Otto F. Kernberg
Encyclopedia
Otto Friedmann Kernberg is a psychoanalyst and professor
of psychiatry
at Weill Cornell Medical College. He is most widely known for his psychoanalytic theories on borderline personality organization and narcissistic pathology. In addition, his work has been central in integrating postwar ego psychology
(which was primarily developed in the United States and the United Kingdom) with Kleinian and other object relations perspectives (which was developed primarily in the United Kingdom and South America). His integrative writings were central to the development of modern object relations, a theory of mind that is perhaps the theory most widely accepted among modern psychoanalysts.
, Kernberg and his family fled Nazi Germany
in 1939, emigrating to Chile
. He studied biology
and medicine
and afterwards psychiatry
and psychoanalysis
with the Chilean Psychoanalytic Society. He first came to the U.S. in 1959 on a Rockefeller Foundation
fellowship to study research in psychotherapy
with Jerome Frank
at the Johns Hopkins Hospital
. In 1961 he emigrated to the U.S. joining the C.F. Menninger Memorial Hospital, later became director of the hospital. He was the Supervising and Training Analyst of the Topeka Institute for Psychoanalysis, and Director of the Psychotherapy Research Project of Menninger Foundation. In 1973 he moved to New York where he was Director of the General Clinical Service of the New York State Psychiatry Institute. In 1974 he was appointed Professor of Clinical Psychiatry at the College of Physicians and Surgeons of Columbia University
and Training and Supervising Analyst at the Columbia University Center for Psychoanalytic Training and Research. In 1976 he was appointed as Professor of Psychiatry at Cornell University and Director of the Institute for Personality Disorders Institute of the New York Hospital-Cornell Medical Center. He was President of the International Psychoanalytical Association
from 1997 to 2001.
His principal contributions have been in the fields of narcissism
, object relations theory
and personality disorder
s. He developed a novel and useful framework for coordinating personality disorders along dimensions of structural organization and severity.
He was awarded the 1972 Heinz Hartmann
Award of the New York Psychoanalytic Society and Institute, 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.
known as Transference-Focused Psychotherapy (TFP)
, which is meant to be more suitable for Borderline Personality Organization (BPO) patients. BPO patients are described as experiencing so-called 'splits' in their affect
and thinking, and the intended aim of the treatment is focused on the integration of split off parts of self and object representations.
TFP is an intense form of psychodynamic psychotherapy
designed particularly for patients with borderline personality organization (BPO) which requires a minimum of two and a maximum of three 45 or 50-minute sessions per week. It views the individual as holding unreconciled and contradictory internalized representations of self and significant others that are affectively charged. The defense against these contradictory internalized object relations is called identity diffusion, and leads to disturbed relationships with others and with self. The distorted perceptions of self, others, and associated affects are the focus of treatment as they emerge in the relationship with the therapist (transference). The consistent interpretation of these distorted perceptions is considered the mechanism of change.
Identity diffusion results from pathological object relations and involves contradictory character traits, discontinuity of self and either very idealized or devalued object relations. Defense operations often applied by BPO patients are splitting, denial, projective identification, primitive devaluation / idealization and omnipotence. Reality testing is negatively influenced by the primitive defense mechanisms as they change a person's perception of self and others.
, that is, the transference
. Techniques of clarification, confrontation, and interpretation are used within the evolving transference relationship between the patient and the therapist.
During the first year of treatment, TFP focuses on a hierarchy of issues:
of self
and other. Partial representations of self and other are paired and linked by an affect in mental units called object relation dyads. These dyad
s are elements of psychological structure. In borderline pathology, the lack of integration of the internal object relations dyads corresponds to a ‘split’ psychological structure in which totally negative representations are split off/segregated from idealized positive representations of self and other (seeing people as all good or all bad). The putative global mechanism of change in patients treated with TFP is the integration of these polarized affect states and representations of self and other into a more coherent whole.
, narcissistic choice of object, narcissistic personality disorder) with narcissistic personality disorder being the most severe of all. Still, narcissism has been a great source of disagreement between Otto Kernberg and Heinz Kohut
. Although both focused on narcissistic, borderline, and psychotic patients, the focus and content of their theory and treatment has been considerably differentiated. Their major diversities emerged in response to their conceptualizations regarding the relationship between Narcissistic and Borderline personalities, normal vs. pathological narcissism, their ideas about narcissistic idealization and the grandiose
self, as well as the psychoanalytic technique and the narcissistic transference.
In Kernberg's view, narcissistic personalities are differentiated from both normal adult narcissism and from fixation at or regression to normal infantile narcissism. Fixation at a primitive stage of development or lack of development of specific intrapsychic structures is not adequate to explain the characteristics of narcissistic personalities. Those characteristics (through a process of pathological differentiation and integration of ego and superego structures) are the consequence of pathological object relationships. Pathological narcissism is not merely the libidinal investment in the self but in a pathological, underdeveloped structure of the self. This pathological structure presents defences against early self and object images, which are either libidinally or aggressively invested. The psychoanalytic process brings to the surface primitive object relations, conflicts and defences, which are typical of the developmental stages that precede the stability of the object.
and aggression
. Their main differences are summarized below.
individual is quite similar to that of the borderline person since the former has a fairly underlying borderline personality organization which becomes obvious when one looks at the defenses of splitting and projective identification. He identifies constitutional along with environmental
factors as the source of disturbance for these individuals by stressing the important role of the mother
surrogate who treats the child on the surface (callously) with little regard for his/her feelings and needs. Kohut on the other hand, sees borderline personality as totally distinct from the narcissistic one and less able to benefit from the analytic treatment
. Equally, a narcissistic personality is more apt for analysis since it is characterized by a more resilient self. According to Kohut , the environment alone is the major cause of troubles for these persons. Moreover, although both focus on the concept of the “grandiose self” in their narcissistic personality theorizing, they provide different explanations for it. For Kohut, “grandiose self” reflects the “fixation of an archaic 'normal' primitive self” while for Kernberg it is a pathological development, different from normal narcissism. For Kohut treatment should be primarily centered on encouraging the patient's narcissistic desires, wishes, and need
s to open up during the process of transference. For Kernberg, the goal of treatment should be to use confrontation strategies so as to help the patient integrate his/hers internal fragmented world.
