Borderline Conditions and Pathological Narcissism

376 Pages·2000·34.583 MB·English

by  Otto F. Kernberg

BORDERLINE CONDITIONS
and
PATHOLOGICAL NARCISSISM
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 Universi
ty Medical College. He is also Training and Supervising Analyst of the
Columbia University Center for Psychoanalytic Training and Research.
In the past, Dr. Kernberg served as Director of the C.F. Menninger
Memorial Hospital, Supervising and Training Analyst of the Topeka In
stitute for Psychoanalysis, and Director of the Psychotherapy Research
Project of the Menninger Foundation. More recently, he was Director of
the General Clinical Service of the New York State Psychiatric Institute,
and Professor of Clinical Psychiatry at the College of Physicians and
Surgeons of Columbia University. Dr. Kern berg is a Vice-President of the
International Psychoanalytic Association, and President of the Associa
tion for Psychoanalytic Medicine. He is also Book Editor of the Journal of
the American Psychoanalytic Association. He was awarded the 1972 Heinz
Hartmann Award of the New York Psychoanalytic Institute and Society,
the 1975 Edward A. Strecker Award from the Institute of Pennsylvania
Hospital, the 1981 George E. Daniels Merit Award of the Association for
Psychoanalytic Medicine, the 1982 William F. Schonfeld Memorial
Award of the American Society for Adolescent Psychiatry, the 1986 Van
Gieson Award from the New York State Psychiatric Institute, the 1987
Teacher of the Year Award from The New York Hospital-Cornell
Medical Center, Westchester Division, and the 1990 MaryS. Sigourney
Award for Psychoanalysis. He is the author of 6 books: Psyclwtherapy and
Psyclwanalysis: Final Report of the Menninger Foundation's Psychotherapy
Research Project (with other authors), Borderline Omditions and Pathological
Narcissism, Object Relations Theory and Clinical Psyclwanalysis, Internal
World and External Reality: Object Relations Theory Applied, Severe Per
sonality Disorders: Psychotherapeutic Strategies, and Aggression in Personality
Disorders and Perversion. He is also author (with Michael Selzer, Harold W.
Koenigsberg, Arthur Carr, and Ann Appelbaum) of Psychodynamic
Psyclwtherapy of Borderline Patients, and guest editor of the volume Nar
cissistic Personality Disorder in the Psychiatric Clinics of North America Series.
BORDERLINE
CONDITIONS
and
PATHOLOGICAL
NARCISSISM
Otto F. Kemberg, M.D.
A JASON ARONSON BOOK
ROWMAN & LITTLEFIELD PUBLISHERS, INC.
Lanham • Boulder • New York • Toronto • Oxford
A JASON ARONSON BOOK
ROWMAN & LI'ITLEFIELD PUBLISHERS, INC.
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Copyright© 1985, 1975 by Jason Aronson Inc.
First softcover edition 1992
First Rowman & Littlefield Edition 2004
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British Library Cataloguing in Publication Information Available
Library of Congress Cataloging-in-Publication Data
ISBN: 978-0-87668-762-8
Library of Congress Catalog Number: 84-45864
Printed in the United States of America
9""
The paper used in this publication meets the minimum requirements of American
National Standard for Information Sciences-Permanence of Paper for Printed Library
Materials, ANSIINISO Z39.48-1992.
To Paulina, Martin, Karen, and Adine

