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Narcissistic Personality Disorder is among a long list of personality disorders that make the patients feel and behave in ways that are socially upsetting. The disorder is marked with a sense of self-centeredness, an inflated vanity, a profound need for approbation and approval, a lack of identifying with feeling and thinking of others and a haughty attitude. All these features conceal an inner frail self-esteem and vulnerable nature. It affects the relations of the patient in various aspects of social life be it in the family, both at work and in relationships. The stuck-up, condescending, and brash attitudes of those that have the disorder make them socially incompatible with most people (Kohut, 2011).

The Diagnostic and Statistical Manual for Mental Disorders identifies the disorder with at least five of nine possible traits of the patients that have Narcissistic Personality Disorder. The persons with the disorder have a sense of pomposity and are preoccupied with fantasies and thoughts of power, success, perfect love, and admiration. They feel they are exceptional and unique in a way that they associate with people who have high social status. Moreover, they look down upon the low class cache of people within society. They require excessive admiration and approval in whatever they do, in their appearances and their possession. They also have a sense of entitlement and thus insist on the meeting of their expectations by other people. This also makes them have the need for favoritism in every aspect of life they partake due to their sense of grandiosity. Furthermore, they are exploitative in that they would use other people extensively to accomplish their ambitions oblivious of the strain they subject to the people. In addition, they do not have an inkling of what other people go through, feel of experience, and thus cannot associate with problems or successes of others. They are often envious or feel as though other people envy them. Arrogance is also prominent among these patients as they put their opinions ahead of other people’s opinion. This is cemented by the monopolizing of conversation and temper tantrums that are uncalled for most of the time (First, 1995).

The causes of the disorder center around biological, genetic, social, and psychological factor, or rather, bio-psychological model of causation. The patients may have had a case of overindulgence with their parents during their childhood. Excessive praise to one in their life also creates narcissism to a level that can lead to the personality disorder. Unreliable parenting could lead to the establishment of this disorder by making the child develop distorted thought, poor temperance, and lack of consideration for other people. The deception an individual gets from people around them can lead them to believe they are exclusively unique. This can also lead to the manifestation of the symptoms of Narcissistic Personality Disorder.

TREATMENT BY COGNITIVE THERAPY

Dr. Aaron T. Beck developed this therapy model to treat various psychological disorders without the need for medication. The American psychiatrist developed this model to modify the thoughts and behaviors of patients by altering their cognitive dysfunctions back to normal functioning. It was first tested on depression patients who earlier were psychoanalyzed based on the understanding that it was caused by interjected hostility. Dr. Beck based his treatments on the systematic preconceived notion that the patients held against themselves and their future. The finding of Dr. Beck in treatment of psychological disorders challenged the prevailing dogma in the 1960s. The treatment model has been integrated in to the treatment of several personality disorders such as schizophrenia, panic disorders, hallucinations, and even substance abuse. The therapy involves both the psychiatrist and the patient actively to build up the aspects of the disorder that require assessment and modification. (Beck, 2006) The therapy requires collaboration of the psychiatrist with the patient to spot dysfunctional thinking, behaviors, and emotional responses of the patient. The features of the patient that make them have the symptoms of the disorder are centered on during the psychiatric analysis. The patients then verify the objectivity of the thoughts, behaviors, and emotional responses they have that make them psychologically unfit with the help of the psychiatric analyst. These include subjective sensations and feelings of the patients and the negative expectations of the patients. They patient analyzes the suitability of their actions to themselves and society in a neutral way to come to a conclusion that their default thought and actions are not in order. (Perris, 1999) This realization of the cognitive distortion in a patient engenders the patient to change their line of thinking. Their previous assumptions that their actions were warranted for are challenged by this analysis. The case of Narcissist Personality disorder calls for a schema-focused cognitive therapy that focuses on their defective natures (Young, 2003). The cognitive dysfunctions in the patients include black and white thinking that makes them think that if something does not benefit them then it is not worth their consideration. They do not empathize with other people, and thus do not consider the effects they have on people. The monopolization of conversation is also an instance of black and white reasoning within the patients. Perfectionism is another behavior of the Narcissistic Personality disorder that needs to be addressed during the psychiatric sessions. This should make them realize that idealism makes coping with life difficult. The effects of this idealism of the patients make them unable to identify when they have crossed the line of trying to impress their conscience. They want extensive praise and take criticism harshly and personally. This shows that they require universal embracements of what they stand for. The analyst makes them realize the insignificance of most of the things that make them because uproars and feel wronged. Overreaction to the certain situation is analyzed to assess the need for such responses. All the symptoms of Narcissist Personality Disorder that manifest in the patient are analyzed to determine the anomalies within them after a critical analysis. The patient gets to understand the negative expectations and thoughts that they have that require to be adjusted. (Kellogg, 2006) The aim of this psychoanalysis is to shift the thinking of the patients. With the mutual agreement that the thoughts, behaviors, and emotional reactions of the patients are distorted, the patients have to change their thinking. They have to cope with their psychological and interpersonal problems from this point. The relation they have with other people changes after the change of their thinking. This culminates in a complete change of, and thus the treatment would have been completed. The narcissistic nature of the patient will have gone at the time the treatment will have ended.

TECHNIQUES IN BECK’S COGNITIVE THERAPY

The techniques used in this case include the use of guided discovery, collaborative empiricism, Socratic question, and systematic desensitization. (Löwe, 2005)

Guided discovery involves the active involvement of the patient in discovering the problems in their thoughts and behaviors. They document their actions by writing or word of mouth. They analyze their actions progressively to point out the anomalies that require to be adjusted to end the disorder. (Young J. E., 1994)

Collaborative empiricism involves both the psychiatrist and the patient in a work-involving task to analyze the thoughts and behaviors of the patient. The experiences of both the psychiatrist and the patient are incorporated to analyze the patients’ mental disorder.

Socratic questioning is used to determine the implication of misconceptions and to determine the facts behind the behaviors of the patients. Assumptions of the patients in various issues get uncovered, and the psychiatrist infers the impingements of these assumptions on the personality. Various aspects obtained from the analysis get used to relate the patient to their cognitive distortions. These are philosophies, theories, facts, problems, and issues concerning the patient. Systematic desensitization gets used to bring down the patient in case the symptoms of the disorder disable them from enacting the transference. The patients of Narcissistic Personality Disorder may have problems with the humbling nature of the psychiatric analysis. This technique allows further opening up on the issues behind their disorder by making them comfortable with the idea that they are not perfect.

 COGNITIVE THEORY

This cognitive therapy is based on the theory that suggests that the way an individual perceives him/herself plays a crucial role in the manifestation of emotions and behaviors. The treatment thus aims at modifying the way the patient think of himself or herself in a bid to eliminate the disorder. Beck’s cognitive therapy model for treatment and Ellis’ cognitive therapy employ this theory extensively in their modeling. (Higgitt, 1992) Research has shown that this theory receives support because it has built the knowledge of how people think and their perceptions too. This has garnered support for the theory and its associated therapies as it provides insight into the working of the mind. The theory also has significant support due to the positive findings it has had over the course of time. This has boosted its support and popularity in the professional and miscellaneous psychology arenas. (Ryle, 2000) Thoughts are abstract in nature and defining them is extremely difficult. This is a shortcoming of this theory, as there is no constant reference scale on which psychiatrists can standardize their findings. The success of this theory’s therapies garners support for it, but the personalities that are analyzed cannot be explained. The development of the personalities cannot be deciphered by this method of analyzing psychological disorders, and thus it receives harsh criticism for this loophole from behaviorists.

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