Question: Narcissism. a grossly inflated sense of self importance with an unquenchable need for adoration, is increasingly being diagnosed by psychiatrists as the underlying problem in patients who complain of other problems, such as inability to sustain relationships or severe depression after minor failure. Narcissism can produce exciting sports, entertainment, and political figures, who typically are charming and friendly to those who play into their needs for praise, superiority, or special treatment. However, narcissism can also produce petty office tyrants and obsessed workaholics. Typically, underneath the narcissist feels life is empty and him-or herself worthless. Treating such patients can be especially difficult, according to New York Times article. "Narcissism Looms Larger as Root of Personality Woes." (November 1, 1988, C1). Narcissists tend to be exploitative and insensitive to other's feelings and find it difficult to form the warm therapist-patient bond that other patients find natural. "Instead, they often become cold or even enraged when a therapist fails to play along with their inflated sense of themselves." This puts therapists in an untenable position because they must eventually deflate the narcissist's protective but self-deluding bubble.

Narcissists confront disapproval or hurt (even minor disapproval or minor hurt) with sharp rage or deep \, depression. "A narcissist patient," according to one \ quoted therapist. "is likely at some point to attack or devalue the therapist. It's hard to sit with such people in your office."

Suppose the psychiatry department of a Massachusetts hospital conducted a 1-year study comparing various treatment methods with the following results:

Assuming valid random samples, test at .05 whether differences in the level of improvement can be attributed to chance fluctuation or, indeed, to actual differences among the four treatments.