Pathological narcissism, self/therapist perceptions, and emotions during treatment: An experience sampling study

Traits of pathological narcissism are linked with dysfunctional interpersonal processes and an array of negative emotions. Given their relevance in clinical settings, this study explores interpersonal and emotional processes linked to narcissism during psychotherapy sessions, using an experience sampling design. Patients enrolled in individual psychotherapy are assessed on a number of trait variables, including grandiose and vulnerable narcissistic traits, prior to entering a 17-week experience sampling (ES) procedure. The ES procedure collects patient’s emotions and patient-reported dominance and hostility (both relative to self and therapist’s behavior) as they occur during treatment, session by session, with a brief survey administered after each psychotherapy session using a smartphone app and following an event-contingent design. Preliminary data are available from 25 patients (19 female), rating an average of 3.72 sessions each and providing a total of 93 observations. Random-intercept multilevel models indicate that grandiose narcissism predicts describing one’s behavior during the sessions as both dominant and warm, while vulnerable narcissism predicts describing one’s behavior as hostile. Perceptions of therapist’s behavior are not predicted by narcissism. Grandiose narcissism also predicts experiencing more pride in the interaction with the clinician. Current data suggest that no additional in-session emotion is predicted by narcissistic traits. Though very preliminary in nature, these findings start shedding new light on the emotional and interpersonal dynamics associated with traits of pathological narcissism in clinical settings.