Pathological narcissism and perfectionism

Today, I present a study of narcissism and therapy. Ge, Hewitt, Mikail, Flett & Kealy (2024) published “Pathological Narcissism’s Impact on Psychodynamic Group Therapy for Perfectionism” in Psychotherapy. Here are the edited abstract and impact statements:

Several decades of theory suggest that pathological narcissism (PN) may limit psychotherapy success, but empirical evidence for such theories is limited and mixed. In addition, it has been proposed that individuals with high levels of PN may benefit more from supportive compared to interpretive psychodynamic therapies, but no studies thus far have investigated this question empirically. As such, our study aimed to extend past research by investigating (a) whether higher levels of pretreatment PN predict poorer treatment outcome and (b) whether the type of psychodynamic therapy (supportive or interpretive therapy) moderates these findings, in a sample of patients undergoing group psychodynamic psychotherapy for perfectionism. The sample was drawn from the University of British Columbia Perfectionism Treatment Study II (Hewitt et al., 2023) and consisted of 80 treatment-seeking adults with elevated perfectionism. 

Pathological narcissism has been theorized for decades by clinicians to interfere with psychotherapy outcome. This study aimed to investigate whether patients higher on pathological narcissism were less likely to improve on mental health, work, and relationship outcomes following group psychodynamic psychotherapy for perfectionism. It also aimed to assess whether patients with pathological narcissism were more likely to benefit from a more supportive rather than interpretive psychodynamic therapy approach. Contrary to expectations, we did not find evidence to suggest that patients with higher levels of pathological narcissism at the beginning of treatment benefitted less from psychodynamic group therapy than those with lower levels of pathological narcissism. Moreover, these findings were not moderated by the type of therapy used (i.e., supportive vs. interpretive). While further research is needed, clinicians can consider, when treating individuals with perfectionism who are elevated in pathological narcissism, using supportive or interpretive group psychodynamic psychotherapy, as this study suggests that patients’ level of pathological narcissism does not interfere with their likelihood of benefiting from these treatments. Future research should investigate the mechanisms in supportive and interpretive psychodynamic therapies that enable individuals with pathological narcissism to benefit from psychotherapy. 

I like it when researchers publish findings that violate their expectations. In this case, while their expectations were not confirmed, the findings are positive in that people high on pathological narcissism seeking therapy for perfectionism may benefit from interpretive as well as supportive therapy. Group therapy can be an efficient and effective way to help clients.