The Many Complexities in Treating and Studying Narcissism

In this commentary I examine conceptual and methodological issues in Dr. Riordan's (2012) presentation of three cases treated using Mitchell’s integrative model that combines aspects of Kernberg and Kohut's technical stances in the treatment of narcissism. Riordan proposes that Mitchell's integrative model provides a useful blend of Kernberg's focus on defense and Kohut's focus on empathy. He then provides case material to illustrate the benefits of Mitchell’s model. In discussing Riordan's paper, I focus on approaches to the case study method and present technical advances in Kernberg's approach that I believe address the concerns articulated by Riordan. These issues are examined in the current context of evidence-based practice.