The analyst's authority in the psychoanalytic situation.
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Adult↗
Biomedical subjects
O F Kernberg
Publications and source records attributed to O F Kernberg.
Thirty methods to destroy the creativity of psychoanalytic candidates.
The author explores formal aspects of psychoanalytic education relevant to the fostering or inhibiting of creativity in the work of candidates. He refers to thirty features of psychoanalytic institutes that inhibit candidates' creativity and, by implication, illustrate problems in psychoanalytic education that require our attention. These features include systematic slowing down of institutional progression of candidates, repetitive and unquestioning teaching of key papers by Freud, monolithic tendencies regarding theoretical approaches, isolation of candidates from the professional and scientific activities of the psychoanalytic society, accentuation of the hieratical relations among the psychoanalytic faculty, graduation rituals, discouragement of original contributions by candidates, intellectual isolation of institutes, lack of full presentation of clinical work by senior members of the faculty, neglect of studies of controversies regarding psychoanalytic technique, 'paranoiagenic' features of the relationship among faculty and regarding requirements for candidates, the 'convoy' system, neglect of exploration of the scientific and cultural boundaries and applications of psychoanalysis and the effects of institutional conflicts around the appointment of training analysts.
Creativity↗
Validation in the clinical process.
The combined analysis of the predominant themes, (a) in the patient's communication of his subjective experience, (b) in the patient's nonverbal behaviour and linguistic style, and in (c) the countertransference, provide indications for the main focus of the analyst's interpretive work, as well as potential evidence, in the corresponding changes in those three areas, of confirmatory or disconfirmatory aspects of the patient's reaction to the interpretation, thus providing the material for validation of the interpretation in the analyst's mind. Exploring a patient's responses to his interpretive interventions in the light of these criteria permitted the author to validate one interpretation at a 'right level in the right moment', to discard other interventions as too superficial, and to characterise one interpretation as probably premature.
Adult↗
Love in the analytic setting.
In the context of viewing the analytic setting as a "clinical laboratory" to study the nature of love relations, this paper starts by outlining the relationships of transference love, "normal" love, neurotic love, and oedipal love. After a description of the vicissitudes of transference love when patient and analyst are of the same sex and of opposite sex, developments of transference love regarding homosexual and heterosexual longings in neurotic and narcissistic pathology are considered. Countertransference reactions in response to transference love are explored next, with emphasis on conditions under which erotic countertransference may become particularly intense. In describing the technical management of erotic countertransference, the analyst's ability to explore his own feelings and fantasies without constraint is stressed. The usefulness of understanding the erotic countertransference in arriving at transference interpretations is illustrated by a clinical case of a female patient with a neurotic personality structure and predominantly masochistic conflicts.
Adult↗
Aggression, trauma, and hatred in the treatment of borderline patients.
This article focuses on the etiology of aggressive affect, behavior, and fantasy in the treatment of patients with severe personality disorders in an effort to further our understanding of the psychopathology and treatment of these patients. In the process, the relationship between inborn disposition to aggressive behavior and the effect of severe trauma and psychosocial pathology in early childhood are examined. Various types of transferences marked by aggression and specific approaches to each of these are outlined. Particular reference is given to the management of intense hatred--as a derivative of aggression--in the transference, and of the unconscious identification with both victim and victimizer in patients who have experienced sexual or physical abuse.
Adult↗
[The current status of psychoanalysis].
In this highly condensed overview, the author sketches the present state of psychoanalysis in the United States and examines its scientific status, forms of organisation and training structures. In part one, Kernberg reflects on the debate conducted in 1989 in Psychoanalytic Quarterly on the future of psychoanalysis. In part two, he presents his own view, looking at psychoanalysis as a branch of learning, its theoretical variety, psychoanalytic treatment, training for analysts, psychoanalysis as a profession and the international situation. Although Kernberg concentrates on the American scenario, in many respects his remarks also present, mutatis mutandis, an accurate picture of the psychoanalytic landscape in Europe.
Cross-Cultural Comparison↗
The erotic in film and in mass psychology.
The medium of film offers a vivid demonstration of the ongoing tension between conventional morality and mature, passionate love. While film activates mass psychology and therefore conventionality, the erotic in film threatens conventional boundaries. The dialectic thus involved in erotic art in film, the conventional film, and pornography sheds light on the unconscious motivations for accepting or rejecting the erotic. The author highlights relevant psychoanalytic theories to help formulate the nature of the erotic in film as well as the structures of the erotic film, the conventional film, and pornography. After discussing several examples, he concludes that both the conventional film and pornography are unconscious allies in opposing mature, passionate love.
