This study used Q methodology to explore clinicians' perspectives regarding optimal psychotherapy process in the treatment of
pathological narcissism, a syndrome of impaired self-regulation. Participants were 34 psychotherapists of various disciplines and theoretical orientations who reviewed 3 clinical vignettes portraying hypothetical cases of grandiose narcissism, vulnerable narcissism, and
panic disorder without
pathological narcissism. Participants then used the Psychotherapy Process Q set, a 100-item Q-sort instrument, to indicate their views regarding optimal
therapy process for each hypothetical case. By-person principal components analysis with varimax rotation was conducted on all 102 Q-sorts, revealing 4 components representing clinicians' perspectives on ideal
therapy processes for narcissistic and non-narcissistic patients. These perspectives were then analyzed regarding their relationship to established
therapy models. The first component represented an introspective, relationally oriented
therapy process and was strongly correlated with established psychodynamic treatments. The second component, most frequently endorsed for the
panic disorder vignette, consisted of a cognitive and alliance-building approach that correlated strongly with expert-rated cognitive-behavioral therapy. The third and fourth components involved
therapy processes focused on the challenging interpersonal behaviors associated with narcissistic vulnerability and grandiosity, respectively. The perspectives on
therapy processes that emerged in this study reflect different points of emphasis in the treatment of
pathological narcissism, and may serve as prototypes of therapist-generated approaches to patients suffering from this issue. The findings suggest several areas for further empirical inquiry regarding psychotherapy with this population. (PsycINFO Database Record