What do you think?
Rate this book
Mentalization-Based Treatment for Pathological Narcissism: A Handbook
Despite the growing cultural and empirical interest in narcissism and narcissistic personality disorder, therapists often feel confused and overwhelmed about how to help patients struggling with these problems. “Mentalization” refers to the ability to read, access, and reflect on mental states in oneself and other people. Research shows that people with narcissism can suffer from extreme difficulties mentalizing themselves and others, leading to
instability in their mood, interpersonal relationships, and sense of self.
Mentalization-based Treatment for Pathological A Handbook provides much needed guidance about how to effectively help patients suffering from narcissistic vulnerabilities. Mentalization-based treatment, or MBT, is an evidence-based therapy for patients with personality disorders, helping patients to reflect on mental states in themselves and others, resulting in significant improvements in everyday functioning.
This book reviews the deficits in mentalizing associated with pathological narcissism, describes how to give the diagnosis of narcissism to patients, outlines how to structure therapy sessions, and offers step-by-step techniques about “what to do and say” when sitting with these patients. Utilizing vibrant case examples and verbatim scripts from actual psychotherapies, the authors explain how to address the most common clinical challenges associated with disconnection
from emotions; impairments in empathy; rigid thinking; monologues and intellectualization; unstable self-esteem; and tendencies to blame other people for disruptions in their relationships.
instability in their mood, interpersonal relationships, and sense of self.
Mentalization-based Treatment for Pathological A Handbook provides much needed guidance about how to effectively help patients suffering from narcissistic vulnerabilities. Mentalization-based treatment, or MBT, is an evidence-based therapy for patients with personality disorders, helping patients to reflect on mental states in themselves and others, resulting in significant improvements in everyday functioning.
This book reviews the deficits in mentalizing associated with pathological narcissism, describes how to give the diagnosis of narcissism to patients, outlines how to structure therapy sessions, and offers step-by-step techniques about “what to do and say” when sitting with these patients. Utilizing vibrant case examples and verbatim scripts from actual psychotherapies, the authors explain how to address the most common clinical challenges associated with disconnection
from emotions; impairments in empathy; rigid thinking; monologues and intellectualization; unstable self-esteem; and tendencies to blame other people for disruptions in their relationships.
429 pages, Kindle Edition
Published August 15, 2023
15 people are currently reading
28 people want to read
Ratings & Reviews
Friends & Following
Create a free account to discover what your friends think of this book!
Community Reviews
Displaying 1 - 2 of 2 reviews
January 5, 2025
cw: sexual assault, psychosis, suicide
i: shitty unwelt of forever ago
I've been putting off this review, because I've been scared of not doing it justice. Because it feels like everything in my trauma recovery arc has led to this point of cataclysmic and terrifying self-recognition. I was raised by two narcissistic parents. For twenty years, I was miserable and lonely. Before learning about trauma, I vacillated between blaming the world and blaming myself. To put it in pseud terms, I believed life was suffering. I couldn't understand social conventions. I felt like I had to perform to keep friends. Whenever I expressed my feelings of despair and terror, I was met with confusion, dismissal, and withdrawal. By my mid-twenties I had cut off ties to my high school friends, sequestered myself into a hikikomori lifestyle of obscure anime, lolicore, and poststructuralist classics, and started doing cough syrup, acid, and molly.
The thing that jolted me out of this self-destructive spiral was a sexual assault. A bandmate forced themselves on me. This was at a time when I was exploring my gender. I brought it up with two other bandmates and they were strangely apologetic to the perpetrator. So I stopped talking about it. I started Honours, but couldn't stop shaking in class. I couldn't walk to campus without breaking into tears. I thought everyone on the street was looking at me, and I couldn't dissociate their looks from violation. I had delirious nightmares about eyes. Bodies transformed into obscene commodities. Capital as a metaphysical force that violates, even as it nourishes. Then, I discovered trauma studies, and everything fell into place. I had PTSD.
So, how does this tie to narcissism? Well, narcissism is a defence mechanism for when your social relations have failed you. Because no one was looking out for me, I developed hypervigilance, a nervous disorder deeply adaptive to a world filled with evil: people who pretend to be your friend so they can take advantage of you; people who violate others without thought because violation is commonplace in their lives. Under such conditions, hypervigilance becomes a survival tactic. As I explored trauma studies further, I started to see this pattern throughout my whole life. A procession of grotesque and tragic responses tied to projection, delusion, and psychosis.
One time, I was on acid, piloting the visuals to a friend's gig with a PS4 controller. As the set progressed, he appeared more and more anxious. His forehead glistened with sweat. He stopped multiple times to look at his bandmate, like he wasn't sure what to do. I started to cry, because he was trapped with everyone's attention on him, and no possibility of escape. At the end of the set, I ran up to him, hugged him with a blanket, and asked if he was okay. He replied, "Yeah, that was awesome." I was floored—and it hit me. I'd only ever read social situations through the stages of my own trauma. I hadn't seen my friend on stage, I'd seen myself, and I'd cried at the awfulness of that scene. It wasn't a profound moment of empathy, but the opposite—narcissism. My friend was having the time of his life, while I was trapped watching a projection of dead images from the past.
