You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
Dr. Otto Kernberg is one of the most influential psychoanalytic thinkers concerned with the severe personality disorders, including borderline and narcissistic structures. His book Severe Personality Disorders—Psychotherapeutic Strategies, is a well written excursion into the authors' theoretical formulations, with particular emphasis on the diagnostic and treatment aspects of cases of borderline and narcissistic pathology.
Section I of the book deals with diagnostic considerations. In it the author describes his technique for differential diagnosis and for conducting what he has called “the structured diagnostic interview.” In this interview he focuses on the symptoms, conflicts, and difficulties of the patient, utilizing clarifications, confrontation, interpretations, and transference interpretations in order to develop his diagnostic thinking about a particular patient. Kernberg feels that the structural approach stresses the importance of diagnosing the patient as a total individual and of appraising his internal life of object relations in terms of his concept of himself and of significant others. Although he has described his techniques in differential diagnosis previously in other works, the description in this book is particularly well organized and includes a table and an illustrative figure in order to assist in the conceptualization. There is ample description of the mechanisms of splitting, primative identification, projective identification, denial, and devaluation, all of which are essential to understanding in this area. Dr. Kernberg feels that the structural interview represents what might be called “a second generation” of the earlier “dynamic interview,” which reflected the impact of the psychoanalytic frame of reference on the diagnostic interview in descriptive psychiatry.
There is a chapter on the differential diagnosis in adolescence with particular attention to narcissistic pathology in this stage of development. This is followed by a chapter on