Borderline Conditions and Pathological Narcissism

by Kernberg, Otto F.

• ISBN13: 9780876681770
• ISBN10: 0876681771
• Edition: Revised
• Format: Paperback
• Copyright: 1995-04-01
• Publisher: Jason Aronson, Inc.

Summary

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

Table of Contents

Preface	ix
Acknowledgments	xiii
Part I Borderline Personality Organization
The Syndrome	3	(46)
Review of the Literature
Descriptive Analysis: The Presumptive Diagnostic Elements: anxiety; polysymptomatic neurosis; polymorphous perverse sexual trends; the ``classical'' prepsychotic personality structures; impulse neurosis and addictions; ``lower level'' character disorders
Structural Analysis: nonspecific manifestations of ego weakness; shift toward primary-process thinking; specific defensive operations at the level of borderline personality organization; pathology of internalized object relationships
Genetic-Dynamic Analysis
Summary
Countertransference	49	(20)
The Concept of Countertransference
Regression and Identification in the Countertransference
Some Chronic Countertransference Fixations
The Importance of Concern as a General Trait of the Analyst
Summary
Three General Principles of Treatment	69	(42)
Introduction
Review of the Pertinent Literature Transference and Countertransference Characteristics
Psychotherapeutic Approaches to the Specific Defensive Operations: splitting; primitive idealization; early forms of projection, and especially projective identification; denial; omnipotence and devaluation
Instinctual Vicissitudes and Psychotherapeutic Strategy
Further Comments on the Modality of Treatment
Prognosis	111	(42)
The Descriptive Characterologic Diagnosis: predominant type of character constellation; ego and superego distortions reflected in individual character traits; self-destructiveness as a character formation and negative therapeutic reaction
The Degree and Quality of Ego Weakness
The Degree and Quality of Superego Pathology
The Quality of Object Relationships
The Skill and the Personality of the Therapist
Summary
Differential Diagnosis and Treatment	153	(32)
A Critical Review of Recent Literature: diagnosis; treatment
Summary of Previous Work: the clinical manifestations of borderline personality; hypotheses regarding the origin of ego weakness; complications in analyzing patients with borderline personality organization, and technical implications for their treatment; some conditions under which analyzability improves or worsens
Further Considerations About Treatment: transference interpretation, regression and reconstruction; transference psychosis
Differential Diagnosis of Schizophrenia and Borderline Conditions
Overall Structuring and Beginning Phase of Treatment	185	(28)
The Overall Treatment Arrangements
The Basic Therapeutic Setting
Special Problems in the Early Stages: conscious withholding of material; consistent devaluation of all human help received; chronic development of ``meaninglessness'' in the therapeutic interaction; paranoid control and withholding; early, severe acting out; misuse of previous information regarding treatment, and of ``psychotherapeutic language''; the predominant quality of separation reactions; the psychotherapist's relationship with the hospital team
The Subjective Experience of Emptiness	213	(14)
Part II Narcissistic Personality
The Treatment of the Narcissistic Personality	227	(36)
Etiological and Dynamic Features
Differential Diagnosis
Considerations in Regard to Technique
Prognostic Considerations: tolerance of depression and mourning; secondary gain of analytic treatment; transference potential for guilt versus transference potential for paranoid rage; the quality of the sublimatory potential; the degree and quality of superego integration; presence of life circumstances granting unusual narcissistic gratifications; impulse control and anxiety tolerance; regression toward primary-process thinking; the motivation for treatment
A Crucial Period in the Treatment
Summary
Clinical Problems of the Narcissistic Personality	263	(52)
Clinical Characteristics of the Narcissistic Personality as a Specific Type of Character Pathology
The Relationship of Narcissistic Personality to Borderline Conditions and the Psychoses
The Relationship of Normal to Pathological Narcissism: developmental arrest or pathological development?; differential qualities of infantile and pathological narcissism; manifestations of pathological narcissism in the analytic situation; genetic considerations; types of idealization and the relationship of narcissistic idealization to the grandiose self; structural characteristics and origins of the grandiose self
Psychoanalytic Technique and Narcissistic Transference: vignette 1; vignette 2; vignette 3; vignette 4
Countertransference and Therapeutic Modification of the Narcissistic Resistances
Prognosis of Narcissism, Treated and Untreated
Normal and Pathological Narcissism	315	(32)
Definition of Normal Narcissism: the ideal self and ego goals; object representations; superego factors; instinctual and organic factors; external factors
Pathological Narcissism
Some diagnostic Applications of This Conceptualization of Narcissistic Pathology
The Treatment of Narcissistic Personalities
Some Problems Regarding Terminology and the Metapsychological Implications of Narcissism
General Bibliography	347	(8)
Index	355