Another time, I wanted to reach the DMT threshold. I was a dirty agnostic, desperately curious about what kind of guardian(s) lay dormant in me. I took 3x more DMT than I should have. I had an immediate psychotic break. I forgot where I was. My thoughts became incoherent. My vision swirled. It was like my body had become a foreign mosaic. I can't describe how utterly alien everything became. My first coherent thought was that someone had poisoned me. That I was at a party, and my drink had been spiked with LSD. They did it to hurt me, to see what would happen. An act of pure malice. It was such a high dose that I would never come back. I'd be a mumbling wreck, unable to communicate anything to my friends, for the rest of my life. After an hour, the psychosis left. I was shaken for months, because I realised there was no guardian, no guiding force, no god in my life, just suffering I cause myself, unwittingly.
This is what narcissism feels like. Being trapped in your own evil fucking world, haunted by attachment wounds, and driven by overwhelming fear, loneliness, and self-hatred. It's not cold manipulation and antisocial glee, but crippling insecurity, paranoia, and shame. It's believing you'll never get out of this space, no matter how hard you try, because you carry yourself everywhere. And it's abjecting this terror out, so you can create some semblance of being, no matter how fragile. The alternative is suicide. While the memories I've mentioned are peak moments of delusional narcissism, they're emblematic of my day to day struggles with anxiety and depression.
ii: attachment wounding and its consequences
While growing up, my needs were not met, nor recognised. This developed into alexithymia. As a kid, I would get overwhelmed, but not be able to identify the feeling, nor the reason behind it. My father predominantly validated my academic pursuits, and my mother overstated the extent of my achievements to relatives. I was humiliated for engaging with anything outside of the norm, like veganism, shamed for having a sexuality, and given no guidance to affection and consent. Together, these processes of undervaluation (of my emotional needs) and overvaluation (of my parents' aspirations) led to perfectionism—an unhealthy striving for social recognition, driven by shame. Nothing I did felt good enough, because I was always looking for goodness outside of myself.
Drozek, Unruh, and Bateman call this disorder Vulnerable Narcissism. Unlike Grandiose Narcissism, it's the image of oneself in the Other that gives stability. However, as those of you who've seen Evangelion will know, this image can never stabilise. Hegelians, Existentialists, and Lacanians will say something about the image's mutability in the mind of the Other, or its impossible transmission across the gap of subjectivity, but for the Vulnerable Narcissist the problem is that the image itself will never be enough. Your parents say so. They dog your mind, no matter how accomplished you become. Your father will stop paying attention to you the moment your achievement is past, and your mother will suck the life out of your achievement by reframing it as her own. Fuck the image, that's not what matters—it's your fucking soul that's dead, and no image from the Other will resuscitate it.
One time, after a suicide attempt, my mother said "Why would you do something so stupid?" After months of being bedridden, my father said "Lying around all day won't help." I was once filled with rage at these moments, but now I just feel sad. They're two people, so deep in their narcissisms, that they can't begin to understand another being. They live in total ignorance of their projections, unable to approach the world with genuine curiosity. They believe that if something doesn't work, it's the thing's fault, not the relation between person and thing. That if a child is suffering, the child, rather than the parent, needs to see a therapist. For the longest time, I wanted nothing to do with them. For a few years, I wanted to help them. Now, I know I can only focus on myself. Their lives are not for me to solve, nor resent, but to learn from, and never repeat ever again.
iii: my anxiety has taken me into its demiurgic maw rendering this review void and incomplete. please leave a comment asking for elaboration instead, so we can short circuit my perfectionism into a carefree yarn amongst friends, with nothing but the warm breeze of solidarity on our backs.
asdfghagssdgfs
i: shitty unwelt of forever ago
I've been putting off this review, because I've been scared of not doing it justice. Because it feels like everything in my trauma recovery arc has led to this point of cataclysmic and terrifying self-recognition. I was raised by two narcissistic parents. For twenty years, I was miserable and lonely. Before learning about trauma, I vacillated between blaming the world and blaming myself. To put it in pseud terms, I believed life was suffering. I couldn't understand social conventions. I felt like I had to perform to keep friends. Whenever I expressed my feelings of despair and terror, I was met with confusion, dismissal, and withdrawal. By my mid-twenties I had cut off ties to my high school friends, sequestered myself into a hikikomori lifestyle of obscure anime, lolicore, and poststructuralist classics, and started doing cough syrup, acid, and molly.
The thing that jolted me out of this self-destructive spiral was a sexual assault. A bandmate forced themselves on me. This was at a time when I was exploring my gender. I brought it up with two other bandmates and they were strangely apologetic to the perpetrator. So I stopped talking about it. I started Honours, but couldn't stop shaking in class. I couldn't walk to campus without breaking into tears. I thought everyone on the street was looking at me, and I couldn't dissociate their looks from violation. I had delirious nightmares about eyes. Bodies transformed into obscene commodities. Capital as a metaphysical force that violates, even as it nourishes. Then, I discovered trauma studies, and everything fell into place. I had PTSD.
