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In Treatment of Severe Personality Disorders: Resolution of Aggression and Recovery of Eroticism, the influential psychoanalyst and psychiatrist Otto Kernberg presents an integrated update of the current knowledge of personality disorders, their neurobiological and psychodynamic determinants, and a specific psychodynamic psychotherapy geared to resolve the psychopathology of these conditions—namely, the syndrome of identity diffusion and its influence on the capacity for emotional wellbeing and gratifying relationships with significant others. The author updates the findings of the Personality Disorders Institute of the Weill Cornell Medical College Department of Psychiatry, which are derived from the empirical research and clinical investigation of severe personality disorders, and addresses the effectiveness of transference-focused psychotherapy, a specific psychodynamic treatment for these disorders developed at the Institute. The volume focuses particularly on an essential group of techniques common to all psychoanalytically derived treatments and clarifies the corresponding differential features of various psychodynamic treatment approaches.
In prose both precise and evocative, the author:
• Examines the classification of personality disorders, the way competing viewpoints have influenced the evolution of DSM-III and DSM-IV, and the impact of new knowledge on the classification of DSM-5, with emphasis on how conflicts between scientific and political considerations have hindered the classification of personality disorders in the past.
• Illustrates in detail how present knowledge of neurobiological structures and neurotransmitters intertwines with the psychodynamic determinants of how psychic experience is organized.
• Explores psychodynamic psychotherapies and contemporary developments and controversies in the field. For example, the role of interpretation in borderline pathology is examined using a clinical case, and a new formulation of supportive psychodynamic psychotherapy is described.
• Addresses severe narcissistic pathology—its diagnosis, prognosis, and treatment. Specifically, the book presents an overview of treatment options for severe narcissistic personality disorder, explores the distortions in verbal communication that may arise during psychotherapy with these patients, and focuses on the differential diagnosis of antisocial behavior.
• Examines the diagnosis and treatment of sexual pathology, and explores the vicissitudes of the love lives of patients with severe personality disorders.
• Concludes with a chapter on the essential preconditions in the education of psychodynamic psychotherapists to carry out the challenging and complex psychotherapeutic work in this field.
In describing both the limits and the advances in therapeutic effectiveness, the Treatment of Severe Personality Disorders: Resolution of Aggression and Recovery of Eroticism performs a great service, and it will surely become a classic of the psychoanalytic literature.
Otto Kernberg has been a prolific and highly influential contributor to the psychiatric literature over many decades. This book is perhaps the most accessible of his many contributions, well curated, nicely organized, and well edited. While comprised of individual essays that stand alone and make for bite-size reading, the individual chapters hang together and tell an overall story of the current status of severe personality disorders, their classification, dynamics, and treatment within a psychodynamic frame of reference, with special reference to borderline and narcissistic pathology.
This book has something for everyone—clinicians who work with patients with personality disorders, students of psychodynamics and psychoanalysis, and those with expertise in dynamic therapies will all find something of interest.
— Eve Caligor, M.D.
Otto F. Kernberg, M.D., is Professor of Psychiatry at the Weill Cornell Medicine and Director of the Personality Disorders Institute at the New York Presbyterian Hospital, Westchester Division, White Plains, NY. He is also Training and Supervising Analyst, Columbia University Center for Psychoanalytic Training and Research, New York, NY, and past President of the International Psychoanalytic Association.
About the Author
Introduction
Acknowledgments
Part I: Personality Disorders
Chapter 1. What is Personality?
Chapter 2. Overview and Critique of the Classification of Personality Disorders Proposed for DSM-5
Chapter 3. Neurobiological Correlates of Object Relations Theory
Part II: Spectrum of Psychoanalytic Psychotherapies
Chapter 4. The Basic Components of Psychoanalytic Technique and Derived Psychoanalytic Psychotherapies
Chapter 5. Interpretation in Borderline Pathology: A Clinical Illustration
Chapter 6. The Spectrum of Psychoanalytic Techniques
Chapter 7. New Developments in Transference-Focused Psychotherapy
Chapter 8. A New Formulation of Supportive Psychodynamic Psychotherapy
Part III: Narcissistic Pathology
Chapter 9. An Overview of the Treatment of Severe Narcissistic Pathology
Chapter 10. Narcissistic Defenses in the Distortion of Free Association and Their Underlying Anxieties
Chapter 11. The Differential Diagnosis of Antisocial Behavior: A Clinical Approach
Part IV: Erotism in the Transference
Chapter 12. Erotic Transferences and Countertransferences in Patients With Severe Personality Disorders: Part I: The Evaluation of Sexual Pathology
Chapter 13. Erotic Transferences and Countertransferences in Patients with Severe Personality Disorders: Part II: Therapeutic Developments
Part V: Hope About Life, Mourning, and the Training of Psychotherapists
Chapter 14. The Denial of Reality
Chapter 15. The Long–Term Effects of the Mourning Process
Chapter 16. A Proposal for Innovation in Psychoanalytic Education