Schema therapy/reparenting for an NPD patient.

Schema therapy was developed by Dr. Jeffrey Young for treating personality disorders, which are deeply ingrained patterns of behavior that are not receptive to traditional therapies used for depression, anxiety, neurotic disorders, etc.
(You can read more about how Schema therapy is used for NPD patients here.)

NPD is one of the most difficult of the personality disorders to treat, and it’s rare a patient will present themselves for treatment, unless they have suffered a narcissistic crisis that led to them becoming depressed.

These three videos are part of a graduate school practicum, showing schema therapy in action on a narcissistic patient (non-pathological narcissism/low spectrum NPD).* In the first video (session 1) the patient, “Sam,” has come to therapy because he is having problems relating to his wife and feels rejected by his coworkers. He is easily irritated and shows a number of narcissistic traits, including entitlement and grandiosity. He doesn’t understand or have empathy for his wife’s complaints about feeling hurt by his “brutal honesty.”

In the second video (session 8), Sam begins to talk about himself at five years old, when he broke his arm and felt rejected because his immediate physical and emotional needs were dismissed by his mother, who took him to the babysitter instead of showing the empathy and concern she should have. Then he is asked to relate how “little Sam” feels and begins to explore the emotions he shut himself off from feeling because of his mother’s rejection.

In the third video (session 16), Sam begins to show emotional discomfort as the therapist has “little Sam” (his true self) talk to “Detached Sam” (his narcissistic mask). He admits he wants to be able to show his wife how much he loves her.

Session 1:

Session 8:

Session 16:

Schema therapy is also commonly used to treat people with Borderline Personality Disorder.

* The patient is an actor but this is still an interesting look at how this method of therapy works.

11 thoughts on “Schema therapy/reparenting for an NPD patient.

  1. When I watched it on Youtube, the first led into the second, but I just noticed here it doesn’t do that. I will link the other two so you don’t have to hunt for them.

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  2. Nice post.

    Interesting how relatively few people seem to respond or notice posts about healing or positive outcomes for narcissistic people.

    Schema therapy is an approach that I like since it’s a modified psychoanalytic / psychodynamic approach. There was a large scale study of it with people labeled BPD that was very impressive:

    http://archpsyc.jamanetwork.com/article.aspx?articleid=209673

    Interestingly, the type of therapy doesn’t matter nearly as much as people think. Studies like Barry Duncan’s (in his book On Becoming a Better Therapist) show that the perceived quality of the relationship between therapist and client is 6-9x more important than the type of therapy/approach to therapy. I was surprised to read this, but I think it is probably close to the truth. People mistakenly think the type of therapy (DBT, Schema, etc.) matters significantly, but it really doesn’t; the quality of the relationship and the duration/frequency of the therapy, whatever kind it is, are much more important.

    I also want to recommend you to check out the cases of “Walter” and “Frank” in Masterson’s book The Search for the Real Self. There are two complete stories of narcissistic healing.

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    • I agree. I have noticed there are few comments whenever I post something positive about treating or curing narcissism instead of bashing them.
      I really am starting to think there’s a lot of prejudice against them, which is understandable since they can be very unpleasant to deal with, and of course there is no excuse for them to treat others the way they do, but these are mentally ill people. I might do a post about this later. We don’t go around bashing schizophrenics or people with bipolar disorder the way we go around bashing people with NPD. They do suffer and became the way they are because they themselves were victimized. Some don’t realize they are mentally ill but they are not happy people. This doesn’t excuse their behavior but I’m losing patience with the attitude that they are all “hopeless” and there is so little interest in general in finding ways to treat them.

      I have to order that book. The one I have is about closet narcissism, I think I ordered the wrong book.

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      • If you mean the Emerging Self, that was one of the ones I mentioned yes. In that book Mastersons discusses “covert” narcissists, what Sam V. would have called more cerebral or less exhibitionistic/overtly grandiose narcissists. I think the case studies in that book are very good.
        The case study of Walter in the Search for the Real Self by Masterson is a good example of an exhibitionistic narcissist in successful treatment. But, I think those type of “narcissists” less frequently would come for treatment because they are less self-aware. You know I don’t really believe in these words, but I can make believe.

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  3. Kind of see myself in the guy. He looks calm on the outside but I sense a deep strong shock. I can relate to him.

    We narcissists are frozen in childhood emotionally I think it would be possible to release it and start feeling emotions again, but I believe, at that point, we should also face what WE have done and how WE acted ever since, how much losers we are and and I think that is what makes impossible to heal.

    Sometimes I feel like my dissociation and emptiness is just protecting me from seeing myself from the emotional perspective. We really should not live it makes zero sense.

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