and edited 17 books, including Mentalization-based Treatment for Personality Disorders: A Practical Guide (2016), and Introduction to Psychoanalysis, Second Edition (2021). He has published numerous book chapters, and over 150 peer reviewed research articles on personality disorder and the use of psychotherapy in psychiatric practice.

Mentalization and pathological narcissism
Introduction to pathological narcissism and Mentalization-based Treatment
A mentalization-based model of pathological narcissism
Beginning the treatment
Assessment and diagnosis of pathological narcissism
The therapeutic approach
Therapeutic stance and clinical principles
Content-focused interventions
Context-focused interventions
Process-focused interventions: Pretend mode
Process-focused interventions: Psychic equivalent mode
Process-focused interventions: Teleological mode
Mentalizing the therapeutic relationship: Auxiliary relational techniques
Mentalizing the therapeutic relationship: The interventional pathway
Clinical applications
Moving forward in the treatment
Case example: After the