Child and parent variables associated with treatment response in narcissistic youths: the role of self-blame and shame

this retrospective study aimed at exploring the impact of parental and youth narcissism on service utilization and response to psychotherapy. thirty-six 9-13 years-old narcissistic youths receiving a combined treatment (psychodynamic psychotherapy + parental counselling) were independently assessed for child pathological narcissism, parental narcissism, child's treatment attitude and psychiatric/ psychosocial services utilization. Parent and child narcissistic characteristics were negatively correlated with the use of OPD services. Child self-blame and lack of empathy predicted a lesser OPD utilization. Child pathological narcissism was significantly correlated with the specific treatment response pattern composed of the set of attitudes consistently observed in psychotherapy with narcissistic youths. Sixty percent of the variance in treatment response was accounted for by four narcissistic characteristics of the child: devaluation of others, avoidance of vulnerability, boredom, and self-blame. Post hoc analyses highlighted the role of the child's self-blame, which mediated the relation between parental narcissism and service use while acting as a moderator in reversing the relation between parent narcissism and treatment response. Relationships between self-blame, shame-proneness and guilt, and limitations of the study are discussed. Prospective studies with a larger sample are needed to confirm the association between self-blame and response to treatment in narcissistic youths.