In-session perceptions of dominance and hostility are shaped by patients’ pathological narcissism

Pathological narcissism refers to a pathology of self-esteem, with core antagonistic themes. Both in its clinical and subclinical manifestations, pathological narcissism can hinder psychotherapy. Moreover, it is associated with deviations from consensual interpersonal perceptions, both of self and others. In our contribution, we will present an empirical study aimed at investigating whether pathological narcissism accounts for distinctiveness (construal) of patients’ interpersonal perceptions, with a focus on treatment settings. Patients enrolled in psychological/psychotherapeutic treatment (N = 150) were involved in the study and asked to describe a specific segment of a session with their clinician. We then collected both patients’ and independent raters’ assessments of in-session dominance and hostility (interpersonal behavior), to quantify the discrepancy between patients’ and consensual perceptions of interpersonal behavior. Furthermore, we assessed patients’ traits of pathological narcissism, to investigate their role in predicting patient-rater discrepancies in interpersonal perceptions. Contrary to our expectations, pathological narcissism was not related to patient-rater discrepancies in the way clinicians were perceived. However, patients’ grandiose narcissism was related to distinctively perceiving oneself as more dominant, while patients’ vulnerable narcissism to distinctively perceiving oneself as more hostile. The former association (but not the latter) also held after incorporating additional raters’ assessments in post-hoc procedures. Self-enhancement may explain the “excess” of self-dominance in patients’ self-ratings, while covert hostility and self-concealment may account for the link between vulnerable narcissism and construal in self-hostility. Clinicians need to detect these defensive processes for effective treatment of narcissism-related themes.