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Handbook of Dynamic Psychotherapy for Higher Level Personality Pathology

Eve Caligor, M.D., Otto F. Kernberg, M.D., and John F. Clarkin, Ph.D.

  • ISBN 978-1-58562-212-2
  • Item #62212

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Offering a sophisticated introduction to a contemporary psychodynamic model of the mind and treatment, this book provides an approach to understanding and treating higher level personality pathology. It describes a specific form of treatment called dynamic psychotherapy for higher level personality pathology (DPHP), which was designed specifically to treat the rigidity that characterizes that condition. Based on psychodynamic object relations theory, DPHP is an outgrowth of transference-focused psychotherapy (TFP) and is part of an integrated approach to psychodynamic treatment of personality pathology across the spectrum of severity—from higher level personality pathology, described in this volume, to severe personality pathology, described in a companion volume, Psychotherapy for Borderline Personality: Focusing on Object Relations. Together, they provide a comprehensive description of an object relations theory-based approach to treatment of personality disorders, embedded in an integrated model of personality.

As a guide to treatment, Handbook of Dynamic Psychotherapy for Higher Level Personality Pathology provides a clear, specific, and comprehensive description of how to practice DPHP from beginning to end, presented in jargon-free exposition using extensive clinical illustrations. The authors offer a comprehensive description of psychodynamic consultation that includes sharing the diagnostic impression, establishing treatment goals, discussing treatment options, obtaining informed consent, and establishing treatment frame. Throughout, the book emphasizes fundamental clinical principles that enable the clinician to think through clinical decisions moment-to-moment and also to develop an overall sense of the trajectory and goals of the treatment. Among the book's benefits:

  • Takes a diagnosis-driven approach, presenting a clear model of both the psychopathology and its treatment;
  • Explains underlying theory and basic elements of DPHP for those first learning dynamic therapy;
  • Offers an integrated, innovative synthesis of contemporary psychodynamic approaches to personality pathology and psychodynamic psychotherapy;
  • Describes goals, strategies, tactics, and techniques of the treatment to demonstrate its flexibility over a relatively long course of treatment;
  • Provides sophisticated discussion of integrating dynamic psychotherapy with medication management and other forms of treatment.

DPHP offers a broad range of patients the opportunity to modify maladaptive personality functioning in ways that can permanently enhance their quality of life. Handbook of Dynamic Psychotherapy for Higher Level Personality Pathology provides experienced clinicians with a hands-on approach to that method, and is also useful as a primary textbook in courses focusing on the technique of dynamic psychotherapy or in courses on psychodynamics.


  • Preface
  • About the Authors
  • Chapter 1. Introduction and overview
  • Part I: Theoretical Understanding of Higher Level Personality Pathology
  • Chapter 2. A psychodynamic approach to personality pathology
  • Chapter 3. Internal object relations, mental organization, and subjective experience in personality pathology
  • Part II: Psychotherapeutic Treatment of Higher Level Personality Pathology
  • Chapter 4. The basic elements of DPHP
  • Chapter 5. The strategies of DPHP and the treatment setting
  • Chapter 6. The techniques of DPHP, part 1: listening to the patient
  • Chapter 7. The techniques of DPHP, part 2: intervening
  • Chapter 8. The tactics of DPHP
  • Part III: Patient Assessment, Phases of Treatment, and Combining DPHP With Other Treatments
  • Chapter 9. Patient assessment and differential treatment planning
  • Chapter 10. The phases of treatment
  • Chapter 11. Combining DPHP with medication management and other forms of treatment
  • Chapter 12. Concluding comments
  • References
  • Index

About the Authors

Eve Caligor, M.D., is Clinical Professor of Psychiatry at the Columbia University College of Physicians and Surgeons in New York City. She is a Training and Supervising Analyst and Director of the Psychodynamic Psychotherapy Division at Columbia University Center for Psychoanalytic Training and Research in New York City.

