Hatred, Emptiness, and Hope: Transference-Focused Psychotherapy in Personality Disorders

278 Pages·2023·4.6 MB·English

by  Otto F. Kernberg

HATRED, EMPTINESS,
Hatred, Emptiness, and Hope offers an updated vision of
psychoanalytic object relations theory, revealing its applica-
tion to transference-focused psychotherapy (TFP), a treat- AND HOPE
ment approach derived from, and related to, psychoanalysis.
Collecting previously published articles and new material
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applications of TFP, illustrating its use in severe personal- reH Personality Disorders
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About the Author is
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Otto F. Kernberg, M.D., is Director of the Personality e
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Disorders Institute at New York Presbyterian Hospital, West- s
chester Division, a Professor of Psychiatry at Weill Medical
College of Cornell University, and a Training and Supervising
Analyst at the Columbia University Center for Psychoanalytic
Training and Research in New York.
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WWW.APPI.ORG
Cover design: Rick A. Prather Otto F. Kernberg, M.D.
Cover image: Dr. Catherine Haran
Hatred, Emptiness,
and Hope
TRANSFERENCE-FOCUSED PSYCHOTHERAPY
IN PERSONALITY DISORDERS

Hatred, Emptiness,
and Hope
TRANSFERENCE-FOCUSED PSYCHOTHERAPY
IN PERSONALITY DISORDERS
By
Otto F. Kernberg, M.D.
Director, Personality Disorders Institute,
New York Presbyterian Hospital, Westchester Division
Professor of Psychiatry, Weill Medical College of Cornell University
Training and Supervising Analyst, Columbia University Center for
Psychoanalytic Training and Research
Note: The authors have worked to ensure that all information in this book is ac-
curate at the time of publication and consistent with general psychiatric and
medical standards, and that information concerning drug dosages, schedules,
and routes of administration is accurate at the time of publication and consis-
tent with standards set by the U.S. Food and Drug Administration and the gen-
eral medical community. As medical research and practice continue to advance,
however, therapeutic standards may change. Moreover, specific situations may
require a specific therapeutic response not included in this book. For these rea-
sons and because human and mechanical errors sometimes occur, we recom-
mend that readers follow the advice of physicians directly involved in their care
or the care of a member of their family.
Books published by American Psychiatric Association Publishing represent
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sarily represent the policies and opinions of American Psychiatric Association
Publishing or the American Psychiatric Association.
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Copyright © 2023 American Psychiatric Association Publishing
ALL RIGHTS RESERVED
First Edition
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Library of Congress Cataloging-in-Publication Data
Names: Kernberg, Otto F., 1928- author. | American Psychiatric Association
Publishing, issuing body.
Title: Hatred, emptiness, and hope : transference-focused psychotherapy in per-
sonality disorders/ by Otto F. Kernberg.
Description: First edition. | Washington, DC : American Psychiatric Association
Publishing, [2023] | Includes bibliographical references and index.
Identifiers: LCCN 2022013016 (print) | LCCN 2022013017 (ebook) | ISBN
9781615374618 (paperback) | ISBN 9781615374625 (ebook)
Subjects: MESH: Personality Disorders—therapy | Psychotherapy—methods |
Transference, Psychology | Object Attachment
Classification: LCC RC554 (print) | LCC RC554 (ebook) | NLM WM 190 |
DDC 616.85/81—dc23/eng/20220412
LC record available at https://lccn.loc.gov/2022013016
LC ebook record available at https://lccn.loc.gov/2022013017
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
To Kay, once again, with love and gratitude

CONTENTS
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xiii
P I
ART
Major Theoretical Statements
1
Object Relations Theory and
Transference Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2
Some Implications of New Developments
in Neurobiology for Psychoanalytic
Object Relations Theory . . . . . . . . . . . . . . . . . . . . . . 15
P II
ART
Technique
3
Extensions of Psychoanalytic Technique
The Mutual Influences of Standard Psychoanalysis
and Transference-Focused Psychotherapy . . . . . . . . . . . . 35
4
Therapeutic Implications of Transference
Structures in Various Personality Pathologies . . . . . . 61
5
Affective Dominance, Dyadic Relationship,
and Mentalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
6
Reflections on Supervision. . . . . . . . . . . . . . . . . . . . 113
P III
ART
Specific Psychopathologies
7
Psychodynamics and Treatment of Schizoid
Personality Disorders. . . . . . . . . . . . . . . . . . . . . . . . 133
8
Psychotic Personality Structure . . . . . . . . . . . . . . . . 147
9
Narcissistic Pathology of Love Relations . . . . . . . . . 165
P IV
ART
Application of Object Relations Theory
10
Psychoanalytic Approaches to Inpatient
Treatment of Personality Disorders
A Neglected Dimension. . . . . . . . . . . . . . . . . . . . . . . . 191
11
Malignant Narcissism and Large Group
Regression. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
12
Challenges for the Future of Psychoanalysis . . . . . . 233
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Introduction
T
he present volume continues my investigation of the psychopathology
and treatment of severe personality disorders. It focuses on the analysis
of particular clinical features of personality pathologies and describes
contemporary psychoanalytic object relations theory as a general theoret-
ical frame of treatment that allows us to conceptualize both normal per-
sonality functioning and the very nature of personality disorders. This
volume also includes my recent contributions to understanding the rela-
tionship between neurobiological dispositions and their interaction with
psychodynamic developments, again, both in normality and psychopa-
thology. Finally, this volume explores the application of object relations
theory to group processes, love relations, and therapists’ training.
Part I of the book includes major theoretical statements. Chapter 1,
“Object Relations Theory and Transference Analysis,” presents a brief,
updated summary of contemporary object relations theory and its direct
relevance to transference analysis, the fundamental therapeutic approach
of transference-focused psychotherapy (TFP). This chapter summarizes
the theoretical approach that informs the new psychotherapeutic devel-
opments in the treatment of severe personality disorders that are de-
scribed throughout the entire volume. Chapter 2, “Some Implications of
New Developments in Neurobiology for Psychoanalytic Object Relations
Theory” summarizes developments in neurobiology regarding the con-
ceptualization of affect systems and their role as the motivational basis
ix