Erotica↗
Suicidal behavior in borderline patients: diagnosis and psychotherapeutic considerations.
This paper summarizes the experiences with suicidal and parasuicidal behavior of the psychotherapy research project on borderline patients in progress at the Westchester Division of the New York Hospital-Cornell Medical Center. In the diagnostic evaluation of these patients, it is important to differentiate acute and chronic suicidal behavior with the presence or absence of depression. The dominant psychodynamic features of chronic characterological suicidal behavior are reviewed, with a particular emphasis on the psychopathology of self-directed and projected primitive hatred, and the defenses against its conscious awareness on the part of the patient. A general psychotherapeutic strategy to deal with suicidal and self-destructive behavior is mapped out, centered upon the transformation of self-destructiveness into specific transference constellations that must be diagnosed, interpreted, and gradually worked through in the transference in the course of the treatment. The treatment of chronic, characterologically anchored suicidal behavior without depression requires the setting up of specific structuring of the psychotherapy from the very beginning of treatment, embodied in the establishment of a treatment contract that contributes to the organizing frame for the entire psychotherapy. The precondition for this psychotherapeutic work and limiting factors affecting its effectiveness are spelled out.
Borderline Personality Disorder↗
The current status of psychoanalysis.
Presented here is an overview of current challenges and controversies regarding psychoanalysis as a science, competing psychoanalytic theories, convergent and divergent trends in psychoanalytic technique, psychoanalytic education, psychoanalysis as a profession. Among other issues stressed are the importance of the relation of psychoanalysis to the University, the research implications of competing theoretical and technical orientations, the need to reexamine the structure of psychoanalytic education, and the importance of international cross-fertilization in expanding the application of psychoanalysis to other fields.
Accreditation↗
The couple's constructive and destructive superego functions.
Just as the couple becomes the repository of both partners' conscious and unconscious sexual fantasies and desires, and of their consciously and unconsciously activated internalized object relations, so does the couple activate both partners' conscious and unconscious superego functions. The interaction of the partners' superego over time results in the forging of a new system, which I am calling the couple's superego. The functions of the couple's joint superego structure is described, as are the symptoms of superego pathology in the couple's love life. The vicissitudes of gratitude and guilt, of stereotyping and conventionality, of deceptiveness and long-range destructive and self-destructive scenarios, are explored in the context of a spectrum reflecting the severity of joint superego pathology. A clinical case vignette illustrates some of these developments in a couple's life.
Adult↗
Convergences and divergences in contemporary psychoanalytic technique.
A broad survey of the psychoanalytic field reveals both convergences and divergences in technique. The major convergences include earlier interpretation of the transference, increased focus on transference analysis, as well as growing attention to countertransference analysis and increasing concern with the risks of 'indoctrinating' patients. Greater emphasis is found on character defences and the unconscious meanings of the 'here-and-now'. Also noted are trends toward translating unconscious conflicts into object-relations terminology, as well as toward considering a multiplicity of royal roads to the unconscious. Regarding divergences, significant controversies continue about the importance of the 'real' relationship, and the therapeutic versus the resistance aspect of regression. Divergences also continue regarding reconstruction and recovery of preverbal experience, drawing the lines between psychoanalytic psychotherapy and psychoanalysis, the role of empathy, and the relation of historical to narrative truth.
Countertransference↗
Between conventionality and aggression: the boundaries of passion.
This paper explores changes in the recent psychoanalytic theory regarding the preconditions and structural characteristics of sexual love. In briefly reviewing Freud's contributions and subsequent developments regarding infantile sexuality and the perversions, the oedipal constellation, superego development and mass psychology, a common frame is provided for the description of the love life of the sexual couple. In this context, this paper also explores how contemporary psychoanalytic formulations may help to clarify certain conflicts between conventional morality and the psychological reality of the couple in love.
Aggression↗
Psychopathic, paranoid and depressive transferences.
This presentation focuses on the superego pathology frequently present in patients with borderline personality organization, an important issue in transference developments that evolve as a consequence and expression of this pathology. I shall describe 'psychopathic transferences' to refer to periods in the treatment when conditions of deceptiveness prevail in the transference, and the importance of systematically interpreting and working through these particular transferences. As a result of such a working through, paranoid transferences usually become dominant, and, in turn, need to be worked through fully. At this point, more advanced transferences characterized by depressive features tend to prevail, signalling the structural transformation of borderline into neurotic personality organization. Clinical case material will illustrate these transformations in the transference.
