Filling a crucial gap in the clinical literature, this book provides a contemporary view of pathological narcissism and presents an innovative treatment approach. The preeminent authors explore the special challenges of treating patients--with narcissistic traits or narcissistic personality disorder--who retreat from reality into narcissistic grandiosity, thereby compromising their lives and relationships. Assessment procedures and therapeutic strategies have been adapted from transference-focused psychotherapy (TFP), a manualized, evidence-based treatment for borderline personality disorder. Rich case material illustrates how TFP-N enables the clinician to engage patients more deeply in therapy and help them overcome relationship and behavioral problems at different levels of severity. The volume integrates psychodynamic theory and research with findings from social cognition, attachment, and neurobiology.

Transference-Focused Psychotherapy for Adolescents With Severe Personality Disorders offers clinicians a comprehensive, compassionate presentation of this specialized psychodynamic psychotherapy. Like the transference-focused psychotherapy model developed for borderline personality disorder (BPD) in adults, the version for adolescents is based on contemporary psychoanalytic object relations theory as developed by the leading thinker in the field, Otto Kernberg, one of the authors of this insightful manual. The book fills an acute need: Currently, there is relatively little research on promising treatments for adolescents with PDs, in part because clinicians hesitate to diagnose PD in patients so young (because of stigma and other factors), although it is evident that a constellation of symptoms can be observed in children and adolescents. However, these personality issues are unlikely to resolve without interventions developed explicitly to treat adolescents. In TFP-A, the psychotherapist provides patients with a safe space to examine emotions, relationships, and past trauma, with the focus on helping them gain better behavioral control; increase affect regulation; develop more intimate and gratifying relationships with family, peers, or close friends; and engage in a productive life aimed at realizing current and future goals. Noteworthy themes and features of the text include: * Emphasis on the therapist as "third voice," acting as interpreter and mediator between the adolescent, the parental couple, and conventional society and its values, with the ultimate goal of fostering ego integration sufficient to allow the adolescent to proceed under his own agency.* Detailed coverage of the techniques of TFP-A, including creating a holding environment, assuming an active stance, engaging in the interpretive process, analyzing transference and countertransference, achieving technical neutrality, and ensuring interventions are developmentally informed.* Practical and accessible review of TFP-A "tactics," including establishing the treatment frame, collaborating with parents, and other interventions that maintain the conditions necessary for working effectively with the adolescent and for protecting treatment integrity.* Thoughtful review of the attributes that make a clinician a good "fit" for transference-focused psychotherapy. For example, therapists must have their own lives "together," because they will have to use countertransference reactions to identity and understand what is projected onto them.* A rich and useful repository of assessment scales and forms in the Appendices, as well as extended and illustrative patient interviews. Navigating adolescence is fraught under the best of circumstances, but patients with PDs are hampered in their quest for individuation. Transference-Focused Psychotherapy for Adolescents With Severe Personality Disorders fills a critical gap in the treatment literature and is an eminently useful guide for clinicians serving this vulnerable population.

The Austen Riggs Center is nationally recognized as the leading psychiatric hospital for treatment-resistant patients, who willingly seek help but just cannot respond to treatment. Here, leaders in treating such challenging patients offer a comprehensive psychodynamic approach for treatment and offer hope for recovery. In this book, readers are given an in-depth view into the psychodynamics systems perspective of treatment resistant disorders, with illustrations of the value of including family therapy, and developing and using a psychodynamic treatment team. Also offered is the first description published in book form of the newly-defined area of psychodynamic psychopharmacology an approach to the use of medications that attends to the meaning of medications to the patient and clinician, as well as to their pharmacologic effects. Important clinical problems such as trauma, psychosis, suicide, family resistant, integrated treatment, and psychopharmacologic failures are covered in detail. Throughout, practical principles are reported in text boxes to help the reader apply learning from Riggs to other outpatient, residential, day treatment, and inpatient settings. The Austen Riggs Center is on the forefront of dealing with difficult-to-treat patients, and this book provides an invaluable resource for both understanding treatment resistance and implementing effective techniques to treat it in clinical practice."

The basic text for the understanding of patients with pathological narcissism.

In this important new volume, Otto F. Kernberg, M.D., of Weill Cornell Medical College, offers an updated vision of psychoanalytic object relations theory, revealing its application to transference-focused psychotherapy (TFP), a treatment approach derived from, and related to, psychoanalysis. Collecting previously published articles and new material based on empirical studies carried out by the Personality Disorders Institute of Weill Cornell, the book illustrates TFP's applicability in scenarios that include: * Schizoid personality disorders* Psychotic personality organization* Disturbances in sexuality and love relations in cases of narcissistic personalities* Inpatient hospital treatment* Large group regression in organizational and political settings as a consequence of malignant narcissism Hatred, Emptiness, and Hope also devotes a chapter to the implications of new developments in neurobiology on psychoanalytic object relations theory, examining the relationship between neurobiological dispositions and their interaction with psychodynamic developments. Besides offering a detailed look at the application of TFP to severe personality disorders, this book also examines the practice of TFP itself, tackling controversial issues regarding the supervision of psychoanalysis and its derived psychotherapies, the challenges for the future of psychoanalysis, and innovations that may serve to strengthen its role as a profession, a treatment approach and a social organization within mental health sciences.

