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Biomedical subjects

Otto F Kernberg

Publications and source records attributed to Otto F Kernberg.

13 recordsLinked to original sources
PubMed2006

Identity: recent findings and clinical implications.

After a review of foundational contributions to the concept of identity, including Erikson's, the author discusses the research methods and findings of the Personality Disorders Institute of the Joan and Sanford I. Weill Medical College of Cornell University regarding the concepts of normal identity and identity diffusion, toward an elucidation of the psychopathology of personality disorders--their etiology, diagnosis, and treatment. The application of an object relations theory model to analyze the development of identity clarifies the relationship of individual identity with the social and cultural frame that influences identity formation and may amplify the effects of pathological identity development. Detailed excerpts are presented from a diagnostic structural interview at the Personality Disorders Institute.

Adult↗
PubMed2006

The mechanisms of change in the treatment of borderline personality disorder with transference focused psychotherapy.

We address how Transference Focused Psychotherapy (TFP) conceptualizes mechanisms in the cause and maintenance of borderline personality disorder (BPD) as well as change mechanisms both within the patient and in terms of specific therapists' interventions that engender patient change. Mechanisms of change at the level of the patient involve the integration of polarized representations of self and others; mechanisms of change at the level of the therapist's interventions include the structured treatment approach and the use of clarification, confrontation, and "transference" interpretations in the here and now of the therapeutic relationship. In addition, we briefly review evidence from our group regarding the following hypothesized mechanisms of change: contract setting, integration of representations, and changes in reflective functioning (RF) and affect regulation.

Borderline Personality Disorder↗
PubMed2006

Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder.

Changes in attachment organization and reflective function (RF) were assessed as putative mechanisms of change in 1 of 3 year-long psychotherapy treatments for patients with borderline personality disorder (BPD). Ninety patients reliably diagnosed with BPD were randomized to transference-focused psychotherapy (TFP), dialectical behavior therapy, or a modified psychodynamic supportive psychotherapy. Attachment organization was assessed with the Adult Attachment Interview and the RF coding scale. After 12 months of treatment, participants showed a significant increase in the number classified secure with respect to attachment state of mind for TFP but not for the other 2 treatments. Significant changes in narrative coherence and RF were found as a function of treatment, with TFP showing increases in both constructs during treatment. No changes in resolution of loss or trauma were observed across treatments. Findings suggest that 1 year of intensive TFP can increase patients' narrative coherence and RF. Future research should establish the relationship between these 2 constructs and relevant psychopathology, identify treatment components responsible for effecting these changes, and examine the long-term outcome of these changes.

Adult↗
PubMed2006

The coming changes in psychoanalytic education: part I.

The author presents a critical overview of the literature on psychoanalytic education, focusing on criticism regarding structural aspects of our educational institutions. He then presents arguments for the need of radical changes in the organizational structure of institutes, and focuses on the problems of the training analysis system. He proposes concrete solutions for these problems, in the form of changes both in the assignment of responsibilities for the personal analysis of candidates and in the selection and function of supervisors.

Certification↗
PubMed2005

Unconscious conflict in the light of contemporary psychoanalytic findings.

In considering unconscious conflict, the author looks at the influence of contemporary psychoanalytic findings on the formulation and treatment of various psychopathologies. Technical considerations related to furthering the understanding of unconscious conflict are addressed, with attention to the roles of drives and affects, and to the influence of deficit theories and other developments on current psychoanalytic thinking and practice. A brief clinical illustration is included.

Adult↗
PubMed2004

The Personality Disorders Institute/Borderline Personality Disorder Research Foundation randomized control trial for borderline personality disorder: rationale, methods, and patient characteristics.