So, how does this tie to narcissism? Well, narcissism is a defence mechanism for when your social relations have failed you. Because no one was looking out for me, I developed hypervigilance, a nervous disorder deeply adaptive to a world filled with evil: people who pretend to be your friend so they can take advantage of you; people who violate others without thought because violation is commonplace in their lives. Under such conditions, hypervigilance becomes a survival tactic. As I explored trauma studies further, I started to see this pattern throughout my whole life. A procession of grotesque and tragic responses tied to projection, delusion, and psychosis.
One time, I was on acid, piloting the visuals to a friend's gig with a PS4 controller. As the set progressed, he appeared more and more anxious. His forehead glistened with sweat. He stopped multiple times to look at his bandmate, like he wasn't sure what to do. I started to cry, because he was trapped with everyone's attention on him, and no possibility of escape. At the end of the set, I ran up to him, hugged him with a blanket, and asked if he was okay. He replied, "Yeah, that was awesome." I was floored—and it hit me. I'd only ever read social situations through the stages of my own trauma. I hadn't seen my friend on stage, I'd seen myself, and I'd cried at the awfulness of that scene. It wasn't a profound moment of empathy, but the opposite—narcissism. My friend was having the time of his life, while I was trapped watching a projection of dead images from the past.
Another time, I wanted to reach the DMT threshold. I was a dirty agnostic, desperately curious about what kind of guardian(s) lay dormant in me. I took 3x more DMT than I should have. I had an immediate psychotic break. I forgot where I was. My thoughts became incoherent. My vision swirled. It was like my body had become a foreign mosaic. I can't describe how utterly alien everything became. My first coherent thought was that someone had poisoned me. That I was at a party, and my drink had been spiked with LSD. They did it to hurt me, to see what would happen. An act of pure malice. It was such a high dose that I would never come back. I'd be a mumbling wreck, unable to communicate anything to my friends, for the rest of my life. After an hour, the psychosis left. I was shaken for months, because I realised there was no guardian, no guiding force, no god in my life, just suffering I cause myself, unwittingly.
This is what narcissism feels like. Being trapped in your own evil fucking world, haunted by attachment wounds, and driven by overwhelming fear, loneliness, and self-hatred. It's not cold manipulation and antisocial glee, but crippling insecurity, paranoia, and shame. It's believing you'll never get out of this space, no matter how hard you try, because you carry yourself everywhere. And it's abjecting this terror out, so you can create some semblance of being, no matter how fragile. The alternative is suicide. While the memories I've mentioned are peak moments of delusional narcissism, they're emblematic of my day to day struggles with anxiety and depression.
ii: attachment wounding and its consequences
While growing up, my needs were not met, nor recognised. This developed into alexithymia. As a kid, I would get overwhelmed, but not be able to identify the feeling, nor the reason behind it. My father predominantly validated my academic pursuits, and my mother overstated the extent of my achievements to relatives. I was humiliated for engaging with anything outside of the norm, like veganism, shamed for having a sexuality, and given no guidance to affection and consent. Together, these processes of undervaluation (of my emotional needs) and overvaluation (of my parents' aspirations) led to perfectionism—an unhealthy striving for social recognition, driven by shame. Nothing I did felt good enough, because I was always looking for goodness outside of myself.
Drozek, Unruh, and Bateman call this disorder Vulnerable Narcissism. Unlike Grandiose Narcissism, it's the image of oneself in the Other that gives stability. However, as those of you who've seen Evangelion will know, this image can never stabilise. Hegelians, Existentialists, and Lacanians will say something about the image's mutability in the mind of the Other, or its impossible transmission across the gap of subjectivity, but for the Vulnerable Narcissist the problem is that the image itself will never be enough. Your parents say so. They dog your mind, no matter how accomplished you become. Your father will stop paying attention to you the moment your achievement is past, and your mother will suck the life out of your achievement by reframing it as her own. Fuck the image, that's not what matters—it's your fucking soul that's dead, and no image from the Other will resuscitate it.
One time, after a suicide attempt, my mother said "Why would you do something so stupid?" After months of being bedridden, my father said "Lying around all day won't help." I was once filled with rage at these moments, but now I just feel sad. They're two people, so deep in their narcissisms, that they can't begin to understand another being. They live in total ignorance of their projections, unable to approach the world with genuine curiosity. They believe that if something doesn't work, it's the thing's fault, not the relation between person and thing. That if a child is suffering, the child, rather than the parent, needs to see a therapist. For the longest time, I wanted nothing to do with them. For a few years, I wanted to help them. Now, I know I can only focus on myself. Their lives are not for me to solve, nor resent, but to learn from, and never repeat ever again.
iii: my anxiety has taken me into its demiurgic maw rendering this review void and incomplete. please leave a comment asking for elaboration instead, so we can short circuit my perfectionism into a carefree yarn amongst friends, with nothing but the warm breeze of solidarity on our backs.
asdfghagssdgfs
May 18, 2024
Excellent book. I found this book really helpful in better understanding MBT as well as MBT-N. I really appreciated the case examples at the end.
Displaying 1 - 2 of 2 reviews