About This Interview
Otto Kernberg on Love, Hate, and the Treatment of Borderline and Narcissistic Personality Disorders
In this MINDinMIND Legacy Interview recording, 97 year old Otto F. Kernberg reflects on the clinical questions that have shaped his life’s work: borderline personality organisation, pathological narcissism, love, hate, aggression, object relations and the treatment of severe personality disorders.
For many clinicians, Otto’s writing is vital but not always easy to enter. In this recording, he sets out the central ideas in conversation with Jane O’Rourke, with Nancy McWilliams and Frank Yeomans bringing further clinical depth and clarity.
The recording carries an added poignancy. Otto speaks from Vienna, the city he was forced to leave as a Jewish child. He recalls that early world of fear, persecution and exile, though the interview is careful not to read his theory straight out of his history. It is a conversation about how one of the most influential psychoanalytic thinkers of the modern era came to think so rigorously about love, hatred, destructiveness and the difficulty of integration.
Nancy McWilliams brings a broad diagnostic perspective, and helps show why Otto’s work has mattered to clinicians well beyond any one school of treatment. Frank Yeomans brings the close clinical view of someone who has worked alongside Otto in developing, teaching and applying Transference-Focused Psychotherapy. Here the ideas are not presented as abstract theory, but tested against clinical experience, disagreement and the realities of the therapeutic relationship.
What makes Otto’s work so important is its refusal to simplify the patient. He asks therapists to stay with the full complexity of psychic life: love and hate, dependency and aggression, longing and attack, vulnerability and omnipotent control. Rather than treating these difficulties only as behaviours to be managed, he gives clinicians a way to think about the internal structures, object relations and defensive organisations that give them meaning.
At the centre of the interview is the challenge of integration. How can the mind come to hold together loving and hateful feelings? How does a patient begin to recognise that the same person can be needed, resented, loved and attacked? How can psychotherapy help a person move beyond split-off states without losing sight of the person behind the pathology?
Otto puts this succinctly when he says:
“We look at personality as something so rigid and petrified. The truth is, it’s a dynamic structure. And there are ways to modify rigidity and serious limitations in personality function.”
Why Watch This Recording?
This recording is for clinicians who want to think more clearly about severe relational disturbance, narcissistic pathology, aggression and the destructive forces that can enter the therapeutic relationship.
You will hear Otto reflect on:
- why his structural model of personality organisation still helps clinicians think beyond diagnostic categories
- why patients may move so rapidly between need, attack, idealisation and devaluation
- how pathological narcissism involves vulnerability, grandiosity, envy, devaluation and attack
- why destructiveness needs to be understood clinically, not simply managed or avoided
- how Transference-Focused Psychotherapy works with split-off states as they appear in the therapeutic relationship
This is a rare chance to hear Otto explain central aspects of his thinking in conversation, with Nancy and Frank helping clinicians see how his ideas apply in the consulting room.
Professor Kernberg’s Contribution
Professor Kernberg’s work helped change the clinical status of patients who had often been considered too difficult, too destructive or too unstable for serious psychotherapy. His 1967 paper on borderline personality organisation helped move the field away from a loose diagnostic category and towards a structural understanding of personality functioning.
His model described borderline personality organisation in terms of identity diffusion, primitive defensive operations such as splitting, idealisation, devaluation and projective identification, and largely intact reality testing. Clinically, this gives therapists a way to think about patients who struggle to sustain a coherent sense of self and other across rapidly changing emotional states.
His work also shaped approaches to assessment, giving clinicians a way to think about personality functioning through identity integration, defensive organisation, reality testing and the quality of object relations.
Running through Professor Kernberg’s work is the challenge of integration: how the mind comes to hold together loving and hateful feelings, good and bad images of self and other, dependency and aggression. This concern runs through his thinking about borderline personality organisation, pathological narcissism and the therapeutic relationship itself.
His work on pathological narcissism remains one of the major psychoanalytic positions in the field, particularly in contrast to Heinz Kohut’s self psychology. Whereas Heinz Kohut emphasised empathic failure, hidden wounds and developmental arrest, Professor Kernberg foregrounded destructive defenses such as aggression, envy, grandiosity, devaluation and pathological internal object relations. Their views together, make for far more nuanced clinical work than any diagnostic label can offer.
