Book
Object Relations Theory and Clinical Psychoanalysis
Kernberg's second book sets out the theory that underlies his clinical work with borderline patients. Gathering papers from 1966 to 1975 with some new material, it offers what he calls a formulation of psychoanalytic object-relations theory within ego psychology. The starting point is clinical: borderline patients alternate between contradictory states of mind, each fully conscious and each held apart from the other, which neither repression, isolation nor denial explains. Kernberg reads this as splitting, and he builds a model of the mind in which the basic units are internalized object relations: a self-representation and an object-representation joined by an affect. Through introjection, identification and ego identity, these units form the ego, the superego and the id. The theoretical half traces how these units develop. It moves from an undifferentiated early stage, through a stage in which self and object images are still fused, to their differentiation and then to the integration of good and bad images into whole representations of the self and of others, ending in the consolidation of ego and superego. Psychosis, borderline pathology and neurosis are placed at successive points on this line. A chapter on instincts and affects argues that affects are the primary building blocks of motivation, and that libido and aggression are organized out of them over development. A historical chapter places the model among the object-relations theories of Klein, Fairbairn, Jacobson and Mahler, among others. The second half applies the model. Kernberg proposes a classification of character pathology on three levels, higher, intermediate and lower, according to the integration of the superego, whether the defences rest on repression or on splitting, and the quality of object relations and identity. The borderline conditions fall at the lowest level. He updates his approach to the transference and countertransference of borderline patients. In two chapters on love, he treats the capacity to fall in love and to stay in love as a developmental achievement that joins sexual desire with tenderness and with relations to a whole, real person, and he traces how narcissistic and borderline pathology limit it, including in adolescence and middle age. A final chapter extends the theory to small groups and hospital administration, sketching a psychiatric hospital in which treatment, group processes and a functional administration together make up a therapeutic community.
Main ideas
- The basic units of the mind are internalized object relations: a self-representation and an object-representation linked by an affect; these units are the building blocks of the ego, the superego and the id.
- Introjection, identification and ego identity are successively higher levels of internalizing object relations.
- Splitting, the active keeping apart of contradictory ego states that are each fully conscious, is the central defence of early development and of borderline patients; repression takes its place as the ego becomes integrated.
- Internalized object relations develop in stages: an undifferentiated beginning, fused self-object images, their differentiation, the integration of good and bad images into whole representations, and the consolidation of ego and superego.
- Psychosis, borderline pathology and neurosis correspond to successive points on this developmental line: failure to differentiate self from object, failure to integrate good and bad images, and conflict within an integrated structure.
- Affects are the primary building blocks of motivation; libido and aggression as drives are organized out of them in the course of development.
- The model integrates British object-relations theories such as Klein's and Fairbairn's with the American ego psychology of Jacobson and Mahler.
- Character pathology can be classified into higher, intermediate and lower levels by superego integration, by whether defences rest on repression or splitting, and by the quality of object relations and identity; the borderline conditions occupy the lowest level.
- In treating borderline patients, the primitive object relations activated in the transference and reflected in the countertransference are the material to be identified and interpreted.
- The capacity to fall in love and to remain in love is a developmental achievement that integrates sexual desire with tenderness and with a relation to a whole, real person; narcissistic and borderline pathology limit it in characteristic ways.
- Object-relations theory can be extended to small groups and organizations: a psychiatric hospital whose treatment, group processes and functional administration are integrated can work as a therapeutic community.
What it shows
- 1976
Otto F. Kernberg developed Object relations theory
Kernberg built an object-relations theory within ego psychology, in which units of self-image, object-image and the affect linking them are the building blocks of psychic structure, drawing together Kleinian, British Middle Group and ego-psychological models.
Margaret Mahler influenced Otto F. Kernberg
At the Menninger Foundation Kernberg built on Mahler's account of separation–individuation, using its phases to place the fixation points of borderline and narcissistic pathology in his developmental model.
Edith Jacobson influenced Otto F. Kernberg
Kernberg took from Jacobson the idea that self-images and object-images, first fused and later told apart, are laid down in early relationships and form the ground of ego and superego; it became the core of his own object-relations theory.
Melanie Klein influenced Otto F. Kernberg
Kernberg drew on Klein's account of primitive defences, splitting, projective identification, idealization and devaluation, for his picture of borderline organization, while setting it within an ego-psychological developmental frame that he held Klein's own theory lacked.
Ronald Fairbairn influenced Otto F. Kernberg
Kernberg drew on Fairbairn's view of the mind as made of internalized relationships, split into separate ego–object units, for his own account of how primitive object relations are built into psychic structure.
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- 1976
Heinz Hartmann influenced Otto F. Kernberg
Kernberg's "Object Relations Theory and Clinical Psychoanalysis" (1976) joins object relations theory to ego psychology, taking up the self- and object representations that go back to Hartmann's 1950 distinction and Edith Jacobson's development of it.
- 1976
Otto F. Kernberg developed Self-representation
Kernberg treated units of self-representation, object representation and the affect linking them as the building blocks of psychic structure in "Object Relations Theory and Clinical Psychoanalysis" (1976).