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This study examined clinician emotional responses and therapeutic alliance in psychotherapy with adolescent patients with specific subtypes of narcissistic personality disorder (NPD). A national sample of therapists (N = 58) completed the Therapist Response Questionnaire for Adolescents to identify patterns of clinician response, the Working Alliance Inventory to evaluate the quality of alliance, and the Shedler-Westen Assessment Procedure-II for Adolescents to assess the personality pathology of a patient in their care. The results showed that the grandiose narcissistic subtype was positively related to angry/criticized and disengaged/hopeless therapist responses and negatively related to warm/attuned response. The fragile subtype was positively related to overinvolved/worried therapist response. The high-functioning/exhibitionistic subtype was negatively related to angry/criticized response. Lower quality of therapeutic alliance was positively associated with the grandiose subtype. Moreover, the empirically founded prototypes of therapist responses to adolescent patients with NPD subtypes strongly resemble theoretical-clinical accounts. The clinical implications are addressed.

This study examined the factor structure and psychometric properties of the Therapist Response Questionnaire for Adolescents (TRQ-A), an 86-item clinician-report instrument measuring a wide range of thoughts, feelings, and behaviors expressed by therapists toward their adolescent patients. A sample of psychodynamic and cognitive-behavioral clinicians (