Narcissism, Case Study Example

Joyce P comes into the agency, asking to meet with a counselor. She is a 28-year-old computer analyst, and was just laid off yesterday after six years at the same company. She presents in an extremely flamboyant way, dressing in bright, loud colors, gesticulating with her hands when speaking, saying hello to everyone she passes in the hallway walking down to my office. She begins by describing her skills, achievements, and successes personally and professionally, openly seeking confirmation from me that I am admiring her. She asks questions like, “Do do you think I look younger than my age? That’s what everyone says,” and “People think I’m a great dresser. Do you think my clothing stands out?” She expresses her belief that she was fired because people are jealous of her. For the same reason, she doesn’t have many friends, she reports. After nearly 45 minutes of this, when I let her know that there is only 15 minutes left, her demeanor changes entirely. She becomes weepy, asking, “I don’t know what’s wrong with me. Why would they fire me?” When she leaves the session, the flamboyance is completely absent and she looks defeated, looking down at the floor and unable to make eye contact when

This client was given the diagnosis of adjustment disorder with mixed disturbance of moods and conduct because she had just lost her job, and was exhibiting a wide range of extreme emotions, from exuberance and grandiosity to tears and depression within a matter of minutes.

The Axis II diagnosis of histrionic personality disorder is based on her presentation: she acts in an extremely dramatic and emotional manner that is designed to draw attention to herself. In addition, she is overly concerned with her appearance. The diagnosis of narcissistic personality

disorder is made based on her exaggerated sense of self-importance and her extreme focus on herself, as well as her active soliciting of admiration from others. The Axis III diagnosis reflects a lack of medical problems that are reported, at least at this point.

The Axis IV diagnosis reflects her current situation, the loss of her job within the last day as well as her ongoing and self-admitted problems interpersonally, stating that she has few friends.

The Global Assessment Score of 55 reflected difficulties that she has in her job situation as well as her social situation.

Other clinicians could conceivably give this client a diagnosis of Adjustment Disorder with Depressed Mood, or Adjustment Disorder with Mixed Emotional Features. In addition, it would be reasonable to view this client as someone with bipolar illness, certainly something to rule out given her mood swings within the one session. One would need to explore and/or experience her pattern of mood swings over time.

Other clinicians could also find that the client has Mixed Personality Disorder or Personality Disorder NOS.

This client’s issues could be addressed by using solution-focused therapy, an approach that assumes that all clients have some idea about what would improve their lives, and that all people who are seeking help already have at least the minimum resources that they need to establish the solutions to their problems. One would ask Linda, “Have you had this kind of problem in the past?” and “What have you done in those instances to help resolve the problem?” The questions that would be asked of Linda would be focused on the present and the future, rather than past issues. An important part of solution-focused therapy is compliments that are designed to reinforce and validate the things that Linda is doing well and acknowledging that she has faced some valid struggles. Linda would then be encouraged to continue to do more of the things that have been working and have been successful coping mechanisms for her.

Szasz did not believe in the concept of mental illness, so that he would have viewed this client as someone who has experienced problems in her lifestyle, psychosocial issues including occupational issues, family problems, social and interactional problems, and those would be the areas that would be the focus of her work. In fact, this without substantially change the way that I would view this case, because I would be focusing on those issues as well in an effort to help this client develop a more successful way of relating to people so that her histrionic and narcissistic presentation would not continue to sabotage her relationships.

This client would be an ideal person with whom to utilize the theory of relational competence, since L’Abate’s focus was on the set of characteristics that people use in order to form successful social and familial relationships, certainly a goal for any work with Linda. The initial relationship that would hopefully begin a different pattern for Linda would be the relationship with me, the therapist, and once she experienced a successful and positive outcome in our connection, she would hopefully be motivated to transfer those relational skills onto her connections with others.