Biomedical subjects

O F Kernberg

Publications and source records attributed to O F Kernberg.

At least 37 records · Page 2Linked to original sources

PubMed1993

Suicidal behavior in borderline patients: diagnosis and psychotherapeutic considerations.

This paper summarizes the experiences with suicidal and parasuicidal behavior of the psychotherapy research project on borderline patients in progress at the Westchester Division of the New York Hospital-Cornell Medical Center. In the diagnostic evaluation of these patients, it is important to differentiate acute and chronic suicidal behavior with the presence or absence of depression. The dominant psychodynamic features of chronic characterological suicidal behavior are reviewed, with a particular emphasis on the psychopathology of self-directed and projected primitive hatred, and the defenses against its conscious awareness on the part of the patient. A general psychotherapeutic strategy to deal with suicidal and self-destructive behavior is mapped out, centered upon the transformation of self-destructiveness into specific transference constellations that must be diagnosed, interpreted, and gradually worked through in the transference in the course of the treatment. The treatment of chronic, characterologically anchored suicidal behavior without depression requires the setting up of specific structuring of the psychotherapy from the very beginning of treatment, embodied in the establishment of a treatment contract that contributes to the organizing frame for the entire psychotherapy. The precondition for this psychotherapeutic work and limiting factors affecting its effectiveness are spelled out.

Borderline Personality Disorder↗

PubMed1993

The current status of psychoanalysis.

Presented here is an overview of current challenges and controversies regarding psychoanalysis as a science, competing psychoanalytic theories, convergent and divergent trends in psychoanalytic technique, psychoanalytic education, psychoanalysis as a profession. Among other issues stressed are the importance of the relation of psychoanalysis to the University, the research implications of competing theoretical and technical orientations, the need to reexamine the structure of psychoanalytic education, and the importance of international cross-fertilization in expanding the application of psychoanalysis to other fields.

Accreditation↗

PubMed1993

The couple's constructive and destructive superego functions.

Just as the couple becomes the repository of both partners' conscious and unconscious sexual fantasies and desires, and of their consciously and unconsciously activated internalized object relations, so does the couple activate both partners' conscious and unconscious superego functions. The interaction of the partners' superego over time results in the forging of a new system, which I am calling the couple's superego. The functions of the couple's joint superego structure is described, as are the symptoms of superego pathology in the couple's love life. The vicissitudes of gratitude and guilt, of stereotyping and conventionality, of deceptiveness and long-range destructive and self-destructive scenarios, are explored in the context of a spectrum reflecting the severity of joint superego pathology. A clinical case vignette illustrates some of these developments in a couple's life.

Adult↗

PubMed1993

Convergences and divergences in contemporary psychoanalytic technique.

A broad survey of the psychoanalytic field reveals both convergences and divergences in technique. The major convergences include earlier interpretation of the transference, increased focus on transference analysis, as well as growing attention to countertransference analysis and increasing concern with the risks of 'indoctrinating' patients. Greater emphasis is found on character defences and the unconscious meanings of the 'here-and-now'. Also noted are trends toward translating unconscious conflicts into object-relations terminology, as well as toward considering a multiplicity of royal roads to the unconscious. Regarding divergences, significant controversies continue about the importance of the 'real' relationship, and the therapeutic versus the resistance aspect of regression. Divergences also continue regarding reconstruction and recovery of preverbal experience, drawing the lines between psychoanalytic psychotherapy and psychoanalysis, the role of empathy, and the relation of historical to narrative truth.

Countertransference↗

PubMed1993

Between conventionality and aggression: the boundaries of passion.

This paper explores changes in the recent psychoanalytic theory regarding the preconditions and structural characteristics of sexual love. In briefly reviewing Freud's contributions and subsequent developments regarding infantile sexuality and the perversions, the oedipal constellation, superego development and mass psychology, a common frame is provided for the description of the love life of the sexual couple. In this context, this paper also explores how contemporary psychoanalytic formulations may help to clarify certain conflicts between conventional morality and the psychological reality of the couple in love.

Aggression↗

PubMed1992

Psychopathic, paranoid and depressive transferences.