Object Relations Theory and Clinical Psychoanalysis is a collection of Kernberg's papers published or presented during the period from 1966 to 1975, with some new material included as well.

Transference-Focused Psychotherapy for Borderline Personality Disorder: A Clinical Guide presents a model of borderline personality disorder (BPD) and its treatment that is based on contemporary psychoanalytic object relations theory as developed by the leading thinker in the field, Otto Kernberg, M.D., who is also one of the authors of this insightful manual. The model is supported and enhanced by material on current phenomenological and neurobiological research and is grounded in real-world cases that deftly illustrate principles of intervention in ways that mental health professionals can use with their patients. The book first provides clinicians with a model of borderline pathology that is essential for expert assessment and treatment planning and then addresses the empirical underpinnings and specific therapeutic strategies of transference-focused psychotherapy (TFP). * From the chapter on clinical assessment, the clinician learns how to select the type of treatment on the basis of the level of personality organization, the symptoms the patient experiences, and the areas of compromised functioning. In order to decide on the type of treatment, the clinician must examine the patient's subjective experience (such as symptoms of anxiety or depression), observable behaviors (such as investments in relationships and deficits in functioning), and psychological structures (such as identity, defenses, and reality testing). * Next, the clinician learns to establish the conditions of treatment through negotiating a verbal treatment contract or understanding with the patient. The contract defines the responsibilities of each of the participants and defines what the reality of the therapeutic relationship is. * Techniques of treatment interventions and tactics to address particularly difficult clinical challenges are addressed next, equipping the therapist to employ the four primary techniques of TFP (interpretation, transference analysis, technical neutrality, and use of countertransference) and setting the stage for and guiding the proper use of those techniques within the individual session.* What to expect in the course of long-term treatment to ameliorate symptoms and to effect personality change is covered, with sections on the early, middle, and late phases of treatment. This material prepares the clinician to deal with predictable phases, such as tests of the frame, impulse containment, movement toward integration, episodes of regression, and termination.* Finally, the text is accompanied by supremely instructive online videos that demonstrate a variety of clinical situations, helping the clinician with assessment and modeling critical therapeutic strategies. The book recognizes that each BPD patient presents a unique treatment challenge. Grounded in the latest research and rich with clinical insight, Transference-Focused Psychotherapy for Borderline Personality Disorder: A Clinical Guide will prove indispensable to mental health professionals seeking to provide thoughtful, effective care to these patients.

Offering a sophisticated introduction to a contemporary psychodynamic model of the mind and treatment, this book provides an approach to understanding and treating higher level personality pathology. It describes a specific form of treatment called "dynamic psychotherapy for higher level personality pathology" (DPHP), which was designed specifically to treat the rigidity that characterizes that condition. Based on psychodynamic object relations theory, DPHP is an outgrowth of transference-focused psychotherapy (TFP) and is part of an integrated approach to psychodynamic treatment of personality pathology across the spectrum of severity -- from higher level personality pathology, described in this volume, to severe personality pathology, described in a companion volume, Psychotherapy for Borderline Personality: Focusing on Object Relations. Together, they provide a comprehensive description of an object relations theory-based approach to treatment of personality disorders, embedded in an integrated model of personality.

As a guide to treatment, Handbook of Dynamic Psychotherapy for Higher Level Personality Pathology provides a clear, specific, and comprehensive description of how to practice DPHP from beginning to end, presented in jargon-free exposition using extensive clinical illustrations. The authors offer a comprehensive description of psychodynamic consultation that includes sharing the diagnostic impression, establishing treatment goals, discussing treatment options, obtaining informed consent, and establishing treatment frame. Throughout, the book emphasizes fundamental clinical principles that enable the clinician to think through clinical decisions moment-to-moment and also to develop an overall sense of the trajectory and goals of the treatment. Among the book's benefits: - Takes a diagnosis-driven approach, presenting a clear model of both the psychopathology and its treatment;- Explains underlying theory and basic elements of DPHP for those first learning dynamic therapy;- Offers an integrated, innovative synthesis of contemporary psychodynamic approaches to personality pathology and psychodynamic psychotherapy;- Describes goals, strategies, tactics, and techniques of the treatment to demonstrate its flexibility over a relatively long course of treatment;- Provides sophisticated discussion of integrating dynamic psychotherapy with medication management and other forms of treatment.

DPHP offers a broad range of patients the opportunity to modify maladaptive personality functioning in ways that can permanently enhance their quality of life. Handbook of Dynamic Psychotherapy for Higher Level Personality Pathology provides experienced clinicians with a hands-on approach to that method, and is also useful as a primary textbook in courses focusing on the technique of dynamic psychotherapy or in courses on psychodynamics.

