Dialogical Relationship Patterns in Narcissistic Personalities: Session Analysis and Treatment Implications

Patients with narcissistic features are difficult to treat in psychotherapy, in particular because of problems in building sound therapeutic relationships with them. Therapists can get easily involved in dysfunctional relationship patterns that have a negative impact on the therapeutic alliance. Tracing the typical patterns that can recur in persons with narcissistic features should, therefore, prove useful in helping therapists to recognize their involvement in them at an early treatment stage and to deal with them effectively. A dialogical theory of the self offers a promising perspective from which to recognize and describe these patterns. From this vantage point, we discuss the treatment of a client diagnosed as having a narcissistic personality. What occurred during this therapy lends support to the idea that there are typical dialogical relationship patterns in patients with narcissistic features and that knowing them might help therapists to make treatment effective, avoid early dropouts, and successfully manage the therapeutic relationship. In addition, we put forward the hypothesis that some of the therapeutic techniques described here also can be applied to other patients displaying similar narcissistic features.     

On Countertransference

Drawing on non-clinical experience and with reference to relevant literature, this article examines countertransference and its impact on the development of a secure frame, focusing in particular on the countertransference dream and on its significance within the therapeutic relationship.     

Questioning the preparatory function of counterfactual thinking

Why do individuals mentally modify reality (e.g., “If it hadn’t rained, we would have won the game”)? According to the dominant view, counterfactuals primarily serve to prepare future performance. In fact, individuals who have just failed a task tend to modify the uncontrollable features of their attempt (e.g., “If the rules of the game were different, I would have won it”), generating counterfactuals that are unlikely to play any preparatory role. By contrast, they generate prefactuals that focus on the controllable features of their ensuing behavior (e.g., “If I concentrate more, I will win the next game”). Here, we test whether this tendency is robust and general. Studies 1a and 1b replicate this tendency and show that it occurs regardless of whether individuals think about their failures or their successes. Study 2 shows that individuals generate relatively few controllable counterfactuals, unless explicitly prompted to do so. These results raise some questions regarding the generality of the dominant view according to which counterfactuals mainly serve a preparatory function.     

Lexicality and Stimulus Length Effects in Italian Dyslexics: Role of the Overadditivity Effect

The effect of lexicality and stimulus length was studied in 32 third- and fourth-grade Italian dyslexics and in 86 age-matched controls. A visual lexical decision task was used. As proposed by Faust et al. (1999) Faust, M. E., Balota, D. A., Spieler, D. H. and Ferraro, F. R. 1999. Individual differences in information-processing rate and amount: Implications for group differences in response latency. Psychological Bulletin, 125: 777–799. [INFOTRIEVE][CROSSREF][CSA][Crossref], [PubMed], [Web of Science ®] , [Google Scholar], the results were analyzed in terms of raw reaction time (RT) data and using the z-score transformation to control for the presence of overadditivity effects. In terms of RTs, dyslexics showed a larger difference between words and nonwords (lexicality effect) and between short and long stimuli (length effect) than proficient readers. When data were transformed into z scores, only the group by length interaction remained significant while that with lexicality vanished. This pattern indicates that stimulus length has a specific role in Italian dyslexics’ reading deficit; in contrast, slowness in responding to nonwords was not specific but was interpreted as one aspect of dyslexics’ general inability to deal with alphabetical material (overadditivity effect).     

Laboratory of functional neuroelectrical imaging and brain–computer interfacing at Fondazione Santa Lucia

The laboratory of functional neuroelectrical imaging and brain–computer interfacing at Fondazione Santa Lucia is based on the joint work of researchers with a bioengineering and clinical neurophysiology background. The activity is mainly devoted to two aims: the non-invasive investigation of the motor cortical function under physiological and pathological conditions, through the development of advanced processing methods of the electroencephalographic signals; the development of a real-time EEG-based brain–computer interface (BCI) and the study of its use as an aid to enhance (or even to allow) the functional independence of persons with different degrees of motor disability.     

The impact of orbital prefrontal cortex damage on emotional activation to unanticipated and anticipated acoustic startle stimuli

Damage to the orbital prefrontal cortex has been implicated in selectively diminishing electrodermal autonomic nervous system responses to anticipated punishing stimuli (e.g., losing money; Bechara, Damasio, & Damasio, 2000), but not to unanticipated punishing stimuli (e.g., loud noises; Damasio, Tranel, & Damasio, 1990). We extended this research by examining the effects of orbitofrontal damage on emotional responses to unanticipated and anticipated acoustic startles and collecting a more extensive set of physiological measures, emotional facial behavior, and self-reported emotional experience. Consistent with previous research, patients showed intact physiology to an unanticipated startle but failed to show appropriate anticipatory cardiovascular responses (patients’ heart rates decreased, controls’ increased). In addition, patients displayed more surprise facial behavior and reported marginally more fear than did controls in response to the unanticipated startle. Thus, orbitofrontal damage may compromise the ability to anticipate physiologically the onset of aversive stimuli, despite intact or enhanced emotional responses when such stimuli occur unexpectedly.