This presentation focuses on the superego pathology frequently present in patients with borderline personality organization, an important issue in transference developments that evolve as a consequence and expression of this pathology. I shall describe 'psychopathic transferences' to refer to periods in the treatment when conditions of deceptiveness prevail in the transference, and the importance of systematically interpreting and working through these particular transferences. As a result of such a working through, paranoid transferences usually become dominant, and, in turn, need to be worked through fully. At this point, more advanced transferences characterized by depressive features tend to prevail, signalling the structural transformation of borderline into neurotic personality organization. Clinical case material will illustrate these transformations in the transference.

Adult↗

PubMed1991

Aggression and love in the relationship of the couple.

In this paper I examine the interplay of love and aggression in a couple's emotional relationship. I explore the activation of dominant repressed or dissociated object relations with the parental figures, and the unconscious collusion of both partners to enact these past relationships in the present. I then examine the couple's relationship as determined by differences in male and female development, as well as the counterpart of these differences--unconscious moves toward "twinship" and complementarity. Unresolved oedipal conflicts are explored as a major cause of invasion of the couple's sexual boundaries, and a vehicle for the expression of dissociated aggression from many sources. Perversity--the "recruitment of love at the service of aggression"--as a threat to the basic fabric of a couple's love life is one alternative to the normal channels for elaboration of aggression in their relationship. Protective functions of the couple's interaction with their social network are examined in the context of their elaborating and integrating aggression with love.

Aggression↗

PubMed1991

Sadomasochism, sexual excitement, and perversion.

Sadomasochism, an ingredient of infantile sexuality, is an essential part of normal sexual functioning and love relations, and of the very nature of sexual excitement. Sadomasochistic elements are also present in all sexual perversions. Sadomasochism starts out as the potential for erotic masochism in both sexes, and represents a very early capacity to link aggression with the libidinal elements of sexual excitement. Sexual excitement may be considered a basic affect that overcomes primitive splitting of love and hatred. Erotic desire is a more mature form of sexual excitement. Psychoanalytic exploration makes it possible to uncover the unconscious components of sexual excitement: wishes for symbiotic fusion and for aggressive penetration and intermingling; bisexual identifications; the desire to transgress oedipal prohibitions and the secretiveness of the primal scene, and to violate the boundaries of a teasing and withholding object. The relation between these wishes and the development of erotic idealization processes in both sexes is explored in the context of a critical review of the pertinent psychoanalytic literature.

Adult↗

PubMed1991

Transference regression and psychoanalytic technique with infantile personalities.

This paper describes a particular form of 'silent' regression during the psychoanalytic treatment of infantile personalities (a type of character pathology related to the hysterical personality). This regression is characterized by the development of rapid interchange in the roles enacted in the transference and projected on to the analyst, an apparent 'disconnexion' of the transference material from that dominant when the patient is in non-regressed states, and the intensification of the analyst's counter-transference reactions. The diagnosis and management of these regressive transferences requires a particular interpretive style and strategy outlined in this paper and illustrated with two case vignettes.

Adult↗

PubMed1989

The narcissistic personality disorder and the differential diagnosis of antisocial behavior.

This article describes a dimension of antisocial behavior that links the narcissistic personality disorder with the antisocial personality disorder, with the syndrome of malignant narcissism as intermediate between the two. Starting with a critique of the DSM-III-R description of the antisocial personality disorder, the author reviews some salient contributions to the concept of the antisocial personality disorder derived from descriptive, sociologic, and psychoanalytic viewpoints. Cleckley's classic description forms the historical background for an updated description of the key characteristics of the antisocial personality disorder. What follows is a summary of the differential diagnosis of antisocial behavior as found in the antisocial personality disorder, the syndrome of malignant narcissism, the narcissistic personality disorders with antisocial behaviors, other severe personality disorders with antisocial features, neurotic personality disorders with antisocial features, symptomatic neuroses, and, finally, dissocial reactions. Prognostic and therapeutic considerations regarding the treatment of antisocial behavior are briefly summarized in the light of this differential diagnosis. A final section describes the psychodynamics of the syndrome of malignant narcissism and of the antisocial personality disorder.

Antisocial Personality Disorder↗

PubMed1989

An ego psychology object relations theory of the structure and treatment of pathologic narcissism. An overview.

This article summarizes the author's contributions to the psychoanalytic understanding of narcissistic personality disorders and their application to a theory of psychoanalytic and psychotherapeutic techniques for the treatment of these patients. The treatment is described as primarily focused on the analysis of the pathologic grandiose self in the transference. The early stages of this transference analysis are differentiated from later stages in the treatment, when the gradual dissolution of the pathologic grandiose self brings to the surface the underlying, dissociated, primitive object relations reflecting unconscious conflicts. The final stage of the treatment is described as approaching the characteristics of the treatment of neurotic patients. Finally, expressive or exploratory psychotherapy and supportive psychotherapy for narcissistic patients are described as psychoanalytically derived alternative treatment methods, and their respective indications and techniques are briefly summarized.

