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This study, based on a qualitative review of therapists\u2019 case reports of individual psychotherapy with eight patients diagnosed with NPD, is the first to identify and explore patterns, processes, and indicators of change in pathological narcissism. All patients showed significant improvement in personality and life functioning, including engagement in work or education and long-term close relationships, with remission of the NPD diagnosis. The process of change was gradual, with some noticeable changes occurring in specific life contexts. Additional factors indicating and contributing to change included patients\u2019 motivation and commitment to psychotherapy, reflective ability, emotion regulation, sense of agency, and interpersonal and social engagement.<\/jats:p>","DOI":"10.1521\/pedi.2023.37.3.337","type":"journal-article","created":{"date-parts":[[2023,6,27]],"date-time":"2023-06-27T15:06:33Z","timestamp":1687878393000},"page":"337-357","source":"Crossref","is-referenced-by-count":24,"title":["Narcissistic Personality Disorder: Patterns, Processes, and Indicators of Change in Long-Term Psychotherapy"],"prefix":"10.1521","volume":"37","author":[{"given":"Elsa","family":"Ronningstam","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"Weinberg","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"377","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1521\/pedi.2018.32.supp.143"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1037\/per0000061"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1002\/9781118093108.ch40"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2014.14060723"},{"key":"ref6","volume-title":"Transformation in psychotherapy: Corrective experiences across cognitive behavioral, humanistic, and psychodynamic approaches","author":"Castonguay L. 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