A Psychodynamic Approach to the Diagnosis and Treatment of Closet Narcissism

The purpose of this article was to increase awareness of an alternative presentation of narcissistic personality disorder, offer treatment strategies specifically geared toward such patients, and demonstrate how an understanding of object relations and defense mechanisms can guide interventions and improve diagnostic refinement. A case study was presented to illustrate this approach. This case study draws mainly from James Masterson’s developmental, self, and object relations approach to the treatment of closet narcissism. Additional psychodynamic theories were also incorporated to provide a more comprehensive conceptualization of the client. Treatment consisted of psychodynamic therapy in which therapeutic neutrality, and analysis of the transference were core features.