Adult↗
Aggression and love in the relationship of the couple.
In this paper I examine the interplay of love and aggression in a couple's emotional relationship. I explore the activation of dominant repressed or dissociated object relations with the parental figures, and the unconscious collusion of both partners to enact these past relationships in the present. I then examine the couple's relationship as determined by differences in male and female development, as well as the counterpart of these differences--unconscious moves toward "twinship" and complementarity. Unresolved oedipal conflicts are explored as a major cause of invasion of the couple's sexual boundaries, and a vehicle for the expression of dissociated aggression from many sources. Perversity--the "recruitment of love at the service of aggression"--as a threat to the basic fabric of a couple's love life is one alternative to the normal channels for elaboration of aggression in their relationship. Protective functions of the couple's interaction with their social network are examined in the context of their elaborating and integrating aggression with love.
Aggression↗
Sadomasochism, sexual excitement, and perversion.
Sadomasochism, an ingredient of infantile sexuality, is an essential part of normal sexual functioning and love relations, and of the very nature of sexual excitement. Sadomasochistic elements are also present in all sexual perversions. Sadomasochism starts out as the potential for erotic masochism in both sexes, and represents a very early capacity to link aggression with the libidinal elements of sexual excitement. Sexual excitement may be considered a basic affect that overcomes primitive splitting of love and hatred. Erotic desire is a more mature form of sexual excitement. Psychoanalytic exploration makes it possible to uncover the unconscious components of sexual excitement: wishes for symbiotic fusion and for aggressive penetration and intermingling; bisexual identifications; the desire to transgress oedipal prohibitions and the secretiveness of the primal scene, and to violate the boundaries of a teasing and withholding object. The relation between these wishes and the development of erotic idealization processes in both sexes is explored in the context of a critical review of the pertinent psychoanalytic literature.
Adult↗
Transference regression and psychoanalytic technique with infantile personalities.
This paper describes a particular form of 'silent' regression during the psychoanalytic treatment of infantile personalities (a type of character pathology related to the hysterical personality). This regression is characterized by the development of rapid interchange in the roles enacted in the transference and projected on to the analyst, an apparent 'disconnexion' of the transference material from that dominant when the patient is in non-regressed states, and the intensification of the analyst's counter-transference reactions. The diagnosis and management of these regressive transferences requires a particular interpretive style and strategy outlined in this paper and illustrated with two case vignettes.
Adult↗
The narcissistic personality disorder and the differential diagnosis of antisocial behavior.
This article describes a dimension of antisocial behavior that links the narcissistic personality disorder with the antisocial personality disorder, with the syndrome of malignant narcissism as intermediate between the two. Starting with a critique of the DSM-III-R description of the antisocial personality disorder, the author reviews some salient contributions to the concept of the antisocial personality disorder derived from descriptive, sociologic, and psychoanalytic viewpoints. Cleckley's classic description forms the historical background for an updated description of the key characteristics of the antisocial personality disorder. What follows is a summary of the differential diagnosis of antisocial behavior as found in the antisocial personality disorder, the syndrome of malignant narcissism, the narcissistic personality disorders with antisocial behaviors, other severe personality disorders with antisocial features, neurotic personality disorders with antisocial features, symptomatic neuroses, and, finally, dissocial reactions. Prognostic and therapeutic considerations regarding the treatment of antisocial behavior are briefly summarized in the light of this differential diagnosis. A final section describes the psychodynamics of the syndrome of malignant narcissism and of the antisocial personality disorder.
Antisocial Personality Disorder↗
An ego psychology object relations theory of the structure and treatment of pathologic narcissism. An overview.
This article summarizes the author's contributions to the psychoanalytic understanding of narcissistic personality disorders and their application to a theory of psychoanalytic and psychotherapeutic techniques for the treatment of these patients. The treatment is described as primarily focused on the analysis of the pathologic grandiose self in the transference. The early stages of this transference analysis are differentiated from later stages in the treatment, when the gradual dissolution of the pathologic grandiose self brings to the surface the underlying, dissociated, primitive object relations reflecting unconscious conflicts. The final stage of the treatment is described as approaching the characteristics of the treatment of neurotic patients. Finally, expressive or exploratory psychotherapy and supportive psychotherapy for narcissistic patients are described as psychoanalytically derived alternative treatment methods, and their respective indications and techniques are briefly summarized.
Ego↗