Otto Kernberg
Kernberg’s major contributions have stemmed from
his work on the psychoanalysis and psychotherapeutic treatment of patients with
severe character disorders, particularly those with borderline personality
organization (Kernberg, 1968), as well as patients with narcissistic character.
The primitive defenses of splitting and projective
identi-fication, first described by Klein, are central to the diagnosis of
borderline personality disorder as conceived by Kernberg (1979). His depiction
of the landscape of the mind also owes some of its salient features to
Jacobson, who first suggested that inter-nal representations of self and object
with an associated affect are the nuclei of the early development of the
psyche. Kernberg’s depiction of the inner world of borderline and psychotic
patients is, however, uniquely his own. Splitting breaks up the internal
representation of objects and of the self into part object represen-tations,
each with an associated affect. The central feature of pro-jective
identification, a primitive defense according to Kernberg, is that it always
involves the projection of an internal object rela-tion with its associated
affect. When projection is effective, the subject eliminates the unacceptable
impulse or idea from any connection with the self. In contrast, in projective
identifica-tion, the connection to the unacceptable contents is preserved along
with the tie between the part self and the part object. The connection cannot
be totally eliminated.
Kernberg envisioned the inner world of the
borderline or psychotic patient as being populated by numerous unintegrated
part self–part object dyads that are each linked by a predominant affect. These
internal nuclei are kept separate by the defense of splitting. The borderline
individual projects these pathological inner contents onto any significant
other with whom he or she interacts. Which of these self-object–affect
structures is active can shift from moment to moment; this results in the
chaotic and shifting pattern of relationships that is the essence of what is
ob-served clinically in patients with borderline psychopathological disorders
(who can be described as being stably unstable).
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