Pathological narcissistic traits interfere with patients’ interpersonal perceptions during psychological treatment

Pathological narcissism manifests along a continuum from subclinical to clinical forms, and with presentations of both grandiosity and vulnerability. It is associated with deviations from consensual perceptions of both self and others, but no study investigates such deviations in a clinical context. This contribution examines whether pathological narcissism accounts for distinctiveness (construal) of patients’ interpersonal perceptions in treatment settings. Patients enrolled in psychological treatment (N = 150) were asked to provide a written description of a segment of a treatment session. Based on the descriptions obtained, both the patients and independent raters evaluated how dominant and hostile clinicians and patients were during these session segments. The degree of discrepancy between patients’ and raters’ perceptions of interpersonal behavior was computed and regressed onto patients’ traits of pathological narcissism. Contrary to expectations, pathological narcissism was not related to patient-rater discrepancies in the way clinicians were perceived. However, patients’ grandiose narcissism was related to discrepancies in perceptions of self-dominance (i.e., self-perceptions of dominance higher than rater-perceptions); and patients’ vulnerable narcissism was related to discrepancies in perceptions of self-hostility (i.e., self-perceptions of hostility higher than rater-perceptions). The former association (but not the latter) also held after incorporating additional raters’ assessments in post-hoc procedures. Results are interpreted in light of self-enhancement and self-concealment processes, which should be detected for effective treatment of narcissism-related themes.