forces or charges in order to provide an etiology
of how this disorder develops. For him the aggression drive
is of secondary importance in respect to the libidinal drive and that is why one should differentiate between ordinary aggression and narcissistic rage
. The first, according to him, is adaptive for eradicating obstructions when heading toward a realistic goal whereas the second is the forceful response to narcissistic injury. Kernberg however, sees Kohut's ideas as de-emphasizing the power of aggression. He allies more to the Freudian conceptualization, by proposing that narcissistic behavior results from pathological development in which aggressive drives play a central role. He argues that narcissism on the whole involves a strong aggressive drive that cannot possibly be analyzed separately from the libidinal one. As he says, “one cannot study the vicissitudes of normal and pathological narcissism without relating the development of the respective internalized object relations to both libidinal and aggressive drive alternatives”
regard the analytic process as well as the role of the analyst in quite different terms.
regards narcissistic illusions within the analytic situation as representations of the patient’s attempt to establish crucial developmental opportunities. These narcissistic illusions thus give an opportunity for revitalization of the self. Therefore, Heinz Kohut advocates that the analyst's position within treatment should be one where a full narcissistic transference should be encouraged instead of being challenged. To establish this, the analyst should be able to show empathic comprehension, which entails a receptivity to the narcissistic illusions and an avoidance at all costs of anything which would challenge them or suggest they are unrealistic. Heinz Kohut
used the concepts of narcissistic transference and self-object needs. He also stressed the significance of infantilism and what appear to be excessive demands on the analyst and everyone else. Rather than instinctual wishes to be renounced, they are missed developmental needs to be warmly received and understood. The patient is groping toward self-cure, by trying to extract from others what was missing early in his development. Heinz Kohut feels the patient knows what he needs, regardless of what the analyst may think he knows. He stresses the importance of hopes in maturity and throughout development. There is an enduring need for ideals and idealization that vitalizes self experience. In his work with narcissistic patients, the defining feature of Heinz Kohut’s psychoanalytic methodology became therefore empathic immersion (or vicarious inspection), whereby he tried to put himself in his patient’s shoes. This view is certainly in contrast with Freud’s early view of the analyzability of narcissistic defenses as discussed above.
From Kohut’s point of view, the methodical interpretive approach recommended by Kernberg is interpreted by the narcissistically vulnerable patient as an assault and generates intense narcissistic rage. As Kernberg instead recommends this methodology for treating these patients, self-psychology regards Kernberg as creating narcissism instead of treating it.
On the other hand, Kernberg (from the more traditional point of view) sees the approach of Kohut as leading to nothing. An unquestioning acceptance of the patient’s illusions with the assumption that they will eventually diminish of their own accord represents a collusion with the patient’s defenses. The analytic process is thereby subverted and the analyst never emerges as a figure who can meaningfully help the patient.
in the first months of his life as struggling to sort out his experience on the basis of the affective valence of this experience. The infant moves back and forth between two different affective states. One state is characterized as pleasurable and gratified; the other state is unpleasurable, painful and frustrating. Regardless of what one is in, no distinction is made between self and other.
s, delusion
s, psychic fragmentation) we can see a lack of being able to separate between internal and external world, own experience and experience of others, own mind and the mind of another.
, or libidinal affects. Hateful images of the self and bad, frustrating object images are held together by negative or aggressive affects. The good is separated from the bad. The developmental task is accomplished, as the child is able to see objects as “whole”, meaning that the child
can see objects as being both good and bad. Next to seeing “whole” objects, the child is required to see the self as being loving and hating, as being good and bad at the same time. When one fails to accomplish this second developmental task, this will result in a borderline pathology, meaning that objects or the self cannot be seen as both good and bad; something is good, or it is bad, but both affects cannot be in the same object together.
This stage is marked by undifferentiated self-object representations. This stage is equated with Mahler
, Pine and Bergman’s conception of autism.
In the beginning of this stage the child is unable to integrate opposing affective valences. Libidinally invested and aggressively invested representations are strictly separated into a ‘good’ self-object representation and a ‘bad’ self-object representation.
In this stage the ‘good’ self-object representation differentiates into a ‘good’ self and a ‘good’ object and shortly thereafter the ‘bad’ self-object representation differentiates into a ‘bad’ self and a ‘bad’ object. A failure of the child to differentiate between self and other results in a psychotic personality organization; one has failed to accomplish the first developmental task and is stuck in stage II. Although in this stage differentiation between self an object has taken place the good and bad self and object representations are strictly separated through the mechanism of splitting in order to protect the ideal, good relationship with the mother from contamination by bad self representations and bad representations of her.
During this stage the ‘good’ (libidinally invested) and ‘bad’ (aggressively invested) self and object representations are integrated into a definite self system and a total object representation. One is able to comprehend the possibility of the self or other containing both positive and negative characteristics. A failure of this results in a borderline personality organization; one has failed to accomplish the second developmental task and is stuck in stage III. Consequently, the good self and object must still be protected from the aggression by the splitting of good and bad.
In this stage ego, superego and id
are consolidated in definite intrapsychic structures.
By successfully completing all the developmental tasks, the child has developed a neurotic personality organization, which is the strongest personality structure.