Otto F. Kernberg, M.D., is Director of the Personality Disorders Institute at the New York Presbyterian Hospital, Westchester Division, and Professor of Psychiatry at the Joan and Sanford I. Weill Medical College and Graduate School of Medical Sciences of Cornell University, New York City. He is a Training and Supervising Analyst at the Columbia University Center for Psychoanalytic Training and Research and is a past president of the International Psychoanalytic Association.

John F. Clarkin, Ph.D., is Co-Director of the Personality Disorder Institute at New York Presbyterian Hospital, Westchester Division, and Clinical Professor of Psychology in Psychiatry at the Joan and Sanford I. Weill Medical College and Graduate School of Medical Sciences of Cornell University in New York City. He is Past President of the International Society for Psychotherapy Research.

Caligor, Kernberg, and Clarkin have equalled, and perhaps surpassed, the excellence of their group's earlier work on the treatment of borderline personality. Here they apply contemporary object relations theory to a new population through Dynamic Psychotherapy for Higher Level Personality Pathology. This volume explains the theory, describes the patients, and discusses everything that a clinician might desire—always with clinical examples, links to underlying theory, and a generous sprinkling of pearls of wisdom that make clear that the authors have been there themselves. Anyone who treats these patients should read it carefully and refer to it frequently, and will learn and enjoy while doing so.—Robert Michels, M.D., Walsh McDermott University Professor of Medicine & Psychiatry, Cornell University; Supervising & Training Analyst, Columbia University Center Psychoanalytic Training & Research

Handbook of Dynamic Psychotherapy for Higher Level Pathology, by Caligor, Kernberg, and Clarkin, is a wonderful new contribution from the Kernberg group. It is an elegant, clear, coherent presentation of an object-relations view of higher-level psychopathology, linked to a step-by-step psychotherapeutic strategy to guide clinicians in their work with these complicated patients.—John M. Oldham, M.D., Senior Vice President and Chief of Staff, The Menninger Clinic, and Professor, Baylor College of Medicine, Houston, Texas

Dr. Caligor and her colleagues offer a most comprehensive and lucid exposition of the theoretical base, the strategies, the techniques, and the operative tactics of dynamic psychotherapy for higher level (neurotic) personality pathology (DPHP). A most fitting companion to the group's earlier delineation of transference focused psychotherapy (TFP), geared to the therapy of more severe, borderline pathology-both therapies based on the specific object-relational development of psychoanalytic theory pioneered by Otto Kernberg. The volume is addressed remarkably successfully to both the psychotherapy neophyte and the seasoned psychodynamic clinician.—Robert S. Wallerstein, M.D., Emeritus Professor and Former Chair, Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, California.

In this very accessible book, the authors offer both a cogent theoretical framework and a concise, 'in the room', clinical approach to the treatment of neurotic patients. This book combines the systematic approach of a manual with the flexibility necessary for real world treatment. Working in the framework of the authors, a therapist can make theoretically informed decisions about when, in what way, and at what level to intervene. The unique strength of this book is the integration of a dynamic conceptual framework grounded in object relations theory with clinical technique.—Steven P. Roose, M.D., Professor of Clinical Psychiatry, College of Physicians & Surgeons, Columbia University; Acting Chief, Department of Biological Psychiatry, New York State Psychiatric Institute

This is a very good book and methodology for the treatment of patients who are functional in most areas of their life but continue to have problems secondary to their personality issues. The breakdown of the guidelines from overall goals to moment to moment interactions in session is well done. The clinical examples are extremely useful in illustrating treatment points.—Doody's Book Review Service, 6/15/2007

As an extension of TFP to the therapy of higher level personality pathology, this text fills an important theoretical and clinical gap in the psychoanalytic literature. To my knowledge, it is the first psychoanalytic work to address work with this population. It expands psychoanalytic expertise into areas covered previously by cognitively oriented authors.—PsycCRITIQUES, 6/15/2007

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