Ego↗

PubMed1988

Clinical dimensions of masochism.

In this paper, I propose a general classification of masochistic psychopathology and describe relations between this clinical domain and other types of psychopathology. My main objective is to provide an outline relevant for diagnostic, prognostic, and treatment considerations of masochistic pathology. This includes descriptions of and relations among a wide variety of masochistic phenomena from the depressive-masochistic personality to extreme forms of self-destructiveness. Ego organization, object relations, superego development, narcissistic organization, and polymorphous perverse infantile sexuality are considered as codeterminants of the levels and clinical features of masochistic pathology. Finally, the relations between masochistic pathology and negative therapeutic reactions are reexamined.

Depressive Disorder↗

PubMed1988

Object relations theory in clinical practice.

This paper outlines the psychoanalytic techniques derived from ego psychology-object relations theory. It stresses the centrality of affects to interpretation and describes how the focus on dominant object relations in the transference modifies the economic, dynamic, and structural criteria for interpretation. Clinical examples illustrate this technique across a broad spectrum of psychopathology. The technique for genetic constructions and reconstructions in the transference is described, and this approach is contrasted with other object relations theories. Finally, the application of this approach to countertransference and dream analysis is summarized.

Adult↗

PubMed1987

The initial contract in the treatment of borderline patients.

The initial treatment contract with a borderline patient recognizes the patient's potential for destructiveness and builds in safeguards. The therapist's effort to protect the treatment mobilizes the patient's primitive defenses. The therapist must be prepared to respond to resistance to the contract by clarification, confrontation, and occasionally interpretation. Although countertransference reactions evoked by the patient's use of primitive defenses complicate the therapist's task of defining the necessary treatment frame, the therapist's recognition of countertransference responses can enable him to establish and enforce an appropriate contract.

Borderline Personality Disorder↗

PubMed1987

Projection and projective identification: developmental and clinical aspects.

Projective identification and projection are defined, described, and contrasted. Projective identification is seen as an early or primitive defensive operation, and projection as later or more advanced and derivative in nature. The developmental origins and adaptive functions of projective identification are examined with an emphasis on the cognitive preconditions for the operation of this defense. The varying functions of both defensive operations are described within the context of psychotic, borderline, and neurotic personality organization. Case material is presented to illustrate the diagnostic approach to and the clinical functions of projective identification, particularly its importance in contributing to complementary identification in the countertransference. Also illustrated is the technical management of severe transference regression under the impact of projective identification. Finally, alternative approaches to the diagnosis and interpretation of projective identification are discussed.

Adult↗

PubMed1987

An ego psychology-object relations theory approach to the transference.

This paper summarizes an ego psychology-object relations theory and its application to psychoanalytic technique, particularly to the analysis of the transference. The relative importance of verbal, nonverbal, and generally relational "channels" of communication in patients with differing degrees of transference regression is examined. The use of countertransference reactions in formulating transference interpretations is reviewed. The relations between unconscious meanings in the "here-and-now" and unconscious meanings in the "there-and-then" are explored in the transferences of patients with varying degrees of severity of psychopathology. Differences with other theoretical approaches are highlighted throughout.

Adult↗

PubMed1987

Projective identification, countertransference, and hospital treatment.

The principal purpose of this article is to illustrate the pivotal function of projective identification within the therapeutic milieu of the hospital. A detailed description of crises in the treatment of two patients undergoing long-term inpatient psychiatric treatment is given. These patients suffered from very different psychiatric illnesses; hence, their cases illustrate some features of hospital treatment that cut across different types and degrees of severity of psychopathology.

Adult↗

PubMed1986

Institutional problems of psychoanalytic education.

I believe that psychoanalytic education is suffering from serious disturbances, which, by analogy, might be examined as an illness affecting the educational structures of psychoanalytic institutes and societies. After describing the symptoms of this illness, I shall explore its causes and suggest a possible course of treatment. My objective is not to present "ideal solutions" to problems, but to provide a theoretical frame that might facilitate such solutions.

Curriculum↗