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To what extent is psychoanalysis art, to what extent science? Psychoanalysts disagree. Otto Kernberg is one whose position is clear. He has attempted to move the discipline further into the scientific realm through the development of his instinctually based system, composed of ego psychological concepts and object relational principles, woven into a comprehensive theory. His latest book furthers his work in this direction. It is an elaboration of his previous contributions to the literature on the borderline, narcissistic, and other severe personality disorders and a critical review of recent developments in clinical psychiatry and psychoanalysis. The book, while highly theoretical, consistently applies theory to the clinical situation. The theory comes alive in a most relevant way, offering the clinician fresh perspectives on formidable problems.
Kernberg reviews the indications and contraindications for the recommendation of psychoanalysis, expressive psychotherapy (his term for what is generally called psychoanalytic psychotherapy), and supportive psychotherapy. His atypical approach to supportive psychotherapy is of particular interest. He employs this modality when the others are contraindicated or when the patient lacks the motivation, psychological-mindedness, or willingness to come two or three times a week. His technique in supportive psychotherapy is geared to help patients gain control of their affects through the awareness of their disorganizing effects. Our readers may quickly recognize the similarity to Horney's approach of identifying the consequences of a solution in order to interest and motivate patients toward change. Kernberg opposes some commonly held positions on supportive psychotherapy such as (1) the transference should not be focused on; (2) the patient does not have to participate actively; (3) the work is easier than in the other two modalities; (4) primitive defenses should be left undisturbed; and (5) frequent sessions promote regression