Professor
A professor is a scholarly teacher; the precise meaning of the term varies by country. Literally, professor derives from Latin as a "person who professes" being usually an expert in arts or sciences; a teacher of high rank...
of psychiatry
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
at Weill Cornell Medical College. He is most widely known for his psychoanalytic theories on borderline personality organization and narcissistic pathology. In addition, his work has been central in integrating postwar ego psychology
Ego psychology
Ego psychology is a school of psychoanalysis rooted in Sigmund Freud's structural id-ego-superego model of the mind.An individual interacts with the external world as well as responds to internal forces. Many psychoanalysts use a theoretical construct called the ego to explain how that is done...
(which was primarily developed in the United States and the United Kingdom) with Kleinian and other object relations perspectives (which was developed primarily in the United Kingdom and South America). His integrative writings were central to the development of modern object relations, a theory of mind that is perhaps the theory most widely accepted among modern psychoanalysts.
Biography
Born in ViennaVienna
Vienna is the capital and largest city of the Republic of Austria and one of the nine states of Austria. Vienna is Austria's primary city, with a population of about 1.723 million , and is by far the largest city in Austria, as well as its cultural, economic, and political centre...
, Kernberg and his family fled Nazi Germany
Nazi Germany
Nazi Germany , also known as the Third Reich , but officially called German Reich from 1933 to 1943 and Greater German Reich from 26 June 1943 onward, is the name commonly used to refer to the state of Germany from 1933 to 1945, when it was a totalitarian dictatorship ruled by...
in 1939, emigrating to Chile
Chile
Chile ,officially the Republic of Chile , is a country in South America occupying a long, narrow coastal strip between the Andes mountains to the east and the Pacific Ocean to the west. It borders Peru to the north, Bolivia to the northeast, Argentina to the east, and the Drake Passage in the far...
. He studied biology
Biology
Biology is a natural science concerned with the study of life and living organisms, including their structure, function, growth, origin, evolution, distribution, and taxonomy. Biology is a vast subject containing many subdivisions, topics, and disciplines...
and medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
and afterwards psychiatry
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
and psychoanalysis
Psychoanalysis
Psychoanalysis is a psychological theory developed in the late 19th and early 20th centuries by Austrian neurologist Sigmund Freud. Psychoanalysis has expanded, been criticized and developed in different directions, mostly by some of Freud's former students, such as Alfred Adler and Carl Gustav...
with the Chilean Psychoanalytic Society. He first came to the U.S. in 1959 on a Rockefeller Foundation
Rockefeller Foundation
The Rockefeller Foundation is a prominent philanthropic organization and private foundation based at 420 Fifth Avenue, New York City. The preeminent institution established by the six-generation Rockefeller family, it was founded by John D. Rockefeller , along with his son John D. Rockefeller, Jr...
fellowship to study research in psychotherapy
Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...
with Jerome Frank
Jerome Frank (psychiatrist)
Jerome Frank was an American psychiatrist. He held the post of Professor of Psychiatry at the Johns Hopkins University Medical School. His book Persuasion and Healing: A Comparative Study of Psychotherapy was highly influential in his field...
at the Johns Hopkins Hospital
Johns Hopkins Hospital
The Johns Hopkins Hospital is the teaching hospital and biomedical research facility of Johns Hopkins University School of Medicine, located in Baltimore, Maryland . It was founded using money from a bequest by philanthropist Johns Hopkins...
. In 1961 he emigrated to the U.S. joining the C.F. Menninger Memorial Hospital, later became director of the hospital. He was the Supervising and Training Analyst of the Topeka Institute for Psychoanalysis, and Director of the Psychotherapy Research Project of Menninger Foundation. In 1973 he moved to New York where he was Director of the General Clinical Service of the New York State Psychiatry Institute. In 1974 he was appointed Professor of Clinical Psychiatry at the College of Physicians and Surgeons of Columbia University
Columbia University
Columbia University in the City of New York is a private, Ivy League university in Manhattan, New York City. Columbia is the oldest institution of higher learning in the state of New York, the fifth oldest in the United States, and one of the country's nine Colonial Colleges founded before the...
and Training and Supervising Analyst at the Columbia University Center for Psychoanalytic Training and Research. In 1976 he was appointed as Professor of Psychiatry at Cornell University and Director of the Institute for Personality Disorders Institute of the New York Hospital-Cornell Medical Center. He was President of the International Psychoanalytical Association
International Psychoanalytical Association
The International Psychoanalytical Association is an association including 12,000 psychoanalysts as members and works with 70 constituent organizations. It was founded in 1910 by Sigmund Freud, on an idea proposed by Sándor Ferenczi...
from 1997 to 2001.
His principal contributions have been in the fields of narcissism
Narcissism
Narcissism is a term with a wide range of meanings, depending on whether it is used to describe a central concept of psychoanalytic theory, a mental illness, a social or cultural problem, or simply a personality trait...
, object relations theory
Object relations theory
Object relations theory is a psychodynamic theory within psychoanalytic psychology. The theory describes the process of developing a mind as one grows in relation to others in the environment....
and personality disorder
Personality disorder
Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors. Personality disorders are noted on Axis II of the Diagnostic and Statistical Manual of Mental Disorders or DSM-IV-TR of the American Psychiatric Association.Personality disorders are...
s. He developed a novel and useful framework for coordinating personality disorders along dimensions of structural organization and severity.
He was awarded the 1972 Heinz Hartmann
Heinz Hartmann
Heinz Hartmann , was a psychiatrist and psychoanalyst. He is considered one of the founders and principal representantives of ego psychology.-Life:...
Award of the New York Psychoanalytic Society and Institute, 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.
Transference-Focused Psychotherapy
Otto Kernberg designed an intensive form of psychoanalytic psychotherapyPsychoanalysis
Psychoanalysis is a psychological theory developed in the late 19th and early 20th centuries by Austrian neurologist Sigmund Freud. Psychoanalysis has expanded, been criticized and developed in different directions, mostly by some of Freud's former students, such as Alfred Adler and Carl Gustav...
known as Transference-Focused Psychotherapy (TFP)
Transference focused psychotherapy
Transference Focused Psychotherapy , is a highly structured, twice-weekly modified psychodynamic treatment based on Otto Kernberg’s object relations model of borderline personality disorder...
