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Aggressivity, Narcissism, and Self-Destructiveness in the Psychotherapeutic Rela

Aggressivity, Narcissism, and Self-Destructiveness in the Psychotherapeutic Rela: New Developments in the Psychopathology and Psychotherapy of Severe Personality Disorders

Otto F. Kernberg
Copyright Date: 2004
Published by: Yale University Press
Pages: 288
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  • Book Info
    Aggressivity, Narcissism, and Self-Destructiveness in the Psychotherapeutic Rela
    Book Description:

    In this book a leading psychoanalytic clinician and theoretician presents his thoughts on the latest psychodynamic developments and insights related to treatment of severe personality disorders. Dividing his discussions into two sections, one on psychopathology and the other on psychotherapy, Dr. Otto F. Kernberg examines borderline personality disorder, narcissism, sexual inhibition, transference and countertransference, suicidal behavior, and eating disorders. In each chapter he integrates the ideas of European and Latin American psychoanalytic thinkers, bringing them to the attention of English-speaking readers.

    This book includes a selection of recently published journal articles. Their collection into one volume makes readily available Dr. Kernberg's present thinking on an important subject.

    eISBN: 978-0-300-12838-3
    Subjects: Psychology

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Preface
    (pp. ix-xiv)
  4. Part One Psychopathology

    • Chapter 1 A Psychoanalytic Theory of Personality Disorders
      (pp. 3-26)

      Why is it important to attempt to formulate a psychoanalytic view of the etiology, structure, and mutual relations of the personality disorders? First, because of recent advances in the psychoanalytic understanding of particular types of personality disorders, and second, because of persistent controversies in psychological and psychiatric research concerning such issues as (1) whether categorical or dimensional criteria should be used for classifying these disorders, (2) the relative influence of genetic and constitutional, psychodynamic, and psychosocial determinants, and, most important, (3) the relation between descriptive or surface behavior and underlying biological and psychological structures. A major problem is the understanding...

    • Chapter 2 Hatred as a Core Affect of Aggression
      (pp. 27-44)

      There is little doubt today about the prevalence of aggression in the behavior, fantasies, and psychodynamics of patients with severe personality disorders. But clinicians, theoreticians, and researchers in this field continue to be troubled by the issue of whether aggression is inborn—an “instinct” or “drive”—or secondary to frustration and trauma. In short, is aggression the result of early experience or of constitution and genetics?

      Studies have shown that early exposure to violence and to physical, psychological, and sexual abuse, particularly incest, is significantly more frequent in patients with severe personality disorders and in children at high risk for...

    • Chapter 3 Pathological Narcissism and Narcissistic Personality Disorder: Theoretical Background and Diagnostic Classification
      (pp. 45-59)

      Clarification of the concept of narcissism is complicated by the existence of two parallel and complementary levels of definition. In the psychoanalytical theory of metapsychology (that is, a consideration of structural, dynamic, economic, adaptive, and genetic principles of mental functioning), narcissism is defined as the libidinal investment of the self. In the ego-psychology frame of reference, the self is regarded as a substructure of the system ego reflecting the integration of all the component self-images or self-representations that develop throughout the individual’s interactions with other human beings (objects). The investment of libido in such objects and their psychic representations (object...

    • Chapter 4 The Diagnosis of Narcissistic Pathology in Adolescents
      (pp. 60-75)

      The most important task for the psychiatrist examining a troubled adolescent is to establish a reliable diagnosis regarding the severity of the psychopathology, differentiating manifestations of emotional turmoil as part of a neurosis or an adjustment reaction from more severe character pathology that makes its first appearance in adolescence. Varying degrees of anxiety and depression, emotional outbursts and temper tantrums, excessive rebelliousness or dependency, sexual inhibition, and polymorphous perverse sexual impulses and activities may present in adolescents without severe character pathology and in those with very severe characterological disturbances. The narcissistic personality disorder, as we have seen, is one of...

    • Chapter 5 Perversion, Perversity, and Normality: Diagnostic and Therapeutic Considerations
      (pp. 76-92)

      Culturally determined value judgments and ideological cross-currents unavoidably influence our evaluation of human sexual life. When “normal” is considered to be equivalent to average or to a predominant pattern, treatment may become a matter of promoting “adjustment,” and we lose the usefulness of normality as a standard of health. On the other hand, if the concept of normality refers to an ideal pattern of behavior, we run the risk of imposing ideologically motivated measures. And if, in ideologically motivated opposition to conventional notions, we proclaim the equivalent nature of any and all manifestations of human sexuality, we may miss significant,...

  5. Part Two Psychoanalytic Psychotherapy

    • Chapter 6 Psychoanalysis, Psychoanalytic Psychotherapy, and Supportive Psychotherapy: Contemporary Controversies
      (pp. 95-119)

      The relation between psychoanalysis and psychoanalytic psychotherapy is becoming a major concern of the psychoanalytic community for several reasons: (1) A broad spectrum of psychoanalytic psychotherapies has been derived from psychoanalysis as a basic underlying theory and a method of treatment, and the usefulness of these widely recognized methods for many patients too ill to participate in a standard psychoanalysis has been widely recognized; thus they create the possibility of reaching a large number of patients by methods carried out in less frequent sessions and at less financial cost than standard psychoanalysis. (2) The conceptual challenges presented by developments in...

