The role of couple therapy in the treatment of narcissistic personality disorder.

Recommendations for psychotherapeutic management of patients with narcissistic personality disorder are based on clinical experience; however, little attention has been given to the role of couple therapy with these patients. A stable intimate relationship appears to positively affect the course and outcome of narcissistic personality disorder. Based on clinical experience with narcissistic individuals in couple therapy and using a psychoanalytic framework, three characteristics that differentiate couples who will from those who will not benefit from couple therapy are described. These characteristics are the ability of the narcissistic individual to curtail acting out, the narcissistic vulnerability as evidenced by their level of defensiveness, and the couple's complementarity of narcissistic gratification. Two clinical examples are given to demonstrate the usefulness of the proposed characteristics in deciding on the appropriateness of couple therapy.