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 Narcissism: 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 narcissism: 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.

Robert P. Drozek, Instructor, Department of Psychiatry, Harvard Medical School,Brandon Unruh, Teaching Associate, Department of Psychiatry, Harvard Medical School,Anthony Bateman, Visiting Professor, University College London

Robert P. Drozek, LICSW, is a staff psychotherapist in the Personality Disorders Service and Division of Alcohol, Drugs, and Addiction at McLean Hospital. He serves as a supervisor in the Mentalization-based Treatment (MBT) Clinic at McLean; a teaching associate in the Department of Psychiatry at Harvard Medical School; and an MBT trainer and supervisor through the Anna Freud Centre in London. His publications examine the interface between psychotherapy and ethics, with an emphasis on the role of ethics in the patient's therapeutic change. He is author of the book Psychoanalysis as an Ethical Process (2019). He maintains a private practice in Belmont, Massachusetts.


Brandon T. Unruh, MD, is the medical director of the Gunderson Residence and founding director of the Mentalization-based Treatment (MBT) Clinic at McLean Hospital. He is an instructor in psychiatry at Harvard Medical School, and an MBT trainer and supervisor through the Anna Freud Centre in London. His clinical approach is anchored in the practice of evidence-based treatments for personality disorders, including MBT, dialectical behaviour therapy, transference-focused psychotherapy, and good psychiatric management. His core academic publications and interests are in the areas of personality disorders, suicidality, spirituality, and flourishing. He is co-editor of the book Borderline Personality Disorder: A Case-based Approach (2018). He has a private practice in Cambridge, Massachusetts.


Anthony W. Bateman MA, FRCPsych, is a consultant psychiatrist, psychotherapist, and MBT Consultant to the Anna Freud National Centre for Children and Families; a Visiting Professor at University College, London; and an Honorary Professor in Psychotherapy at the University of Copenhagen. With Peter Fonagy, he developed Mentalization-based Treatment for borderline personality disorder, studying its effectiveness in research trials. He has authored, co-authored, and edited 17 books, including Mentalization-based Treatment for Personality Disorders: A Practical Guide (2016), and Introduction to Psychoanalysis, Second Edition (2021). He has published numerous book chapters, and over 150 peer reviewed research articles on personality disorder and the use of psychotherapy in psychiatric practice.

Mentalization and pathological narcissism
Introduction to pathological narcissism and Mentalization-based Treatment
A mentalization-based model of pathological narcissism
Beginning the treatment
Assessment and diagnosis of pathological narcissism
The therapeutic approach
Therapeutic stance and clinical principles
Content-focused interventions
Context-focused interventions
Process-focused interventions: Pretend mode
Process-focused interventions: Psychic equivalent mode
Process-focused interventions: Teleological mode
Mentalizing the therapeutic relationship: Auxiliary relational techniques
Mentalizing the therapeutic relationship: The interventional pathway
Clinical applications
Moving forward in the treatment
Case example: After the “accident”
Case example: I-mode, me-mode, and we-mode in clinical process
Case example: William the firefighter