, which is meant to be more suitable for Borderline Personality Organization (BPO) patients. BPO patients are described as experiencing so-called 'splits' in their affect
Affect (psychology)
Affect refers to the experience of feeling or emotion. Affect is a key part of the process of an organism's interaction with stimuli. The word also refers sometimes to affect display, which is "a facial, vocal, or gestural behavior that serves as an indicator of affect" .The affective domain...
and thinking, and the intended aim of the treatment is focused on the integration of split off parts of self and object representations.
TFP is an intense form of psychodynamic psychotherapy
Psychodynamic psychotherapy
Psychodynamic psychotherapy is a form of depth psychology, the primary focus of which is to reveal the unconscious content of a client's psyche in an effort to alleviate psychic tension. In this way, it is similar to psychoanalysis. It also relies on the interpersonal relationship between client...
designed particularly for patients with borderline personality organization (BPO) which requires a minimum of two and a maximum of three 45 or 50-minute sessions per week. It views the individual as holding unreconciled and contradictory internalized representations of self and significant others that are affectively charged. The defense against these contradictory internalized object relations is called identity diffusion, and leads to disturbed relationships with others and with self. The distorted perceptions of self, others, and associated affects are the focus of treatment as they emerge in the relationship with the therapist (transference). The consistent interpretation of these distorted perceptions is considered the mechanism of change.
Suitable Patients
Kernberg designed TFP especially for patients with BPO. According to him, these patients suffer from identity diffusion, primitive defense operations and unstable reality testing.Identity diffusion results from pathological object relations and involves contradictory character traits, discontinuity of self and either very idealized or devalued object relations. Defense operations often applied by BPO patients are splitting, denial, projective identification, primitive devaluation / idealization and omnipotence. Reality testing is negatively influenced by the primitive defense mechanisms as they change a person's perception of self and others.
Goals of TFP
The major goals of TFP are better behavioral control, increased affect regulation, more intimate and gratifying relationships and the ability to pursue life goals. This is believed to be accomplished through the development of integrated representations of self and others, the modification of primitive defensive operations and the resolution of identity diffusion that perpetuate the fragmentation of the patient’s internal representational world. To do this, the client’s affectively charged internal representations of previous relationships are consistently interpreted as the therapist becomes aware of them in the therapeutic relationshipTherapeutic relationship
The therapeutic relationship, also called the helping alliance, the therapeutic alliance, and the working alliance, refers to the relationship between a healthcare professional and a client...
, that is, the transference
Transference
Transference is a phenomenon in psychoanalysis characterized by unconscious redirection of feelings from one person to another. One definition of transference is "the inappropriate repetition in the present of a relationship that was important in a person's childhood." Another definition is "the...
. Techniques of clarification, confrontation, and interpretation are used within the evolving transference relationship between the patient and the therapist.
Contract
The treatment begins with the development of the treatment contract, which consists of general guidelines that apply for all clients and of specific items developed from problem areas of the individual client that could interfere with the therapy progress. The contract also contains therapist responsibilities. The client and the therapist must agree to the content of the treatment contract before the therapy can proceed.Therapeutic Process
TFP consists of the following three-steps:- (a) the diagnostic description of a particular internalized object relation in the transference
- (b) the diagnostic elaboration of the corresponding self and object representation in the transference, and of their enactment in the transference /countertransference and
- (c) the integration of the split-off self representations, leading to an integrated sense of self and others which resolves identity diffusion.
During the first year of treatment, TFP focuses on a hierarchy of issues:
- the containment of suicidal and self-destructive behaviors
- the various ways of destroying the treatments
- the identification and recapitulation of dominant object relational patterns (from unintegrated and undifferentiated affects and representations of self and others to a more coherent whole).
Mechanisms of change
In TFP, hypothesized mechanisms of change derive from Kernberg’s developmentally based theory of Borderline Personality Organisation, conceptualized in terms of unintegrated and undifferentiated affects and representationsRepresentations
Representations is an interdisciplinary journal in the humanities published quarterly by the University of California Press. The journals was established in 1983 and is the founding publication of the New Historicism movement of the 1980s. It covers topics including literary, historical, and...
of self
Self (psychology)
The psychology of self is the study of either the cognitive and affective representation of one's identity or the subject of experience. The earliest formulation of the self in modern psychology derived from the distinction between the self as I, the subjective knower, and the self as Me, the...
and other. Partial representations of self and other are paired and linked by an affect in mental units called object relation dyads. These dyad
Dyad
Dyad may refer to:*Dyad , a pair of sister chromatids occurring in prophase I of meiosis; may also be used to describe protein morphology*Dyad , Greek philosophers' principle of "twoness" or "otherness"...
s are elements of psychological structure. In borderline pathology, the lack of integration of the internal object relations dyads corresponds to a ‘split’ psychological structure in which totally negative representations are split off/segregated from idealized positive representations of self and other (seeing people as all good or all bad). The putative global mechanism of change in patients treated with TFP is the integration of these polarized affect states and representations of self and other into a more coherent whole.
Theory on Narcissism and the Controversy with H. Kohut
Otto Kernberg states that there are three types of narcissism: normal adult narcissism, normal infantile narcissism, and pathological narcissism. Pathological narcissism, defined as the libidinal investment in a pathological structure of the self, is further divided into three types (regression to the regulation of the infantile self-esteemSelf-esteem
Self-esteem is a term in psychology to reflect a person's overall evaluation or appraisal of his or her own worth. Self-esteem encompasses beliefs and emotions such as triumph, despair, pride and shame: some would distinguish how 'the self-concept is what we think about the self; self-esteem, the...