Treating borderline patients is one of the most challenging areas in psychotherapy because of the patient's extreme emotional expressions, the strain it places on the therapist, and the danger of the patient acting out and harming himself or the therapeutic relationship. Many clinicians consider this patient population difficult, if not impossible, to treat. However, in recent years dedicated experts have focused their clinical and research efforts on the borderline patient and have produced treatments that increase our success in working with borderline patients. Transference-Focused Therapy (TFP) is psychodynamic treatment designed especially for borderline patients. This book provides a concise and comprehensive introduction to TFP that will be useful both to experienced clinicians and also to students of psychotherapy. TFP has its roots in object relations and it emphasizes that the transference is the key to understanding and producing change. The patient's internal world of object representations unfolds and is lived in the transference with the therapist. The therapist listens for and makes use of the relationship that is revealed through words, silence, or, as often occurs in the case of individuals with some borderline personality disorder, acting out in subtle or not-so-subtle ways. This primer offers clinicians a way to understand and then use the transference and countertransference for change in the patient.

Otto Kernberg is a towering figure in the field of psychoanalysis and has accomplished seminal work in object relations and the treatment of borderline and narcissistic patients. This volume collects his recent work in several areas: severe personality disorders, couples in conflict, and religious experience. In each area, he explores the relationship between the psychoanalytic, clinical psychiatric, and neurobiological approaches, yielding insights and analysis that are compelling, thought-provoking, and at times startling in their penetrating brilliance. In addition, the book addresses the challenges that psychoanalysis faces in the current medical environment, and the need to strengthen its ties with academic institutions.

Beautifully written, the book is designed to both provoke questions and provide enlightenment on a variety of critical issues within psychotherapy. Specifically, the volume: - Explores new approaches to diagnosis and new psychotherapeutic techniques to treat the most severe personality disorders, particularly severe narcissistic psychopathology, based on new research findings;- Relates psychoanalytic theory to neurobiological findings by illuminating the influences of neurobiological structures and intrapsychic conflicts on the development of the personality;- Examines the psychoanalytic and neurobiological underpinnings of sexual love, from the organization of brain structures and neurotransmitters to the overall systems of erotic activation, attachment and bonding. This systematic approach provides insight into the nature of passionate love and the psychodynamic features of the love relationship; - Addresses psychodynamic factors in the religious experience and the search for universal ethical values, and explores the crucial function of religious experience in dealing with the ideological challenges of social life; and- Identifies the serious problems facing psychoanalytic education, institutions, and the profession of psychoanalysis, and proposes solutions to energize the field and increase its contributions to scientific research and progress.

In The Inseparable Nature of Love and Aggression: Clinical and Theoretical Perspectives, Kernberg demonstrates his belief that the collaboration of psychoanalysis and neurobiology has the potential to significantly advance our understanding of the human mind. The full spectrum of mental health clinicians, as well as educated general readers, will find this to be a work of creativity and substance.

Deftly combining contemporary theory with clinical practice, Psychodynamic Therapy for Personality Pathology: Treating Self and Interpersonal Functioning is an invaluable resource for any clinician seeking a coherent model of personality functioning and pathology, classification, assessment, and treatment. This insightful guide introduces Transference-Focused Psychotherapy-Extended (TFP-E), a specialized but accessible approach for any clinician interested in the skillful treatment of personality disorders. Compatible with the DSM-5 Section III Alternative Model for Personality Disorders-and elaborating on that approach, this volume offers clinicians at all levels of experience an accessible framework to guide evaluation and treatment of personality disorders in a broad variety of clinical and research settings. In this book, readers will find: * A coherent model of personality functioning and disorders based in psychodynamic object relations theory* A clinically near approach to the classification of personality disorders, coupled with a comprehensive approach to assessment* An integrated treatment model based on general clinical principles that apply across the spectrum of personality disorders* An understanding of specific modifications of technique that tailor intervention to the individual patient's personality pathology* Descriptions of specific psychodynamic techniques that can be exported to shorter-term treatments and acute clinical settings Patient assessment and basic psychodynamic techniques are described in up-to-date, jargon-free terms and richly supported by numerous clinical vignettes, as well as online videos demonstrating interventions. At the end of each chapter, readers will find a summary of key clinical concepts, making this book both a quick reference tool as well as a springboard for continued learning. Clinicians looking for an innovative, trustworthy guide to understanding and treating personality pathology that combines contemporary theory with clinical practice need look no further than Psychodynamic Therapy for Personality Pathology: Treating Self and Interpersonal Functioning.

Object Relations Theory and Clinical Psychoanalysis is a collection of Kernberg's papers published or presented during the period from 1966 to 1975, with some new material included as well.

The basic text for the understanding of patients with pathological narcissism.