Therapeutic Relationship in Psychiatry

• Select one of the personality disorders from the DSM-5-TR (e.g., paranoid, antisocial, narcissistic).
• Briefly describe the personality disorder you selected, including the DSM-5-TR diagnostic criteria.
• Explain a therapeutic approach (individual, family, or group) and a modality you might use to treat a client presenting with this disorder. Explain why you selected the approach and modality justifying their appropriateness.
• Next, briefly explain what a therapeutic relationship is in psychiatry. Explain how you would share your diagnosis of this disorder with the client to avoid damaging the therapeutic relationship. Compare the differences in how you would share your diagnosis with an individual, a family, and in a group session.

Support your response with at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly and please ttach the PDFs of your sources.

Personality Disorder: Narcissistic Personality Disorder (NPD)

Description and Diagnostic Criteria (based on DSM-5-TR): Narcissistic Personality Disorder is characterized by a pervasive pattern of grandiosity (in fantasy or behavior), a constant need for admiration, and a lack of empathy for others, beginning by early adulthood and present in various contexts. The DSM-5-TR outlines specific criteria for diagnosing NPD, including having at least five of the following symptoms:

1. A grandiose sense of self-importance and exaggerating achievements and talents.
2. Preoccupation with fantasies of unlimited success, power, beauty, or ideal love.
3. Belief in being special and unique, and a need for excessive admiration.
4. A sense of entitlement and expecting favorable treatment from others.
5. Exploiting others for personal gain and lacking empathy for their feelings.
6. Envious of others or believing that others are envious of them.
7. Displaying arrogant, haughty behaviors or attitudes.

Therapeutic Approach and Modality for NPD:

Therapeutic Approach: Cognitive-Behavioral Therapy (CBT) CBT focuses on identifying and changing negative thought patterns and behaviors that contribute to the disorder. It can help individuals with NPD develop more realistic and adaptive ways of thinking and improve their interpersonal skills.

Therapeutic Modality: Individual Therapy Individual therapy is well-suited for NPD treatment because it allows the therapist to focus exclusively on the client’s specific issues, thought patterns, and behaviors. It also helps build a strong therapeutic alliance and allows for personalized interventions.

Justification: CBT is an evidence-based therapeutic approach widely used in treating various mental health disorders, including personality disorders like NPD. Its structured and goal-oriented nature is beneficial for clients with NPD, as it addresses their distorted thinking patterns and maladaptive behaviors.

Individual therapy is recommended for NPD due to the nature of the disorder, which often involves difficulties in forming healthy and authentic relationships. Individual sessions provide a safe and private space for clients to explore their self-centeredness, grandiosity, and challenges with empathy without the interference of others.

Therapeutic Relationship in Psychiatry:

A therapeutic relationship in psychiatry refers to the collaborative and professional connection between a therapist and a client. It is built on trust, empathy, and respect, with the aim of facilitating healing and positive change in the client.

Sharing the Diagnosis:

When sharing the diagnosis of Narcissistic Personality Disorder with a client to avoid damaging the therapeutic relationship:

1. Individual Therapy:
   • The therapist should approach the topic with sensitivity and empathy, acknowledging the client’s struggles and validating their feelings.
   • The focus should be on discussing specific behaviors and thought patterns rather than using the diagnostic label to label the person as a whole.
   • Emphasize that the diagnosis is not a judgment on their worth but a way to understand their challenges better and work on personal growth.
2. Family Therapy:
   • In family therapy, the therapist might choose to involve the family members to help them understand the diagnosis’s implications and how it impacts family dynamics.
   • The therapist should emphasize that the diagnosis does not blame or single out any particular family member but aims to improve overall family interactions and communication.
3. Group Therapy:
   • In a group setting, the therapist needs to be cautious about how the diagnosis is discussed to prevent negative reactions from other group members.
   • The focus should be on fostering understanding and empathy among group members and finding common ground in their struggles.

Sources:

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
2. Ronningstam, E. (2016). Narcissistic Personality Disorder: Progress in Recognition and Treatment. Focus (American Psychiatric Publishing), 14(2), 160–169.
3. Levy, K. N., Reynoso, J. S., Wasserman, R. H., & Clarkin, J. F. (2019). Narcissistic Personality Disorder. In J. F. Clarkin, P. Fonagy, & G. Gabbard (Eds.), Psychodynamic Psychotherapy for Personality Disorders: A Clinical Handbook (pp. 77–103). American Psychiatric Publishing.