Assessment and Treatment Plan for Narcissism, A Clients' Story
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Client’s History
A 25-year-old patient presents with narcissistic personality disorder that interferes with his learning progress. The condition presents the patient with a feeling of being important and that he should be the center of attraction for his tutor, colleagues and friends in every aspect. The patient had wanted fame from the thesis he undertook, and felt that the mentor was supposed to concentrate on him more and offer him much more support, even though, the mentor was not for his ideas. His pace of undertaking the thesis is slow yet he complains that the rest are jealous over him and expresses envy for those moving ahead of him. Even though he do not show much progress in his work and is not willing to cooperate with others, believing in his success, the patient thinks of becoming a professor (Endicott, Robins & Spitzer, 1981).
The patient had previously shown rapid infatuation with women and persistent fantasies on different new women. He records a history of turning over different women after a shorter period (Endicott, Robins & Spitzer, 1981). He is said not to be considerate on others and continuously push for his agenda. He is also seen to be self-centered and a person who does not keep friends who do not heed to his demands. He has experienced criticism of his esteem from the mentor and friends and cannot continue with his work to progress accordingly or keep his friends. He continually expresses displeasure whenever he felt that the person around him does not give him the attention he deserves and not even his classmates or friends can keep with him.
Problem and Symptoms
Narcissism is a personality disorder and a person suffering from it can be said to have narcissistic personality disorder. It manifests as either fantasy or a person’s actual behavior and affects even people around such person (Narcissist, 2015). A person expresses the need for continuous admiration with the full force of self-centeredness and lack of consideration for others. This disorder mostly affects the victim’s social life and relations as such individual finds it difficult keeping up with others. Such people are commonly seen as to be living in denial out of the real them with loosed esteem, which is replaced with the plastic self (Campbell & Miller, 2011). Persons with this personality believe that in any place they are, they are the single source of importance over others in a manner that is considered inappropriate or without expressing the factor that grant them such importance.
Persons with this condition always tend to complain about minor things and infuriate whenever they do not feel recognized. The disorder affects a person’s mentality function, interpersonal function or control of anger. It can be experienced anytime from the adolescence stage of adulthood (Narcissist, 2015). The patients cover the past wounds or lost esteem by presenting an idealized self with strangest feeling that they do not express or admit and are unconcerned on how or if their actions affect others. Another aspect that can be realized in such people is like domineering conversations, boastful, pretense and perceiving other people as inferiors. Actually, such people are hiding the feelings of shame, insecurity and humiliation and cannot handle criticism.
It is notable that a patient with narcissist personality disorder expresses abnormal sense of self-importance and expects to be considered superior without anything tangible to show for it. In a real sense, such people show exaggerated achievement in an unrealistic manner and are overtaken with fantasies of beauty, power, perfection, beauty, brilliance and success (Fonagy, Person & Sandler, 2012). Such person continually require admiration and believing that they are special and unique and can only be associated with or be understood by those of higher status. Such people again expect that their expectations be the reality with a sense of automatic entitlement. They continue to undermine and exploit other people to achieve their desires or to have their way without taking into account the feelings and needs of the rest. Such people are envious of others, believe that other people are jealous of them, and continually show arrogance and strange behaviors and attitudes.
A narcissist overtakes a conversation to monopolize it without giving other people any or enough time to express themselves. They can interrupt a conversation and switch the focus of discussion to themselves, and they tend to undermine rules and norms even through persuading other people to divert from the norm (Narcissist, 2015). Such people are very charming and charismatic when they want to get something from a person, after which the contact or relationship is cut without a second thought. They can influence other people’s thoughts significantly to achieve their goals and meet inadequacies within themselves. Narcissists are never accommodative of criticism, disregard any inattentiveness, and give a response to any disagreeing view with an intense argument or emotional abuse.
Additional Information to Know About the Client
It is important to establish the approximated period in which the client started experiencing the disorder. In that manner, it is easier to trace back the events that might have led to the patient’s condition and design an intervention or therapy from that. Those with the disorder are suffering from lost or low self-esteem, previous injury that they may want to cover up, or an occurrence that they have never accepted. Examining the root of the situation in terms of the period and the appearance is essential to bringing previous experience to terms with the current situation of the client that would aid in healing process.
It is important to bring the client into feeling of a real person through examining the progress socially, academically or professionally. It is important to weigh the reality with fantasy in order to bring some sense of reality in the person. Other information to know about the client is the likes and dislikes, which will aid therapist to establish the extent at which the client deviates from the norm, and where the patient is likely to undermine other people or the order of a place. In another way, it can be established the interest of the patient with other people and if the relationships in the past reflect what is expected of a person. The therapist can also seek to establish the extent and cause of depression the client might be experiencing because narcissism at its advanced level is presented with series of low esteem due to perceived rejection or criticism. It is also important to know if the patient has ever seen another doctor to follow and comply with the history of medication and treatment of the patient.
