A Mentalizing Approach for Narcissistic Personality Disorder: Moving From “Me-Mode” to “We-Mode”

Narcissistic personality disorder (NPD) is a prevalent condition that frequently co-occurs with other diagnoses that bring patients into treatment. Narcissistic disturbances are not often the chief complaint, but they complicate the development of an adequate therapeutic alliance. Typical countertransference challenges, combined with stigma related to NPD, result in difficulty for the therapist to relate to these patients empathically. Mentalization-based treatment provides a means for therapists to reach these patients by taking a “not-knowing” stance with interest and curiosity in clarifying and expanding a shared awareness of the patient’s emotional experiences. By understanding the attachment functions, mentalizing imbalances, and problems of epistemic disregard among patients with NPD, therapists can break through the self-centered “me-mode” of the therapeutic dyad, where the typical lack of engagement or power struggles prevail, to a “we-mode,” where the patient and therapist are joined in attention to what happens in the patient’s mind and in interactions with others.