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Psychoanalysts today are often called upon to evaluate and treat patients for whom treatment in psychoanalysis proper is inappropriate because of the severity of the presenting psychopathology, but who seem able to benefit from a sophisticated, dynamically informed treatment of some sort. In this book, Otto Kernberg provides a detailed guide for the analyst's thinking about such patients. He offers a carefully elaborated theoretical framework for their evaluation and the determination of which forms of treatment are likely to be beneficial, as well as specific technical suggestions for structuring and conducting such treatments and for dealing with many of the complex and difficult clinical problems that commonly arise in working with severe psychopathology.
The book is comprised of four major theoretical chapters, seven chapters addressing special clinical situations, two concerning countertransference issues, and one devoted to the detailed presentation of a clinical case. In the first theoretical chapter, “A Psychoanalytic Theory of Personality Disorders,” Kernberg argues for the value of a dimensional model for the classification of personality disorders. He sets out such a model based on the level of development of internalized object relations, with particular attention to the stability of self-object differentiation and the attainment of object constancy, as well as to the level of superego integration and the use of primitive defenses. This developmentally based model leads to a linked network of personality disorders defined