A Contribution to the Theory of Treatment of Personality Disorders

In this paper, I will focus on the field of the personality disorders, a subject which has been the interest of all psychoanalysts since the early days of this science. In the past decade, an explosion of newer theoretical formulations and advances in psychodynamic theory have occurred, and it behooves the clinician to test their application in the clinical field at his disposal. “The Widening Scope of Indications for Psychoanalysis” (Stone, 1954) has been mainly in the understanding and treatment of patients with difficult personalities, traditionally thought to be unsuited for psychoanalytic treatment because of their inability to form the necessary alliance with the analyst. Some writers who have made major contributions to this area over the past few decades include, but are not restricted to, the following: Balint (1969) with his elucidation of the area of the “basic fault,” Fairbairn (1963) and Guntrip in their studies of the schizoid personality, Kernberg (1975) with his description of the borderline personality organization, and Kohut (1971, 1977) with his clinical and developmental elucidation of the narcissistic sector of their personality and of the “bipolar self.” It is noteworthy that for the most part, these advances have been made through the study of one or another aspect of object relations theory. In the treatment of personality disorders, the most influential clinical guiding influences have come in the past directly from the clinical theory of ego psychology. It is the purpose of this paper to compare and contrast some aspects of this theory with more recent theoretical formulations advanced by “self psychology.” In my view, Kohut and his followers have called into question some technical and theoretical assumptions thought until recently to be axiomatic and unshakeable. The