A Self-Psychology Approach to Narcissistic Personality Disorder: A Nursing Reflection
| Autor: | RN Donna M. Czuchta Romano |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Adult
Male Psychotherapist media_common.quotation_subject Psychiatric Nursing Psychology Child Empathy Nurse's Role Personality Disorders Nursing Narcissistic personality disorder medicine Narcissism Humans Transference Psychology Philosophy Nursing Psychoanalytic theory Child Self Psychology Autoeroticism media_common Depressive Disorder Grandiosity General Medicine medicine.disease Object Attachment Self Concept Therapeutic relationship Self psychology Countertransference Patient Participation Pshychiatric Mental Health medicine.symptom Nurse-Patient Relations Psychology Social psychology |
| Zdroj: | Perspectives In Psychiatric Care. 40:20-28 |
| ISSN: | 1744-6163 0031-5990 |
| DOI: | 10.1111/j.1744-6163.2004.00020.x |
| Popis: | TOPIC. The use of Heinz Kohut's self-psychology perspective in understanding and providing care for patients with narcissistic personality disorder (NPD). PURPOSE. To describe how nurses* can apply the self-psychology perspective as a way to understand the development of self for individuals with NPD and to enhance the therapeutic relationship between the nurse and patient with NPD. SOURCES. Theoretical literature; the author's clinical experience. CONCLUSIONS. Self-psychology provides nurses with a theoretical perspective that can enhance the interpersonal relationship between the nurse and patient with NPD. Search terms: Kohut, narcissistic personality disorder, self-object, self-psychology ********** There have been many theoretical contributions to the evolution of the concept of narcissistic personality disorder (NPD). Havelock (1898) invoked the Greek myth of Narcissus, who fell in love with his own reflection, to illustrate a psychological state in reporting a case of autoeroticism. Freud's classic paper "On Narcissism" was published in 1914 (Akhtar & Thomson, 1982). The term narcissistic personality disorder was introduced to the literature by Kohut (1968), who is considered a major theorist in examining the concept of NPD (Akhtar & Thomson). For the purposes of this paper, Kohut's self-psychology approach is used to provide a theoretical perspective in understanding individuals with NPD. Features of Narcissistic Personality Disorder The essential features of NPD are a pervasive pattern of grandiosity, need for admiration, and lack of empathy that can be present in a variety of contexts. Individuals with this disorder have a grandiose sense of self-importance and are often preoccupied with fantasies of unlimited success, power, and beauty. Often they believe they are superior, special, or unique, and expect others to recognize them as such. Individuals with NPD generally require excessive admiration that often takes on the form of a need for constant attention. A sense of entitlement is apparent in these individuals, which, combined with a lack of sensitivity to the needs of others, may result in the exploitation of others. Individuals with NPD generally have a lack of empathy, are often envious of others or believe that others are envious of them. Arrogant, haughty behaviors characterize these individuals, as they often display snobbish or patronizing attitudes toward other (American Psychiatric Association, 1994). Relevance of Theoretically Understanding NPD Nurses may encounter patients with NPD in their clinical practice. These patients are therapeutically challenging as they present with a wide range of behavioral symptoms. Patients with NPD often distance themselves from their therapists in a consistently demeaning and devaluing manner. In light of this, one may ask how does or can a nurse therapeutically establish a relationship with a patient who has difficulty trusting and who is prone to outbursts of anger, which may manifest in a hostile, self-destructive manner? Self-psychology provides a theoretical perspective for understanding both NPD and treatment methods found to be effective in working with affected patients (Ashton, 1990; Cara, 1992; Deitz, 1991; Grosch, 1994; Nighorn, 1988). This understanding allows the nurse to engage in a therapeutic relationship with individuals who have this disorder and to approach the difficult behavior by understanding, rather than reacting, to it. While the body of Kohut's literature was based on his psychoanalytic work, the principles of self-psychology have considerable application for psychotherapeutic intervention for NPD patients who are admitted to an inpatient psychiatry unit, as well as those individuals undergoing long-term outpatient therapy. Kohut's Self-Psychology Perspective The emergence of self-psychology is based largely on the theoretical perspectives of Kohut (1971, 1977; Kohut & Wolf, 1978). … |
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