, narcissistic choice of object, narcissistic personality disorder) with narcissistic personality disorder being the most severe of all. Still, narcissism has been a great source of disagreement between Otto Kernberg and Heinz Kohut
Heinz Kohut
Heinz Kohut was an Austrian-born American psychoanalyst best known for his development of Self psychology, an influential school of thought within psychodynamic/psychoanalytic theory which helped transform the modern practice of analytic and dynamic treatment approaches.-Early life:Kohut was born...
. Although both focused on narcissistic, borderline, and psychotic patients, the focus and content of their theory and treatment has been considerably differentiated. Their major diversities emerged in response to their conceptualizations regarding the relationship between Narcissistic and Borderline personalities, normal vs. pathological narcissism, their ideas about narcissistic idealization and the grandiose
Grandiosity
Grandiosity is chiefly associated with narcissistic personality disorder, but also commonly features in manic or hypomanic episodes of bipolar disorder....
self, as well as the psychoanalytic technique and the narcissistic transference.
Kernberg's Developmental Model
Another major contribution of Kernberg is his developmental model. In this model he describes 3 developmental tasks an individual has to accomplish. When one fails to accomplish a certain developmental task, this responds to the increased risk to develop certain psychopathologies. Whereby failing the first developmental task, which is psychic clarification of self and other, an increased risk of development of varieties of psychosis results. Not accomplishing the second task (overcoming splitting) results in an increased risk of developing a borderline personality disorder.Theory on Narcissism
According to Kernberg, the self is an intrapsychic structure consisting of multiple self representations. It is a realistic self which integrates both good and bad self-images. That is, the self constitutes a structure that combines libidinally and aggressively invested components. Kernberg defines normal narcissism as the libidinal investment of the self. However, it needs to be emphasized that this libidinal investment of the self is not merely derived from an instinctual source of libidinal energy. On the contrary, it stems from the several relationships between the self and other intrapsychic structures, such as the ego the superego and the id.Normal Adult Narcissism
This is a normal self-esteem based on normal structures of the self. The individual has introjected whole representations of objects, has stable objects relationships and a solid moral system. The superego is fully developed and individualized.Normal Infantile Narcissism
Regulation of self esteem occurs through gratifications related to the age, which include or imply a normal infantile system of values, demands or prohibitions.Pathological Narcissism
Three Subtypes- Regression to the regulation of infantile self-esteem. The ideal ego is dominated by infantile pursuits, values and prohibitions. The regulation of self-esteem is overly dependent on expressions or defences against infantile pleasures, which are discarded in adult life. This is the mildest type of narcissistic pathology.
- Narcissistic choice of object. This type is more severe than the first one but more rare. The representation of the infantile self is projected on an object and then identified through that same object. Thus, a libidinal association is generated, where the functions of the self and the object have been exchanged.
- Narcissistic personality disorder. This type is different from both normal adult narcissism and from regression to normal infantile narcissism. It is the most severe type and is suitable for psychoanalysis.
In Kernberg's view, narcissistic personalities are differentiated from both normal adult narcissism and from fixation at or regression to normal infantile narcissism. Fixation at a primitive stage of development or lack of development of specific intrapsychic structures is not adequate to explain the characteristics of narcissistic personalities. Those characteristics (through a process of pathological differentiation and integration of ego and superego structures) are the consequence of pathological object relationships. Pathological narcissism is not merely the libidinal investment in the self but in a pathological, underdeveloped structure of the self. This pathological structure presents defences against early self and object images, which are either libidinally or aggressively invested. The psychoanalytic process brings to the surface primitive object relations, conflicts and defences, which are typical of the developmental stages that precede the stability of the object.
Kernberg vs. Kohut
Otto Kernberg and Heinz Kohut can be considered to be the two theorists that have markedly influenced past and current psychoanalytic thinking. Both focused on the observation and treatment of patients that were otherwise thought to be unsuitable for analytic therapy. Their main work has been mostly related to individuals with narcissistic, borderline, and psychotic psychopathology. Still, their perspectives concerning the causes, psychic organization, and treatment of these disorders have been considerably different. Taken as a whole, Kohut is regarded as a self theorist who radically departed from Sigmund's Freud conjectural conceptualizations, focusing mostly on people's need for self-organization and self-expression. Kernberg in contrast, remained faithful to the Freudian metapsychology, concentrating more on people's struggle between loveLove
Love is an emotion of strong affection and personal attachment. In philosophical context, love is a virtue representing all of human kindness, compassion, and affection. Love is central to many religions, as in the Christian phrase, "God is love" or Agape in the Canonical gospels...
and aggression
Aggression
In psychology, as well as other social and behavioral sciences, aggression refers to behavior between members of the same species that is intended to cause humiliation, pain, or harm. Ferguson and Beaver defined aggressive behavior as "Behavior which is intended to increase the social dominance of...
. Their main differences are summarized below.
Relationship between Narcissistic personality & Borderline personality
One of the main disagreements between the two theorists revolves around their conceptualization among narcissistic and borderline disorders. According to Kernberg, the defensive structure of the narcissisticNarcissism
Narcissism is a term with a wide range of meanings, depending on whether it is used to describe a central concept of psychoanalytic theory, a mental illness, a social or cultural problem, or simply a personality trait...
individual is quite similar to that of the borderline person since the former has a fairly underlying borderline personality organization which becomes obvious when one looks at the defenses of splitting and projective identification. He identifies constitutional along with environmental
Natural environment
The natural environment encompasses all living and non-living things occurring naturally on Earth or some region thereof. It is an environment that encompasses the interaction of all living species....
factors as the source of disturbance for these individuals by stressing the important role of the mother
Mother
A mother, mum, mom, momma, or mama is a woman who has raised a child, given birth to a child, and/or supplied the ovum that grew into a child. Because of the complexity and differences of a mother's social, cultural, and religious definitions and roles, it is challenging to specify a universally...
surrogate who treats the child on the surface (callously) with little regard for his/her feelings and needs. Kohut on the other hand, sees borderline personality as totally distinct from the narcissistic one and less able to benefit from the analytic treatment
Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...
