Kernberg - Treatment of severe personality disorders : resolution of aggression and recovery of eroticism

Otto F. Kernberg, M.D.

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Library of Congress Cataloging-in-Publication Data

Names: Kernberg, Otto F., 1928 author. | American Psychiatric Association Publishing, issuing body.

Title: Treatment of severe personality disorders : resolution of aggression and recovery of eroticism / Otto F. Kernberg.

Description: Washington, DC: American Psychiatric Association Publishing, [2018] | Includes bibliographical references and index.

Identifiers: LCCN 2017043849 (print) | LCCN 2017044627 (ebook) | ISBN 9781615371884 (ebook) | ISBN 9781615371433 (pbk. : alk. paper)

Subjects: | MESH: Personality Disorderstherapy | Psychotherapy methods | Transference (Psychology)

Classification: LCC RC480 (ebook) | LCC RC480 (print) | NLM WM 190 | DDC

616.89/14dc23

LC record available at https://lccn.loc.gov/2017043849

British Library Cataloguing in Publication Data

A CIP record is available from the British Library.

To Kay,
with all my love

PART I
Personality Disorders

PART II
Spectrum of Psychoanalytic Psychotherapies

PART III
Narcissistic Pathology

PART IV
Erotism in the Transference

PART V
Denial of Reality, Mourning, and the Training of Psychotherapists

This book presents an overview of my recent work regarding the neurobiological and psychodynamic determinants of the structure, development, and functioning of normal personality and personality disorders. It updates the findings of the Personality Disorders Institute of the Weill Cornell Medical College Department of Psychiatry that were derived from the empirical research and clinical investigation of severe personality disorders, and the related experience of the effectiveness of transference-focused psychotherapy (TFP), a specific psychodynamic treatment for these disorders developed at our institute. In this book, I focus particularly on an essential group of techniques common to all psychoanalytically derived treatments and clarify the corresponding differential features of various psychodynamic treatment approaches. Parts I and II of this book present this material.

, I examine general existential issues related to the management of the challenges of life tasks experienced by these patients, the effects of the capacity for mourning processes, and lastly, some essential preconditions in the education of psychodynamic psychotherapists to carry out the challenging and complex psychotherapeutic work in this field.

What follows is a capsule summary of the context of all the chapters of this book.

explores a contemporary concept of personality that does justice to both the genetic and constitutional determinants of personality functioning as expressed in the vicissitudes of the organization of the central nervous system, and the derived influence of intrapsychic developments that constitute a second level of structural determinants of personality functioning. In short, this chapter represents an effort to integrate genetic and neurobiological influences with psychodynamic and environmental influences on the organization and functioning of the personality.

examines the present classification of personality disorders by the American Psychiatric Association. In the process, it discusses the consequences of the various viewpoints that, in their mutual confrontations, have influenced the way in which both the traditional classification of DSM-III and DSM-IV have come about, and the impact of new knowledge on the new classification of DSM-5. This latter proposal does greater justice to our current understanding of personality structure while illustrating the conflicts between scientific and political considerations that have hindered the classification of personality disorders in the past.

illustrates in some detail how our present knowledge of neurobiological structures and neurotransmitters meshes with the psychodynamic determinants of organization of psychic experience. In the process, the complex interaction between neurobiological and psychodynamic features that determine psychological organization is spelled out.

Jointly, these three chapters provide an updated review of what we know about personality functioning, the relationship between personality and personality disorders, and the developmental aspects of the constitution of severe personality disorders.

describes four essential psychoanalytic techniques that are considered the common basis for standard psychoanalysis as well as for all derived psychoanalytic psychotherapies. They are interpretation, transference analysis, technical neutrality, and countertransference utilization .

illustrates how the key technique of interpretation is applied in the TFP of severe personality disorders, demonstrating with a clinical case the fact that, in contrast to older assumptions, patients with severe personality disorder are able to benefit from interpretation as an essential technical tool.

reflects a complete technical psychotherapeutic armamentarium that is common to psychoanalysis and all psychoanalytic psychotherapies.

is a brief summary of TFP, the specific psychodynamic psychotherapy for the treatment of severe personality disorders developed by the Personality Disorders Institute, and updates this treatment with the latest clinical and research findings. This chapter also describes the four essential psychoanalytic techniquesinterpretation, transference analysis, technical neutrality, and countertransference utilizationthat are considered the common basis for standard psychoanalysis as well as for all derived psychoanalytic psychotherapies.

, the final chapter of this section, summarizes a contemporary supportive psychodynamic psychotherapy, thus completing the entire spectrum ranging from psychoanalysis, on one end, to supportive psychotherapy, on the other.