The Personality Disorder Institute/Borderline Personality Disorder Research Foundation randomized control trial (PDI/BPDRF RCT) is a controlled outcome study for borderline personality disorder (BPD), in which 90 participants were randomized to one of three manualized and monitored, active psychosocial treatment conditions. These treatments are: (a) Transference-Focused Psychotherapy (TFP; Clarkin, Yeomans, & Kernberg, 1999), a treatment for BPD based on object-relational and psychoanalytic principles first applied to BPD by Kernberg (1996), notable for its particular emphasis on interpretation of object relations activated in the ongoing therapeutic relationship; (b) Dialectical Behavior Therapy (DBT; Linehan, 1993), a popular treatment for BPD, with evidence of efficacy (Linehan, Armstrong, Suarez, Allmon, & Heard, 1991) that emphasizes a balance between acceptance and change in its combination of cognitive-behavioral and Zen principles; and (c) supportive psychotherapy (Rockland, 1992), another object-relational and psychoanalytically based treatment for BPD which, in contrast to TFP, eschews transference interpretation and places primary emphasis on development of a collaborative engagement with the patient to foster identity development. Patients received medication, if clearly indicated, according to the treatment algorithm developed by Soloff (2000). This article describes the significance and rationale of the study and the overall design, methods, plan of analysis, and demographic characteristics of the recruited sample of patients.

Adult↗
PubMed2004

Executive neurocognitive functioning and neurobehavioral systems indicators in borderline personality disorder: a preliminary study.

It is argued that borderline personality disorder (BPD) represents the interaction of underlying neurobehavioral systems that are reflected principally in the phenotypic constructs of positive emotion, negative emotion, and nonaffective constraint (Depue & Lenzenweger, 2001). This preliminary and exploratory study sought to examine predictions made from the Depue-Lenzenweger model with respect to controlled (effortful) information processing in BPD. It was hypothesized that (a) BPD subjects may display deficits on tasks that require controlled information processing (sustained attention, spatial working memory, and executive functioning), (b) they may reveal elevated negative emotion as well as decreased positive emotion and nonaffective constraint, and (c) nonaffective constraint should be substantially inversely associated with accurate performance on controlled information processing tasks. The results of this study, which examined 24 BPD diagnosed individuals and 68 normal adults, found support for each of these predictions in relation to performance on the Wisconsin Card Sorting Test. The implications of these results for further experimental psychopathology investigations of BPD as well as further refinement of theoretical models of the disorder are discussed.

Adult↗
PubMed2003

The management of affect storms in the psychoanalytic psychotherapy of borderline patients.

Affect storms are a frequent complication in the psychoanalytic approach to borderline patients. The descriptive, psychodynamic, and structural characteristics of these storms are explored, and the verbal, nonverbal, and countertransference manifestations that permit the formulation of interpretations under such conditions are described, as are the interventions required to maintain the treatment frame as a precondition for an analytic approach. The principal theoretical formulations regarding the affect pathology of borderline patients are reviewed and related to a proposed interpretive approach. An apparently opposite development, the utter absence of emotional developments in the sessions, is examined, and its defensive function of avoiding affect storms is explored. Clinical case material illustrates the proposed approach to these storms, and clinical evidence is given to support the approach, which centers on systematic analysis of the primitive internalized object relations of these patients in the transference, the use of countertransference analysis without countertransference communication to the patient, and the repeated restoration of technical neutrality in the service of protecting the treatment frame.

Acute Disease↗
PubMed2003

Sanctioned social violence: A psychoanalytic view--part I.

This paper is the first of a series of two that present an effort to systematize the application of psychoanalytic theory of group processes to the outbreak of massive violence. It explores the origins and social amplification of primitive aggression by means of group psychology and mass psychology, and the combined influences of the regressive pull of ideologies, the personality features of social and political leadership, and the triggering impact of historical trauma and social crises. The paper describes a spectrum of narcissistic-paranoid mechanisms that provide a common matrix for the analysis of those aspects of social psychology that co-determine socially sanctioned violence.

Aggression↗
PubMed2003

Sanctioned social violence: a psychoanalytic view. Part II.

This paper is the second in a series of two papers. In Part I, the first paper, the author reviewed the influence on the development of socially sanctioned violence of psychodynamics of group psychology and mass psychology, the regressive pull of ideologies, personality features of social and political leadership, and historical trauma and social crises. In this Part II, the author explores, from a psychoanalytic perspective, the dehumanization processes related to fundamentalist ideologies and terrorism.

Culture↗