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Gillman, R.D. (1986). Severe Personality Disorders: Psychotherapeutic Strategies: By Otto F. Kernberg. New Haven/London: Yale University Press, 1984. 381 pp.. Psychoanal Q., 55:502-508.

(1986). Psychoanalytic Quarterly, 55:502-508

Severe Personality Disorders: Psychotherapeutic Strategies: By Otto F. Kernberg. New Haven/London: Yale University Press, 1984. 381 pp.

Review by:
Robert D. Gillman

In a 1976 book review, Kernberg stated that "psychoanalysis has yet to develop a systematic theory and technique of psychotherapy, and … the development of such a theory and technique would expand psychoanalytic knowledge and its application to the large number of patients who require psychoanalytic psychotherapy, but who cannot benefit from non-modified psychoanalysis…" This statement describes the thread that runs through and binds together the twenty-two chapters of this book on the diagnosis and treatment of patients with severe psychopathology. The book is a quest for the expansion of psychoanalytic knowledge through psychoanalytically informed diagnostic and psychotherapeutic work.

Fenichel also expressed a hope for attainment of the elusive goal of psychoanalysis establishing a systematic basis for psychotherapy. He stated: "An analyst is able to use the patient's symptoms, history, behavior, and utterances for the purpose of establishing a 'dynamic diagnosis' about the patient's leading conflicts, the relative strength of repressing and repressed forces respectively, the defense system and its weak spots, the patient's rigidity and elasticity, and his general accessibility." He listed different kinds of therapeutic interventions, including interpretation, and predicted that "a psychoanalytic theory of non-psychoanalytic influence [would] soon be advanced."

In his search to reach this goal, Kernberg emerges as a skilled psychiatric diagnostician, a resourceful clinician, a consultant who has experience with a wide variety of treatment cases, and a hospital director with a wealth of knowledge about inpatient groups and inpatient management. The first chapter, "Diagnostic Considerations," sets the stage for understanding the intrapsychic structural characteristics of patients with severe pathology. The next chapter, "The Structural Interview," sharpens the concept of differential


1 Kernberg, O. F. (1976): Review of G. Blanck & R. Blanck: Ego Psychology: Theory and Practice. Int. J. Psychoanal., 57:363.

2 Fenichel, O. (1944): Brief psychotherapy. In The Collected Papers of Otto Fenichel, Second Series. New York: Norton, 1954, p. 256.

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