Pathological narcissism and therapeutic alliance: Evaluating the mediating role of interpersonal problems and the moderating role of psychotherapy motivation

This study aims to (1) examine the relationship between narcissism and therapeutic alliance; (2) compare vulnerable and grandiose narcissism in terms of therapeutic alliance; (3) compare vulnerable and grandiose narcissism in terms of their total scores on interpersonal problems; (4) compare vulnerable and grandiose narcissism in terms of their scores on sub-domains of interpersonal problems; (5) investigate direct and indirect (via interpersonal problems) relationships between pathological narcissism and therapeutic alliance, also to examine the moderating role of psychotherapy motivation on both direct and indirect (via interpersonal problems) relationships between pathological narcissism and therapeutic alliance. The sample of this study consists of 361 adults who are undergoing psychotherapy for at least 3 sessions. Pathological Narcissim Inventory (PNI), Working Alliance Inventory Short Form (WAI-S), Inventory of Interpersonal Problems Circumplex Scales (IIP-C) and Client Motivation for Therapy Scale (CMTS) were used to collect data. The results revealed that (1) there was a significant, negative correlation between narcissism and therapeutic alliance; (2) participants whith high scores of vulnerable narcissism scored significantly higher on therapeutic alliance than participants with high scores of grandiose narcissism; (3) participants whith high scores of vulnerable narcissism scored significantly higher on interpersonal problems than participants with high scores of grandiose narcissism; (4) participants with high scores of vulnerable narcissism scored significantly higher on cold/distant, socially avoidant, nonassertive, exploitable and overly nurturant subscales than participants with high scores of grandiose narcissism; while participants with high scores of grandiose narcissism scored significantly higher on domineering/controlling and vindictive subscales than participants with high scores of vulnerable narcissism. No significant difference was found on the intrusife sub-scale. Lastly, (5) interpersonal problems was found to have a mediating role in the relationship between narcissism and therapeutic alliance; psychotherapy motivation was found to have a moderating role both in the relationship between narcissism and therapeutic alliance and in the relationship between interpersonal problems and therapeutic alliance.