. Equally, a narcissistic personality is more apt for analysis since it is characterized by a more resilient self. According to Kohut , the environment alone is the major cause of troubles for these persons. Moreover, although both focus on the concept of the “grandiose self” in their narcissistic personality theorizing, they provide different explanations for it. For Kohut, “grandiose self” reflects the “fixation of an archaic 'normal' primitive self” while for Kernberg it is a pathological development, different from normal narcissism. For Kohut treatment should be primarily centered on encouraging the patient's narcissistic desires, wishes, and need
Need
A need is something that is necessary for organisms to live a healthy life. Needs are distinguished from wants because a deficiency would cause a clear negative outcome, such as dysfunction or death. Needs can be objective and physical, such as food, or they can be subjective and psychological,...
s to open up during the process of transference. For Kernberg, the goal of treatment should be to use confrontation strategies so as to help the patient integrate his/hers internal fragmented world.
Normal vs. pathological narcissism
One of the main arguments between Kohut and Kernberg is about normal and pathological narcissism. As mentioned earlier, Kohut assumes that a narcissistic personality suffers from developmental arrest. Specifically, he assumes that this type of personality mirrors adaptive narcissistic wishes, needs, and objectives that, nevertheless, have not been satisfied during childhood development by the parental environment. Here, the grandiose self is nothing more than an archaic form that prospectively ought to become the normal self. When this does not occur then pathological narcissism emerges. In his explanation of pathological narcissism, he pays attention on the libidinalLibido
Libido refers to a person's sex drive or desire for sexual activity. The desire for sex is an aspect of a person's sexuality, but varies enormously from one person to another, and it also varies depending on circumstances at a particular time. A person who has extremely frequent or a suddenly...
forces or charges in order to provide an etiology
Etiology
Etiology is the study of causation, or origination. The word is derived from the Greek , aitiologia, "giving a reason for" ....
of how this disorder develops. For him the aggression drive
Drive theory
The terms drive theory and drive reduction theory refer to a diverse set of motivational theories in psychology. Drive theory is based on the principle that organisms are born with certain physiological needs and that a negative state of tension is created when these needs are not satisfied...
is of secondary importance in respect to the libidinal drive and that is why one should differentiate between ordinary aggression and narcissistic rage
Rage (emotion)
Rage is a feeling of intense anger. It is associated with the Fight-or-flight response and oftentimes activated in response to an external cue, such as the murder of a loved one. The phrase, 'thrown into a fit of rage,' expresses the immediate nature of rage that occurs before deliberation. If left...
. The first, according to him, is adaptive for eradicating obstructions when heading toward a realistic goal whereas the second is the forceful response to narcissistic injury. Kernberg however, sees Kohut's ideas as de-emphasizing the power of aggression. He allies more to the Freudian conceptualization, by proposing that narcissistic behavior results from pathological development in which aggressive drives play a central role. He argues that narcissism on the whole involves a strong aggressive drive that cannot possibly be analyzed separately from the libidinal one. As he says, “one cannot study the vicissitudes of normal and pathological narcissism without relating the development of the respective internalized object relations to both libidinal and aggressive drive alternatives”
Relationship Between Narcissistic Idealization and Grandiose Self
Kohut departed from the classical Freudian view, which suggested that some patients could not be analyzed given that they lacked the ability to develop transferences. He postulated that narcissistic patients are capable of presenting transferences but these are somewhat different from those of other patients, such as the neurotics. He distinguished three types, namely the idealizing, the mirror, or the twinship transference. His debate with Kernberg concerns mostly the idealizing transference, which, according to Kohut, relates to a fixation at an archaic level of normal development. Still Kernberg believed that the idealizing transference is nothing more than a pathological type of idealization that is produced as a response to the substantial instigation of the grandiose self in the transference.Psychoanalytic Technique and Narcissistic Transference
Otto F. Kernberg and Heinz KohutHeinz Kohut
Heinz Kohut was an Austrian-born American psychoanalyst best known for his development of Self psychology, an influential school of thought within psychodynamic/psychoanalytic theory which helped transform the modern practice of analytic and dynamic treatment approaches.-Early life:Kohut was born...
regard the analytic process as well as the role of the analyst in quite different terms.
The analytical situation concerning pathological narcissism according to Otto F. Kernberg
Kernberg requests a methodological and persistent interpretation of the defensive function of grandiosity and idealization as they emerge in transference. The role of the analyst should be neutral rather than supportive, especially during the confrontation process, in order to modify the narcissist's pathological structure. “The analyst must be continuously focusing on the particular quality of the transference in these cases and consistently counteract the patient’s efforts toward omnipotent control and devaluation”. This traditional emphasis on aggressive interpretation of narcissistic phenomena derives from and is wholly consistent with Freud’s early view of narcissistic neuroses as unanalysable and narcissistic defenses as generating the most recalcitrant resistances to the analytic process.The analytical situation concerning pathological narcissism according to Heinz Kohut
In contrast to seeing primitive grandiosity or idealization as a representation of a defensive retreat from reality, Heinz KohutHeinz Kohut
Heinz Kohut was an Austrian-born American psychoanalyst best known for his development of Self psychology, an influential school of thought within psychodynamic/psychoanalytic theory which helped transform the modern practice of analytic and dynamic treatment approaches.-Early life:Kohut was born...
