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The basic text for the understanding of patients with pathological narcissism.
- Sales Rank: #766513 in Books
- Published on: 1995-04-01
- Original language: English
- Number of items: 1
- Dimensions: 8.94" h x 1.09" w x 6.60" l, 1.29 pounds
- Binding: Paperback
- 376 pages
Review
"...includes a careful phenomenological description of borderline personalities as well as numerous comments about treatment possibilities and problems." -- (Arnold Goldberg, 1985)
"This book should be carefully studied by all psychotherapists who work with 'difficult' patients." -- (Malcolm Pines, The British Journal of Psychiatry, 1985)
About the Author
Otto F. Kernberg, M.D., F.A.P.A. , is associate chairman and medical director of The New York Hospital-Cornell Medical Center, Westchester Division, and professor of psychiatry at the Cornell University Medical College. He is also training and supervising analyst of the Columbia University Center for Psychoanalytic Training and Research.
Most helpful customer reviews
0 of 0 people found the following review helpful.
Five Stars
By Su, jung chia
great item
3 of 12 people found the following review helpful.
What are we really talking about?
By Mrk
Strong thinking from Kernberg in the pre-post-classical sens?What do I mean?Thats the question I am asking to Kernberg.The language is a mix bag.Sometime classical,sometime interpersonal and object relational or sometime ego oriented it is difficult to follow a real thread here.In that sens I believe Kohut is way ahead conceptually and in the consistency of his thinking.
My main objection here;the patient is shown rather on the guilty side rather that on the "victimized by the family" side.So we still are in an all,old Freudian Victorian type of school.Society is not responsible, the patient is.This position is not sustainable in 2010.
Fundamentally it is a very good book especially on narcissism but the equation language/thinking is outdated.
Concepts and language dont match because today "trauma and dissociation" radical developments,discoveries and datas have changed everything and turned 100% the psychoanalytic world up side down. So what we do need here is a good 2010 update.
26 of 28 people found the following review helpful.
The definitive book on Borderline Personality Disorder
By Sophia Bezirganian
When I first heard Dr. Kernberg speak, I thought he deserved his reputation as a brilliant but intimidating psychiatrist. After reading this book I came away with a very different understanding-- that he is not simply a master theoretician on personality disorder, but also a gifted healer, with deep understanding and wisdom in his approach to his patients. First written in 1975, this book remains the definitive comprehensive work on Borderline Personality Disorder and on Narcissistic pathology.
Early in his text, Dr. Kernberg summarizes the salient contributions to his evolving understanding of personality development, made by prior leading pioneers: Anna Freud (on the understanding of defense mechanisms, their essential hierarchical ordering, from primitive to most mature, based on their order of appearance in the developing child), Melanie Klein (on the origin and the nature of the infantile oral aggression which is the fundamental disturbance from which spring the hallmark symptoms of splitting, idealization, overvaluation, and their vicissitudes), Helene Deutsch (on the concept of the "as if" personality, which beautifully explains the nature of the identity disturbance and emptiness of the BPD).
He follows his literature review with what I believe is the best chapter (and one whose reading alone makes owning this book worthwhile) "The Syndrome". Here is found perhaps his greatest contribution into the elucidation of the condition (the seeds of which he gives credit to Dr. Karl Menninger): the idea of mental illness as a unitary process, and personality pathology as organized on a dimensional continuum. In this conceptualization, an understanding of BPD emerges which allows the reader to break through (what was for me) the confusing DSM IV catalogue defining the disorder as a many-headed hydra of pathological symptoms and behaviors: BPD is unstable affects--anger, rage, dysphoria, anxiety. It is emptiness, lack of identity. It is also impulsivity, promiscuity, eating disorder symptoms, substance abuse, self-injury, suicidal acts. Wait...it is also unstable relationships--frantic efforts, devaluation, idealization! Reading this chapter of Dr. Kernberg's book finally gave me a clear basis for understanding each of the DSM IV criteria, how they interrelate, how they arise within the psyche, and how the presence and severity of each, and their unique combination in each patient predicts her/his prognosis, and guides treatment.
Kernberg's great contribution is that Borderline Personality is not a separate and discrete entity. It is in fact better understood as a spectrum of "Borderline Conditions" which is then to be understood as a unique dimension of personality pathology. This dimension is in turn superimposable on a second continuum consisting of many other personality disorders. The latter in turn are ordered from the "lowest" and most severe, characterized by the most primitive defenses: Narcissistic, (containing Paranoid and Antisocial subtypes), Infantile (with Dependent subtypes), and finally Hysterical, Depressive/Masochistic, and Obsessive personalities, which utilize "higher level" defenses(Reaction Formation, Identification with the Aggressor).(Those in this last group in particular however, may be rendered much sicker if colored by severe forms of the Borderline Conditions).
The elucidation of this theory may well appear arcane and esoteric. The clinician may be tempted to dismiss it as an academic exercise with little salience to the modern treatment of Borderline and other severe personality disorders, and return to his much more user-friendly DBT manual! If he hangs in however, and forges through more of this book the reader will find that the remaining chapters are much easier to understand, once the first two sink in, and confer much wisdom into the treatment of BPD, and of the other serious personality constellations that it so often colors and coexists with, one of which, the Narcissistic constellation, receives comprehensive attention in the second half of the book.
I can touch on just a few treatment pearls that are presented:
1. How to determine capacity for intensive work thus decide if psychodynamic vs. supportive therapy is indicated; and on length of therapy and session frequency(e.g. level of anxiety tolerance, presence of the capacity for depression and guilt (indicative of more developed superego and better prognosis).
2. The potential pitfalls in therapy (transference and counter-transference based)and how to avoid them: patient idealization or devaluation of the therapist, splitting by patient of her negative states after acting out within them (rendering them unavailable to work with in therapy), therapist masochistic submission to patient's aggression (taking calls at all hours, responding to serial spurious "crises"), a sense of therapist's impotence, and/or exaggerated fear of criticism by third parties (leading to therapist fear & aggression: retaliating to patient's threats of suicide with punitive involuntary hospitalization, or with countertherapeutic "contracts" whereby the patient is given rigid conditions for ejection from therapy).
I hope my review influences the reader who may, like myself, (in real life) have little opportunity to practice Dr. Kernberg's recommended many years of weekly psychotherapy,to dive into this book nevertheless; he will emerge with much more wisdom, understanding, and empathy for many of his sickest patients.
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