    • Chapter 7 Psychodynamic Psychotherapy for Patients with Borderline Personality Organization: An Overview
      (pp. 120-129)

      From a therapeutic perspective, psychodynamic psychotherapy as described in this chapter is a psychoanalytic psychotherapy that explores the syndrome of identity diffusion, its expression in primitive tranferences as they reflect early internalized object relations of an idealized and persecutory kind. The goal of the treatment is to identify these paradigms and then to facilitate their gradual integration, so that splitting and other primitive defensive operations are replaced by more mature defensive operations and identity diffusion is eventually resolved (O. Kernberg 1984).

      The strategy involves three consecutive steps: (1) The dominant primitive object relation is identified in the transference and is...

    • Chapter 8 The Psychodynamics and Psychotherapeutic Management of Psychopathic, Narcissistic, and Paranoid Transferences
      (pp. 130-153)

      It is essential to the treatment of any case in which antisocial features are at issue to evaluate (1) the presence or absence of pathological narcissism; (2) the extent to which superego pathology dominates—that is, where the patient falls in the continuum from the narcissistic to the antisocial personality disorders; (3) the intensity of egosyntonic aggression and whether it is directed against the self in the form of suicidal, parasuicidal, or self-mutilating and self-destructive behavior or against others in the form of physical violence, homicidal tendencies, or a life-endangering sadistic perversion; (4) the severity of the paranoid tendency; and...

    • Chapter 9 A Severe Sexual Inhibition in a Patient with Narcissistic Personality Disorder
      (pp. 154-166)

      Whereas oedipal conflicts may emerge at any phase of the psychoanalytic treatment of narcissistic personalities, it is particularly in the advanced stages of resolution of narcissistic transferences that the intimate connection between oedipal and preoedipal conflicts, with the growing dominance of oedipal conflicts, tends to become remarkable in the sessions (Grunberger 1989; O. Kernberg 1984; Rosenfeld 1987). The following case highlights how the analysis of oedipal conflicts gradually resolved a severe and extended inhibition of sexual desire that developed in the course of analytic treatment. The enactment in the countertransference of castration anxiety against which the patient was successfully defending...

    • Chapter 10 Acute and Chronic Countertransference Reactions
      (pp. 167-183)

      The early concept of countertransference defined it as the analyst’s unconscious reaction to the patient or to the transference derived from the analyst’s own transference potential, to be overcome by the analyst’s self-analysis in order to return to a position of technical neutrality (Little 1951; Reich 1951). This concept and our view of the importance of countertransference in the psychoanalytic situation have since undergone significant changes. Under the influence of psychoanalytic contributions made in the 1950s, particularly those of Paula Heimann (1950) and Heinrich Racker (1957), a global or totalistic view of countertransference, now defined as the analyst’s total emotional...

    • Chapter 11 Omnipotence in the Transference and in the Countertransference
      (pp. 184-191)

      Omnipotence was first described by Freud (1913, 1921) as a characteristic of the magic thinking of primitive cultures and of infantile thinking. He linked it to the state of primary narcissism and the hallucinatory gratification of desire under conditions of frustration. This primitive mode of thinking might then reappear as omnipotence in psychopathology, particularly in obsessive thinking. Later theorists of both ego-psychological and object-theoretical thinking described omnipotence as a defensive operation in the psychoses, one aspect of the permanence of magical thinking under conditions of loss of reality testing.

      Edith Jacobson (1967, 1971a), for example, described the omnipotent implications of...

    • Chapter 12 The Risk of Suicide in Severe Personality Disorders: Differential Diagnosis and Treatment
      (pp. 192-204)

      In all cases of severe personality disorder the presence of suicidal ideation, suicidal intention, a history of such ideation and intention, and, of course, the nature and severity of any actual suicidal attempts is routinely investigated. For a patient who is not currently depressed and shows no evidence of suicidal ideation, intention, or behavior, the history of past suicidal ideation or action becomes part of the psychiatric record but requires no immediate intervention. When, however, a patient clearly presents a history of recent suicidal intention, desire, or behavior, the acute risk of a further attempt constitutes the highest priority for...

    • Chapter 13 A Technical Approach to Eating Disorders in Patients with Borderline Personality Organization
      (pp. 205-219)

      Most patients with severe eating disorders suffer from significant character pathology. Although the focus of our borderline psychotherapy research project at the Westchester Division of the New York Hospital—Cornell Medical Center is not on eating disorders per se, we believe that the experience gained in the psychodynamic treatment of borderline patients has relevance for treating patients with these disorders. In addition, the availability of a cognitive-behavioral inpatient service specializing in the treatment of eating-disorder patients has provided us with the opportunity to compare and relate the experiences of these patients. Finally, my own clinical experience in the psychoanalytic and...

    • Chapter 14 The Management of Affect Storms in the Psychoanalytic Psychotherapy of Borderline Patients
      (pp. 220-244)

      The following discussion is based on experience treating borderline patients with the psychoanalytic psychotherapy referred to as transference-focused therapy (TFP) that we have developed at the Personality Disorders Institute of the Cornell University Medical College (Clarkin, Yeomans, and Kernberg 1999) . The management of affect storms in the sessions of patients with borderline personality organization and severe regression in the transference presents us with two apparently opposite and yet complementary situations. The first is one in which an open, observable affect storm explodes in the psychotherapeutic setting, usually with an intensely aggressive and demanding quality but also, at times, with...

  6. References
    (pp. 245-258)
  7. Index
    (pp. 259-271)