Aggressivity, Narcissism, and Self-Destructiveness in the Psychoterapeutic Relationship: New Developments in the Psychopathology and Psychotherapy of Severe Personality Disorders PDF
Preview Aggressivity, Narcissism, and Self-Destructiveness in the Psychoterapeutic Relationship: New Developments in the Psychopathology and Psychotherapy of Severe Personality Disorders
Aggressivity, Narcissism, and Self-Destructiveness in the Psychotherapeutic Relationship Aggressivity, Narcissism, and Self-Destructiveness in the Psychotherapeutic Relationship New Developments in the Psychopath- ology and Psychotherapy of Severe Personality Disorders Otto F. Kernberg, M.D. Yale University Press New Haven and London Copyright © Otto F. Kernberg. All rights reserved. This book may not be reproduced, in whole or in part, including illustrations, in any form (beyond that copyright permitted by Sections and of the U.S. Copyright Law and except by reviewers for the public press), without written permission from the publishers. Set in Adobe Garamond type by The Composing Room of Michigan, Inc. Printed in the United States of America. ISBN: 0-300-10180-5 A catalogue record for this book is available from the Library of Congress and the British Library. The paper in this book meets the guidelines for permanence and durability of the Committee on Production Guidelines for Book Longevity of the Council on Library Resources. To my children: Martin, Karen, and Adine Contents Preface, ix Part One Psychopathology, 1 1 A Psychoanalytic Theory of Personality Disorders, 2 Hatred as a Core Affect of Aggression, 3 Pathological Narcissism and Narcissistic Personality Disorder: Theoretical Background and Diagnostic Classification, 4 The Diagnosis of Narcissistic Pathology in Adolescents, 5 Perversion, Perversity, and Normality: Diagnostic and Therapeutic Considerations, Part Two Psychoanalytic Psychotherapy, 93 6 Psychoanalysis, Psychoanalytic Psychotherapy, and Supportive Psychotherapy: Contemporary Controversies, vii viii Contents 7 Psychodynamic Psychotherapy for Patients with Borderline Personality Organization: An Overview, 8 The Psychodynamics and Psychotherapeutic Management of Psychopathic, Narcissistic, and Paranoid Transferences, 9 A Severe Sexual Inhibition in a Patient with Narcissistic Personality Disorder, 10 Acute and Chronic Countertransference Reactions, 11 Omnipotence in the Transference and in the Countertransference, 12 The Risk of Suicide in Severe Personality Disorders: Differential Diagnosis and Treatment, 13 A Technical Approach to Eating Disorders in Patients with Borderline Personality Organization, 14 The Management of Affect Storms in the Psychoanalytic Psychotherapy of Borderline Patients, References, Index, Preface Significant advances have taken place in our present-day understand- ing of the etiology, psychopathology, and treatment of patients with severe personality disorders. The prevalence of severe personality dis- orders and their complications—disturbances in the capacity for work and intimate relationships, antisocial behvior, drug and alcohol dependency, and in particular suicidal and parasuicidal behavior—is a challenging concern in the treatment of emotional disorders. The etiology of personality disorders involves genetic and constitutional factors, especially the predisposition to the activation of excessive neg- ative affect and affect dysregulation, expressed in temperamental dis- position. To these causes have to be added the important influence of early attachment and its pathology, and the influence of psychic trauma—in particular, physical and sexual abuse, chronic family dis- organization, and abandonment. The intricate mechanisms that link genetic and constitutional disposition with psychosocial environmen- tal factors in the development of pathological behavior patterns that characterize personality disorders still are under investigation. Alter- native theoretical approaches have proposed various mechanisms that ix
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