Instruments used to Asses Narcissistic Patient
Narcissistic personality inventory is one of the tools that can be used to assess a client with narcissistic personality disorder (American Psychiatric Association, 2013). Continued research seeks to establish whether the inventory can determine the pathological narcissism in a patient or not. Such instrument must meet the criteria set for developing personality disorders. There are different versions of the instrument with its forty item forced choices being commonly used in current research. It is based on the DSM clinical criteria for personality disorders and often used to measure non-pathological narcissistic personality disorder in people (Campbell & Miller, 2011). This inventory is often used but is subjected to manipulation by those examined who give wrong responses to the criteria.
Another instrument for the narcissism that includes thirty-three questions based on the characteristics of pathological narcissism is the diagnostic interview for narcissism (Campbell & Miller, 2011). The thirty-three items are grouped into five categories that include interpersonal relations, grandiosity, over activeness, moods and general adaptations. The questions are based on the criteria established in DSM-IV personality disorder criteria and scores per item are added to determine the presence of the disease in a person. The instrument is used primarily to assess vulnerable forms of narcissism in a person.
Instrument or Technique Used in this Case
Since there is a lot of research and preference of the use of the narcissistic personality inventory, a criterion would best suit to assess the client in this case (Campbell & Miller, 2011). This instrument is commonly used in measuring non-clinical narcissism giving results of the highest levels of narcissism. The tool has since gone on through modifications to take into consideration the changes in definition and criteria for assessing the disorder. The tool is valuable because it has facets that sample all the aspects that can be related to narcissism and that would help in establishing higher-level narcissism in a client (Campbell & Miller, 2011). The instrument has experienced a reduction of its components from 220 to the current 40 items most commonly used as of late.
The inventory has considerable proof of validity supported by researchers that have been conducted to verify its appropriateness. It can be used to correlate other items of self-reported measures that will aid in reducing the situation of a client. High scores on the instrument have been related to the real factors on the criteria for establishing the disorder (Campbell & Miller, 2011). It is a dominating choice for personality researchers and has some extent of predictions on theoretical interventions with the said disease. Even with continued criticism, researchers have shown the effectiveness of the inventory in determining the presence of the disease in a person, with small cheats.
The assessment results are essential for modifying treatments and designing interventions for the client. Effective treatment is only possible in the case where the client is adequately assessed to establish the situation vividly and understand the constructs of the condition. Different patients will express different characteristics for the same cases and mostly when it comes to disorders (Campbell, Miller, Morse & Pilkonis, 2008). Assessing comprehensively the situation in a client helps to understand the progress and severity or complexity of the situation for proper medication.
Diagnosis based on DSM-IV-TR® Multi-axial Format
Signs and symptoms established with the client help in diagnosis of the disorder. A thorough mental assessment is carried out with a physical examination to rule out any physical cause of the problem. Narcissism is classified under personality disorders with other disorders, its analysis focuses more on the mind and character, and therefore it is essential to make sure that the diagnosis is that of narcissism and not other personality disorder. There should be established any deviation from the norm by the client in cognition in terms of perception and thoughts, the emotional response of the person, interpersonal functions and impulsivity.
Grandiose state of the mind is based on to establish narcissism together with a stable disorder that is less defined by grandiosity than severely distributed interpersonal relations are. The client must express the pervasive pattern of grandiosity in fantasy and behavior to be diagnosed with narcissism (Narcissism, 2015). The disorder can be considered to be mild impairment when the condition results in minor occasional problems and is considered moderate in the event of a person missing routine duties, experiences performance problems or underperformance, tend to avoid and continually alienate friends with significant risk of harming self and others inconsiderably (Narcissism, 2015). In the event a person begins staying in bed the whole day, being completely introverted and severely at risk of self-harming or harming others then the condition is severe. The diagnosis of the client in the case meets the criteria of being classified as a narcissistic with moderate impairment.
Treatment Plan for the Individual
The client, in this case, requires continuous psychotherapy to contain his situation and correct the disorder. The client will be taken through mental therapies in order to eradicate the perceived being and make him come to the self-being (Pincus & Roche, 2015). The focus will be to eliminate fantasies and behaviors related to the disorder in a more organized manner in order to achieve all he designed therapies. A discussion is also based on ensuring that the client comes into acceptance with self and realize the level of equality existing between the client and other people. The interpersonal relations are coached in the patient through every means possible so that the relationship and perception of the client are modified to fit the norm other than feeling of being an exceptional (Narcissism, 2015). It is important that the patient be brought to terms with the caregiver and interventions designed to benefit from the course. In some cases, the client can be involved in developing response to ensure active participation in the whole process.
It is essential at the first stages that the patient be treated as he wants, and trend that is then transformed into bits until that time the desired form is achieved (Pincus & Roche, 2015). As the client is in a defensive state to maintain status, the care provider must be in an offensive to ensure that the client accepts the interventions in place. A systematic approach is necessary cautiously to avoid any possibility of installing pathologic grandiosity in the patient (Campbell & Miller, 2011). The initial acceptance of the patient is followed by ordered activities to transform the previous status to the desired state. Any mental disorder, physical condition or clinical case are treated aside from the disorder and therapist ensuring that by the end of the process, the patient achieve reality of things as they are and the general wellbeing.