regards narcissistic illusions within the analytic situation as representations of the patient’s attempt to establish crucial developmental opportunities. These narcissistic illusions thus give an opportunity for revitalization of the self. Therefore, Heinz Kohut advocates that the analyst's position within treatment should be one where a full narcissistic transference should be encouraged instead of being challenged. To establish this, the analyst should be able to show empathic comprehension, which entails a receptivity to the narcissistic illusions and an avoidance at all costs of anything which would challenge them or suggest they are unrealistic. Heinz Kohut
Heinz Kohut
Heinz Kohut was an Austrian-born American psychoanalyst best known for his development of Self psychology, an influential school of thought within psychodynamic/psychoanalytic theory which helped transform the modern practice of analytic and dynamic treatment approaches.-Early life:Kohut was born...
used the concepts of narcissistic transference and self-object needs. He also stressed the significance of infantilism and what appear to be excessive demands on the analyst and everyone else. Rather than instinctual wishes to be renounced, they are missed developmental needs to be warmly received and understood. The patient is groping toward self-cure, by trying to extract from others what was missing early in his development. Heinz Kohut feels the patient knows what he needs, regardless of what the analyst may think he knows. He stresses the importance of hopes in maturity and throughout development. There is an enduring need for ideals and idealization that vitalizes self experience. In his work with narcissistic patients, the defining feature of Heinz Kohut’s psychoanalytic methodology became therefore empathic immersion (or vicarious inspection), whereby he tried to put himself in his patient’s shoes. This view is certainly in contrast with Freud’s early view of the analyzability of narcissistic defenses as discussed above.
Approaches as regarded by Heinz Kohut and Otto F. Kernberg
Both Kohut and Kernberg regarded each other’s approaches as counterproductive.From Kohut’s point of view, the methodical interpretive approach recommended by Kernberg is interpreted by the narcissistically vulnerable patient as an assault and generates intense narcissistic rage. As Kernberg instead recommends this methodology for treating these patients, self-psychology regards Kernberg as creating narcissism instead of treating it.
On the other hand, Kernberg (from the more traditional point of view) sees the approach of Kohut as leading to nothing. An unquestioning acceptance of the patient’s illusions with the assumption that they will eventually diminish of their own accord represents a collusion with the patient’s defenses. The analytic process is thereby subverted and the analyst never emerges as a figure who can meaningfully help the patient.
An integrative relational approach
However, Mitchel offers an integrative relational approach in which the perspectives of both Kernberg and Kohut are connected. In his opinion, “the more traditional approach to narcissism highlights the important ways in which the narcissistic illusions are used defensively, but misses their role in health and creativity and in consolidating certain kinds of developmentally crucial relationships with others. The developmental-arrest approach (Kohut) had generated a perspective on narcissism which stresses the growth-enhancing function of narcissistic illusions, but overlooks the extent to which they often constrict and interfere in real engagements between the analysant and other people, including the analyst”. Mitchell recommends a “subtle dialectic between articulating and embracing the analysant’s illusions on the one hand, and the provision of larger context in which they can be experienced, on the other”.Kernberg's Developmental Model
One of Kernberg's major contributions is his developmental model. This model is built major on the developmental tasks one has to complete in order to develop healthy relationships. Completing each developmental task represents a level of psychopathology, as is described under the heading developmental stages. Furthermore, his developmental model includes Kernberg's view about drives, in which he differs from Freud. Kernberg was obviously inspired by Melanie Klein, whose model draws mainly on the paranoid-schizoid position and on the depressive position. More elaborate information on Kernberg's ideas can be found in a recent publication by Cohen M. (2000).First Months
Kernberg saw the infantInfant
A newborn or baby is the very young offspring of a human or other mammal. A newborn is an infant who is within hours, days, or up to a few weeks from birth. In medical contexts, newborn or neonate refers to an infant in the first 28 days after birth...
in the first months of his life as struggling to sort out his experience on the basis of the affective valence of this experience. The infant moves back and forth between two different affective states. One state is characterized as pleasurable and gratified; the other state is unpleasurable, painful and frustrating. Regardless of what one is in, no distinction is made between self and other.
First developmental task: psychic clarification of self and other
The first developmental task embodies being able to make a distinction between what is self and what is other. When this task would not be accomplished, one cannot develop a dependable sense of the self as separate and distinct because one cannot make a distinction between one's own experience and the experience of others. This failure is hypothesized to be the major precursor for all psychotic states. In the symptoms of schizophrenic symptoms (hallucinationHallucination
A hallucination, in the broadest sense of the word, is a perception in the absence of a stimulus. In a stricter sense, hallucinations are defined as perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid,...
s, delusion
Delusion
A delusion is a false belief held with absolute conviction despite superior evidence. Unlike hallucinations, delusions are always pathological...
s, psychic fragmentation) we can see a lack of being able to separate between internal and external world, own experience and experience of others, own mind and the mind of another.
Second developmental task: overcome splitting
The second developmental task is to overcome splitting. When the first developmental task is accomplished, one is able to differentiate between self-images and object images; however, these images remain segregated affectively. Loving self images and images of good objects are held together by positive affectsAffect (psychology)
Affect refers to the experience of feeling or emotion. Affect is a key part of the process of an organism's interaction with stimuli. The word also refers sometimes to affect display, which is "a facial, vocal, or gestural behavior that serves as an indicator of affect" .The affective domain...
, or libidinal affects. Hateful images of the self and bad, frustrating object images are held together by negative or aggressive affects. The good is separated from the bad. The developmental task is accomplished, as the child is able to see objects as “whole”, meaning that the child
Child
Biologically, a child is generally a human between the stages of birth and puberty. Some vernacular definitions of a child include the fetus, as being an unborn child. The legal definition of "child" generally refers to a minor, otherwise known as a person younger than the age of majority...
can see objects as being both good and bad. Next to seeing “whole” objects, the child is required to see the self as being loving and hating, as being good and bad at the same time. When one fails to accomplish this second developmental task, this will result in a borderline pathology, meaning that objects or the self cannot be seen as both good and bad; something is good, or it is bad, but both affects cannot be in the same object together.