CONTENTS
Preface xiii
Acknowledgments XV
Part I Borderline Personality Organization
One The Syndrome 3
Review of the Literature/Descripliue Analysis: The Presumpliue
Diagnostic Elements: anxiety; polysymptomatic neurosis;
polymorphous perverse sexual trends; the "classical"
prepsychotic personality structures; impulse neurosis
and addictions; "lower level" character disorders/Struc
tural Analysis: nonspecific manifestations of ego
weakness; shift toward primary-process thinking;
specific defensive operations at the level of borderline
personality organization; pathology of internalized
object relationships/ Genetic-Dynamic Analysis/Summary
Two Countertransference 49
The Concept of Countertransference/Regression and Identification
in the Countertransference/Some Chronic Countertransference
Fixations/The Importance of Concern as a General Trait of the
Analyst/Summary
Three General Principles of Treatment 69
Introduction/Review of the Pertinent Literature Transference and
Countertransference Characteristics/Psychotherapeutic Approaches
to the Specific Defensiue Operations: splitting; primitive
idealization; early forms of projection, and especially
Borderline Conditions and Pathological Narcissism
X
projective identification; denial; omnipotence and
devaluation/Instinctual Vicissitudes and Psychotherapeutic
Strategy/Further Comments on the Modality of Treatment
Four Prognosis 111
The Descriptive Characterological Diagnosis: predominant
type of character constellation; ego and superego
distortions reflected in individual character traits; self
destructiveness as a character formation and negative
therapeutic reaction/The Degree and Quality of Ego
Weakness/The Degree and Quality of Superego Pathology/The
Quality of Object Relationships/The Skill and the Personality of
the Therapist/Summary
Five Differential Diagnosis and Treatment 153
A Critical Review of Recent Literature: diagnosis;
treatment/Summary of Previous Work: the clinical
manifestations of borderline personality; hypotheses
regarding the origin of ego weakness; complications in
analyzing patients with borderline personality
organization, and technical implications for their
treatment; some conditions under which analyzability
improves or worsens/Further Considerations About Treat
ment: transference interpretation, regression and
reconstruction; transference psychosis/Differential
Diagnosis of Schizophrenia and Borderline Conditions
Six Overall Structuring and Beginning Phase
of Treatment 185
The Overall Treatment Arrangements/The Basic Therapeutic
Setting/Special Problems in the Early Stages: conscious
withholding of material; consistent devaluation of all
human help received; chronic development of
"meaninglessness" in the therapeutic interaction;
paranoid control and withholding; early, severe acting
out; misuse of previous information regarding treat
ment, and of "psychotherapeutic language"; the
predominant quality of separation reactions; the
psychotherapist's relationship with the hospital team
Contents xi
Seven The Subjective Experience of Emptiness 213
Part II Narcissistic Personality
Eight The Treatment of the Narcissistic
Personality 227
Etiological and Dynamic Features/Differential Diagnosis/Con
siderations in Regard to Technique/Prognostic Considerations:
tolerance of depression and mourning; secondary gain
of analytic treatment; transference potential for guilt
versus transference potential for paranoid rage; the
quality of the sublimatory potential; the degree and
quality of superego integration; presence of life
circumstances granting unusual narcissistic
gratifications; impulse control and anxiety tolerance;
regression toward primary-process thinking; the
motivation for treatment/A Crucial Period in lhe
Treatment/Summary
Nine Clinical Problems of the Narcissistic
Personality 263
Clinical Characteristics of the Narcissistic Personality as a Specific
Type of Character Pathology/The Relationship of Narcissistic
Personality to Borderline Conditions and the Psychoses/The
Relationship of Normal to Patholgical Narcissism: developmen-
tal arrest or pathological development?; differential
qualities of infantile and pathological narcissism;
manifestations of pathological narcissism in the analytic
situation; genetic considerations; types of idealization
and the relationship of narcissistic idealization to the
grandiose self; structural characteristics and origins of
the grandiose self/Psychoanalytic Technique and Narcissistic
Transference: vignette 1; vignette 2; vignette 3; vignette
4/Countertransference and Therapeutic Modification of the
Narcissistic Resistances/Prognosis of Narcissism, Treated and
Untreated
Ten Normal and Pathological Narcissism 315
Definition of Normal Narcissism: the ideal self and ego goals;
object representations; superego factors; instinctual
and organic factors; external factors/Pathological Nar
cissism/Some Diagnostic Applications of This Conceptualization of