Treatment of Severe Personality Disorders: Resolution of Aggression and Recovery of Eroticism

by Otto F. Kernberg MD

Overview

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.

Product Details

ISBN-13:	9781615371884
Publisher:	American Psychiatric Association Publishing
Publication date:	04/05/2018
Sold by:	Barnes & Noble
Format:	eBook
Pages:	319
File size:	4 MB
Age Range:	18 Years

About the Author

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.

Table of Contents

About the AuthorIntroductionAcknowledgmentsPart I: Personality DisordersChapter 1. What is Personality?Chapter 2. Overview and Critique of the Classification of Personality Disorders Proposed for DSM-5Chapter 3. Neurobiological Correlates of Object Relations TheoryPart II: Spectrum of Psychoanalytic PsychotherapiesChapter 4. The Basic Components of Psychoanalytic Technique and Derived Psychoanalytic PsychotherapiesChapter 5. Interpretation in Borderline Pathology: A Clinical IllustrationChapter 6. The Spectrum of Psychoanalytic TechniquesChapter 7. New Developments in Transference-Focused PsychotherapyChapter 8. A New Formulation of Supportive Psychodynamic PsychotherapyPart III: Narcissistic PathologyChapter 9. An Overview of the Treatment of Severe Narcissistic PathologyChapter 10. Narcissistic Defenses in the Distortion of Free Association and Their Underlying AnxietiesChapter 11. The Differential Diagnosis of Antisocial Behavior: A Clinical ApproachPart IV: Erotism in the TransferenceChapter 12. Erotic Transferences and Countertransferences in Patients With Severe Personality Disorders: Part I: The Evaluation of Sexual PathologyChapter 13. Erotic Transferences and Countertransferences in Patients with Severe Personality Disorders: Part II: Therapeutic DevelopmentsPart V: Hope About Life, Mourning, and the Training of PsychotherapistsChapter 14. The Denial of RealityChapter 15. The Long--Term Effects of the Mourning ProcessChapter 16. A Proposal for Innovation in Psychoanalytic Education

What People are Saying About This

Richard C. Friedman

A brilliant contribution by a psychoanalytic pioneer and pathfinder. An up to date review of eroticism and aggression in personality disorders. The discussion of transference is especially needed and useful. All psychotherapists must read and assimilate this book. It restores "the erotic" to the modern psychotherapeutic domain. Recommended without reservation.

Univ.-Prof. Dr. Stephan Doering

More than anyone else, Otto F. Kernberg shaped our idea of borderline personality and narcissism as well as their psychoanalytical treatment. In his thrilling latest book, he deepens our insight into aggressive and sexual aspects of the relationships of patients with personality disorders. In his clarity and depth, he discloses new dimensions of the transference relationship and the treatment technique related to it.

Eve Caligor

In this wonderful volume Kernberg present an integrated, updated and expanded view of his contributions to the study of personality disorders and their treatment, with special attention to narcissism and love relations. The book is clearly organized and beautifully written, drawing the reader in as it tells the story Kernberg's theoretical and clinical contributions to the field while linking them to contemporary neurobiology and personality disorders studies. For those familiar with Dr. Kernberg's many earlier publications, this book is a jewel in the crown. For those new to Kernberg, this is an accessible and clearly elaborated overview of current perspectives.

Robert Michels

Otto Kernberg is one of the most illustrious and most frequently cited psychoanalysts alive. This, his most recent volume, discusses the topics that have been identified with him for the last several decades—serious personality disorders, their etiology, diagnosis and treatment, research on those treatments, the psychoanalytic theories that link what we know about these disorders with their treatment, and special problems that emerge with these patients in relation to eroticism, aggression, and reality. Kernberg's thinking provides an essential context for any contemporary clinician working with these patients.

Editorial Reviews

Reviewer: Marina Bayeva, M.D., Ph.D.(Northwestern University Feinberg School of Medicine)
Description: Otto Kernberg's book on severe personality disorders derives from several decades of work at the Personality Disorders Institute of Weill Cornell Medical College in New York. Dr. Kernberg is a leading expert in borderline and narcissistic pathologies who greatly contributed to our understanding of structure, development, and psychoanalytic treatments of personality disorders. Although the title suggests that the author's primary focus will be on treatment, the actual scope of the book is much broader, ranging from in-depth discussions of normal and "disordered" personalities to neurobiological correlates of character traits to exploration of antisocial traits, sexual behaviors, erotic transference, normal mourning, and much more. A common thread throughout is the use of transference-focused psychotherapy (TFP) in the treatment of personality disorders, which is one of author's the key contributions to modern psychiatry and psychotherapy.
Purpose: The author's stated goal is for this book to "be helpful to all clinicians working to help" patients with severe personality disorders through introduction of TFP - an empirically-validated treatment with an "ambitious goal of modifying the personality structure of the patient." More broadly, the author aims to clarify what psychoanalytic therapy is and is not, by defining its essential components and proposing various technical modifications.
Audience: Practicing mental health clinicians and therapists, including psychiatrists, psychologists, and social workers, are likely to find this book useful and directly applicable to their work. The author draws heavily from several psychoanalytic schools of thoughts, including ego psychology, Kleinian and other object relations and developmental theories, while presuming readers are familiar with their key concepts. Thus, trainees and clinicians who are not well versed in the foundations of analytic theory may find certain chapters challenging.
Features: The book is composed of five parts, with the first three following a logical progression from psychological structure and neurobiology to diagnosis to treatment of severe personality disorders, and the last two parts presenting a looser collection of related topics. Part I outlines normal vs. disordered character structure, as well as developmental considerations and neurobiological underpinnings of thereof. Part II defines essential components of psychoanalytic treatments before homing in on TFP as the preferred treatment modality for severe personality disorders. Part III expands these discussions to patients with narcissistic pathologies and antisocial traits. Part IV explores normal sexuality, sexual disturbances, and challenges faced by clinicians in delving into the most intimate aspects of patients' lives. Finally, Part V is an agglomeration of several topics, including patients' denial of reality, normal mourning process, and the author's own vision of the future of psychoanalytic training programs.
Assessment: This is undoubtedly a valuable addition to the current literature on personality disorders. A prominent expert in the field, the author draws from his rich clinical and theoretical experiences to show how TFP proper and its variations (including dynamically-oriented supportive approach) can inform everyday therapeutic work. By including a broad range of topics pertinent to personality disorders, he sheds light on why and how TFP "works" to foster characterological change. Although the primary focus of the book is on treatment of personality disorders, certain chapters appear to stand on their own. This includes an extended section on eroticism, which is more concerned with normal sexuality and sexual dysfunction in higher-functioning neurotics than with more severely impaired patients. Similarly, the discussion of the mourning process is mostly limited to its normal manifestations, with less emphasis on pathological mourning and its relevance to personality disorders. The author builds upon selected analytic theories, while other psychoanalytic, cognitive, and behavioral schools of thought remain beyond the scope of this book. In summary, this book provides a comprehensive overview of severe personality disorders through the lens of contemporary ego psychology, with the introduction of TFP as the primary treatment modality for these patients.

Doody's Review Service

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.

Journal of Psychiatric Practice May 2019 - Eve Caligor