Psychoanalytic Psychotherapy for Personality Disorders: An Interview with Otto Kernberg, MD
Working with severe personality disorders is perhaps the most challenging task clinicians face. And while the psychoanalytic literature offers profound insights on this topic, it also can be quite daunting to many therapists.
In this interview, Kernberg first lays out the core principle of Object Relations theory, and his concept of the “borderline personality organization,” characterized by identity diffusion, that underlies severe personality disorders. He walks viewers through the Structured Interview for Personality Organization, giving therapists the opportunity to learn a highly effective and pragmatic way to begin treatment by assessing whether patients suffer from an underlying personality disorder. Kernberg goes on to describe his detailed, manualized, psychoanalytic treatment protocol, explaining the four core treatment techniques: interpretation, transference analysis, technical neutrality, and counter-transference analysis.
Weaving in examples of his own challenging cases, such as an enraged patient who brought in scissors to session and cut up all of his plants, Kernberg serves as a guide for therapists who want support in understanding and managing the dynamics of the oftentimes difficult therapeutic relationship with severely disturbed patients. He discusses how to set limits with chronically suicidal patients, how to work with aggression and violence, how to deal with countertransference reactions, and the essentiality of collegial support.
This interview offers much more than a discussion of the theoretical foundations of an object relations approach to therapy. By watching this video, you will have the experience of learning concrete tools and techniques from the leading expert on personality disorders that you can begin utilizing with your most difficult patients immediately. One thing that Kernberg conveys very effectively is the lack of a coherent identity that is at the core of a severe personality disorder. This is dramatically illustrated by his description of one such patient on the video. He reports asking the patient to describe herself and she responds:
“Well, that depends with whom I am. I'm different. And there's always something underneath,” she said. She said, “Sometimes I feel like an onion, you know?” “What do you mean?” “You can peel it, and there's a deeper wave, the real onion comes out, and then you continue peeling and there's another onion, and at the end you have nothing.” And the patient looked kind of slightly ironic and sad at the same time.
Otto Kernberg: Live Case Consultation
Amy presents the case of a woman who grew up being severely sexually abused. According to Amy, “She’d be happy if she never had sex for the rest of her life.” Amy wants to be able to better help her client free herself from her victim stance and black/white thinking.
Steve discusses a client he has been seeing for four months yet still feels like a stranger. Steve wonders why his client’s conflicts with his wife, which led him into therapy in the first place, don’t come up in sessions.
Annie describes her work with an isolated, single man who is longing for a fully expressed sexual life, yet is caught in masochistic and fetishistic wishes. Annie has tried to help him with his extreme sexual inhibition yet feels stuck when her convictions clash with the approach of the 12-step group he attends.
By viewing these consultations, you’ll get a keen sense of Kernberg’s mastery of working with extremely challenging patients, as well as his skill as a teacher and consultant. By asking a series of wisely chosen questions, he is able to quickly hone in on key characterological aspects of the patients, as well as the dynamics of the therapist-client interactions, and then offer extremely useful and jargon-free suggestions on how each therapist can proceed in a more effective manner.
Dr. Kernberg and his colleagues at the Personality Disorders Institute have done extensive research on diagnosing and treating patients with severe personality disorders for several decades, so he is definitely the expert to turn to when you need support with your most difficult cases. This is a great opportunity to be a “fly on the wall” as he consults with three different therapists who have three different theoretical orientations: client-centered, psychoanalytic, and cognitive-behavioural. This video will be particularly useful for therapists who want to hone their consulting/supervising skills.
By watching this video, you will:
- Gain an understanding of Kernberg’s unique and effective approach to both case consultation and to working with challenging patients.
- Learn what questions are essential to ask early on in treatment in order to make an accurate diagnosis and treatment plan.
- Develop skills to more effectively apply an object relations approach to assess, diagnose, and treat people with personality disorders.
About Otto Kernberg, MD
Otto Kernberg, MD is the Director of the Personality Disorder Institute at the New Your Presbyterian Hospital, Westchester Division, and Professor of Psychiatry at the Joan and Sandford I. Weill Medical College and Graduate School of Medical Sciences of Cornell University. He is also Training and Supervising Analyst of the Columbia University Center for Psychoanalytic Training and Research and is the Past-President of the International Psychoanalytic Association. He has received numerous awards for his excellence in Psychiatry and has authored or coauthored over twenty books.
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