Treatment of Severe Personality Disorders

Resolution of Aggression and Recovery of Eroticism

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  • 2018
  • 319 pages

ISBN 978-1-61537-143-3
Item #37143

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  • Description

    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.

  • Contents

    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

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  • Editorial Reviews

    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.—Robert Michels, M.D., Walsh McDermott University Professor of Medicine and Psychiatry, Cornell University, Training and Supervising Analyst, Columbia University Center for Psychoanalytic Training and Research, Former Joint Editor-in-Chief, The International Journal of Psychoanalysis


    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.—Univ.-Prof. Dr. Stephan Doering, head of the clinic for psychoanalysis, and psychotherapy, Medical University of Vienna


    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.—Richard C. Friedman, M.D., Clinical Professor Psychiatry, Cornell University Medical College

  • Contributors

  • 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.

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