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By Otto Kernberg

During this booklet a number one psychoanalytic clinician and theoretician offers his options at the newest psychodynamic advancements and insights with regards to remedy of serious character problems. Dividing his discussions into sections, one on psychopathology and the opposite on psychotherapy, Dr. Otto Kernberg examines borderline character sickness, narcissism, sexual inhibition, transference and countertransference, suicidal behaviour, and consuming issues. In every one bankruptcy he integrates the guidelines of ecu and Latin American psychoanalytic thinkers, bringing them to the eye of English-speaking readers. This booklet features a collection of lately released magazine articles. Their assortment into one quantity makes on hand Dr. Kernberg's current pondering on a huge topic.

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Extra resources for Aggressivity, Narcissism, and Self-Destructiveness in the Psychoterapeutic Relationship: New Developments in the Psychopathology and Psychotherapy of Severe Personality Disorders

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These patients’ excessive dependency and easy sense of frustration go hand in hand with their “faulty metabolism” of aggression; depression ensues when an aggressive response would have been appropriate, and an excessively aggressive response to the frustration of their dependency needs may rapidly turn into a renewed depressive response as a consequence of excessive guilt feelings. FURTHER IMPLICATIONS OF THIS CLASSIFICATION Using the classification I have presented, which combines structural and developmental concepts of the psychic apparatus based on a theory of internalized object relations, we may differentiate personality disorders according to the severity of the pathology, the extent to which it is dominated by aggression, the extent to which pathological affective dispositions influence personality development, the effect of the development of a pathological grandiose structure of the self, and the potential influence of a temperamental disposition toward extroversion or introversion.

Temperament also includes genetically and constitutionally determined behavioral and cognitive patterns, such as some gender-role-specific traits. Accepting in theory the possibility that genetic and constitutional factors as well as environmental and psychodynamic factors may play a role, the question of how to conceptualize aggression and understand its involvement in the development of severe psychopathology remains. Contemporary biological instinct theory has evolved into an integrated view of instinct and environment, conceptualizing inborn dispositions to behavior patterns that are activated under determinate environmental conditions, leading to the activation of a sequence of exploratory and consummatory behaviors.

Conflicts are not so much repressed as expressed in mutually dissociated ego states reflecting the primitive defense of splitting. The activation of primitive object relations that predate the consolidation of ego, superego, and id is manifest in the transference as apparently chaotic affect states; these, as noted above, have to be analyzed in sequential steps. Interpretation of the primitive transferences of borderline patients brings about a transformation of part-object relations into total object relations, of primitive transferences (largely reflecting stages of development that predate object constancy) into the advanced transferences of the oedipal phase.

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