Frances spends the session grappling with her relationship with her dying sister and her angry teenage daughter. She wants Paul to feed her--she's hungry and he must have food, after all he lives here--but he refuses.
She leaves the stage to be with her sister after months of estrangement. They have a nice moment after Frances rescues the sister, bathes her, and puts her to bed. But it's short lived--the sister wakes up confused and needs to go to the hospital.
Frances has a tendency to look at all of her interactions as centering on herself. Her sister's warm declarations become meaningless when replaced by febrile mumblings. Paul's look is skeptical. She feels constantly judged and she looks for repeated approval and reassurance. Her daughter hates her, and it can't just be that the daughter is a teenager who is struggling with her aunt's terminal illness, her parent's divorce, and the tumultuous world of teenagers, it has to be about Frances. Ah, the teenager says Frances is a narcissist and that's untreatable. Is this true?
From my point of view, I don't believe that people change their personalities much. But therapy does seem to help people re-frame things, recognize their patterns, say "oh, I'm doing that again" and question what is going on. If I don't think I can "fix" something, I work on reframing it in a positive way. Most traits can be both good and bad, and the choice of words makes all the difference in the world. A shrink might tell Frances that it seems to be true that she likes being the center of attention, most actresses do, and it's a pretty helpful characteristic to have if you're going to be the star of the show. But maybe the sister's death isn't about Frances, and maybe she shouldn't take everyone else's distress too personally.
Ah, and here's a link to an editorial in the NY Times about the fate of Narcissistic Personality Disorder in the New DSM.