Developmental stages
Kernberg’s model of self and object development rests on five stages that delineate the growth of the internalized object relations units, some of which already start taking place during the precipitating stage. The stages are not static, but fluent.- Stage 1 (0 to 1 month): Normal autism
This stage is marked by undifferentiated self-object representations. This stage is equated with Mahler
Margaret Mahler
Margaret Schönberger Mahler was a Hungarian physician, who later became interested in psychiatry. She was a central figure on the world stage of psychoanalysis...
, Pine and Bergman’s conception of autism.
- Stage 2 (2 months to 6–8 months): Normal symbiosisSymbiosisSymbiosis is close and often long-term interaction between different biological species. In 1877 Bennett used the word symbiosis to describe the mutualistic relationship in lichens...
In the beginning of this stage the child is unable to integrate opposing affective valences. Libidinally invested and aggressively invested representations are strictly separated into a ‘good’ self-object representation and a ‘bad’ self-object representation.
- Stage 3 (6–8 months to 18–36 months): Differentiation of self from object relations
In this stage the ‘good’ self-object representation differentiates into a ‘good’ self and a ‘good’ object and shortly thereafter the ‘bad’ self-object representation differentiates into a ‘bad’ self and a ‘bad’ object. A failure of the child to differentiate between self and other results in a psychotic personality organization; one has failed to accomplish the first developmental task and is stuck in stage II. Although in this stage differentiation between self an object has taken place the good and bad self and object representations are strictly separated through the mechanism of splitting in order to protect the ideal, good relationship with the mother from contamination by bad self representations and bad representations of her.
- Stage 4 (36+ months through the oedipal period): The integration of self representations and object representations
During this stage the ‘good’ (libidinally invested) and ‘bad’ (aggressively invested) self and object representations are integrated into a definite self system and a total object representation. One is able to comprehend the possibility of the self or other containing both positive and negative characteristics. A failure of this results in a borderline personality organization; one has failed to accomplish the second developmental task and is stuck in stage III. Consequently, the good self and object must still be protected from the aggression by the splitting of good and bad.
- Stage 5: Consolidation of superego and ego integration
In this stage ego, superego and id
Id, ego, and super-ego
Id, ego and super-ego are the three parts of the psychic apparatus defined in Sigmund Freud's structural model of the psyche; they are the three theoretical constructs in terms of whose activity and interaction mental life is described...
are consolidated in definite intrapsychic structures.
By successfully completing all the developmental tasks, the child has developed a neurotic personality organization, which is the strongest personality structure.
Kernberg's View About Drives
In contrast with Freud's perspective, drives are not inborn according to Kernberg. The libidinal and aggressive drives are shaped, developed over time by experiences of interactions with others. The child's good and bad affects become consolidated and shaped into libidinal and aggressive drives. Good, pleasurable interactions with others consolidate, over time, into a pleasure-seeking (libidinal) drive. In the same way bad, unsatisfying and frustrating interactions with others, become consolidated into a destructive (aggressive) drive over time.General references
- Christopher, J.C., Bickhard, M.H., & Lambeth, G.S. (2001). Otto Kernberg's object relations theory: a metapsychological critique. Theory & Psychology, 11,687-711.
- Clarkin, J.F., Yeomans, F.E., & Kernberg O.F. (1999). Psychotherapy for Borderline Personality. New York: J. Wiley and Sons.
- Cohen, M. (2000). Love Relations: Normality and Pathology: Otto Kernberg, Yale University Press. Journal of American Academic Psychoanalysis, 28, 181-184.
- Consolini, G. (1999). Kernberg Versus Kohut: A (Case) Study in Contrasts. Clinical Social Work Journal, 27, 71-86.
- Foelsch, P. A. & Kernberg, O. F. (1998). Transference-Focused Psychotherapy for Borderline Personality Disorders. In Session: Psychotherapy in Practise. 4/2:67-90.
- Kernberg, O.F., Selzer, M.A., Koenigsberg H.A., Carr, A.C. & Appelbaum, A.H. (1989). Psychodynamic Psychotherapy of Borderline Patients. New York: Basic Books.
- Kernberg, O.F. (2001). The suicidal risk in severe personality disorders: Differential diagnosis and treatment. Journal of Personality Disorders. The Guilford Press
- Kernberg, O. F. (1975). Borderline conditions and pathological narcissism.
- Koenigsberg, H.W., Kernberg, O.F., Stone, M.H., Appelbaum, A.H., Yeomans, F.E., & Diamond, D.D. (2000). Borderline Patients: Extending the Limits of Treatability. New York: Basic Books.
- Mitchell, S.A. and Black, M., (1995). Freud and beyond: A history of modern psychoanalytic thought. Basic Books: New York.
- Solan, Ronnie (1998) Narcissistic Fragility in the Process of Befriending the Unfamiliar. Psychoanal. Amer. J. Psycho-Anal., Vol. 58:(2)163-186. http://www.springerlink.com
- Solan, Ronnie (1999). The Interaction Between Self and Other: A Different Perspective on Narcissism. Psychoanal. Study of the Child, 54: 193-215.
- Yeomans, F.E., Clarkin, J.F., & Kernberg, O.F. (2002). A Primer of Transference-Focused Psychotherapy for the Borderline Patient. Northvale, NJ: Jason Aronson.
- Yeomans, F.E., Selzer, M.A., & Clarkin, J.F. (1992). Treating the Borderline Patient: A Contract-based Approach. New York: Basic Books. Kernberg, O. (2001) The suicidal risk in severe personality disorders: differential diagnosis and treatment
External links
- Interview with Otto Kernberg (Psychotherapy.net)
- Kernberg, O. F., and Michels, R. (2009). Borderline Personality Disorder. American Journal of Psychiatry, 166, 505-508.
- Kernberg’s Borderline Conditions and Pathological Narcissism. Psychiatric Times, 26(2).