With colleagues, Professor Kernberg also helped move psychoanalytic psychotherapy for severe personality disorders into a more systematic, teachable and researchable form, without abandoning its focus on transference, defense and internal object relations.
Having held major institutional roles, including as Past President of the International Psychoanalytical Association, Professor Kernberg has also been a persistent critic of psychoanalytic institutions and training culture, challenging authoritarianism, conformity and the inhibition of creativity in analytic candidates. His 1996 paper, “Thirty Methods to Destroy the Creativity of Psychoanalytic Candidates,” specifically addresses aspects of psychoanalytic education that foster or inhibit creativity.
His legacy is therefore not only clinical and theoretical, but institutional: he asks psychotherapy to examine its own structures as rigorously as it examines the patient.
Special Guests
Nancy McWilliams & Frank Yeomans
Nancy McWilliams
Professor Nancy McWilliams has devoted her career to teaching clinically useful psychodynamic ideas, especially those involving personality structure, to therapists of all backgrounds and orientations. She is Visiting Professor Emerita at Rutgers Graduate School of Applied & Professional Psychology and has a private practice in Lambertville, NJ. She is author of four textbooks (on psychoanalytic diagnosis, case formulation, therapy, and supervision) and is co-editor of all three editions of the Psychodynamic Diagnostic Manual. A former president of the Society for Psychoanalysis and Psychoanalytic Psychotherapy of the American Psychological Association, she is a member of the Austen Riggs Center Board of Trustees. Her books are available in more than 20 languages and she has taught in person or remotely in more than 50 countries.
Frank Yeomans
Dr. Frank Yeomans is Clinical Professor of Psychiatry at the Weill Medical College of Cornell University, Director of Training at the Personality Disorders Institute of Weill-Cornell, Lecturer in Psychiatry at the Columbia University College of Physicians and Surgeons Center for Psychoanalytic Training and Research, and President, International Society for Transference-Focused Psychotherapy. His primary interests are the development, investigation, teaching, and practice of psychotherapy for personality disorders. He has participated in establishing training programs for psychodynamic therapy of personality disorders in numerous sites in North and South America, Europe, Asia and Australia, and is the author of numerous articles and books.
About Otto Kernberg
Professor Otto F. Kernberg is one of the most influential psychiatrists, psychotherapists and psychoanalysts of the modern era. His work on borderline personality organisation, pathological narcissism, object relations theory and severe personality disorders continues to shape clinicians across psychoanalysis, psychiatry and psychotherapy.
He is widely known for his structural model of personality organisation and for the development of Transference-Focused Psychotherapy with colleagues including John Clarkin and Frank Yeomans. His major publications include Borderline Conditions and Pathological Narcissism, Object Relations Theory and Clinical Psychoanalysis, Severe Personality Disorders: Psychotherapeutic Strategies and Hatred, Emptiness, and Hope: Transference-Focused Psychotherapy in Personality Disorders.
Now in his late nineties and still professionally active, Professor Kernberg remains an unusually important and challenging voice in psychotherapy and psychoanalysis.
Who This Is For
- Therapists working with trauma, dissociation and attachment disturbance
- Clinicians wanting to understand AEDP from its founder
- Psychotherapists interested in emotional processing, vitality and transformational change
- Supervisors and teachers looking to deepen their thinking about what actually promotes change in therapy
- Mental health professionals seeking a clinically grounded, relationally serious approach to trauma work
- Therapists who believe that it is possible to rewire internal working models, but wish to grasp how. Put it after ‘transformational change’
Interviewer
Otto is in conversation with Jane O’Rourke.
Jane O’Rourke, founder of MINDinMIND and a former award-winning BBC journalist now practising as a Child and Adolescent Psychotherapist, draws upon her combined expertise to create rich and thoughtful conversations with leading mental health clinicians. Her interviews weave together the personal and professional threads of her guests’ journeys, capturing the experiences that have shaped their clinical work and thinking.
“This interview with Otto and the guests felt profound. That is the word I want to use. It was like listening to distilled wisdom.”
– Interview attendee
“Its richness surpassed all of my classroom experiences during psychoanalytic training.”
– Interview attendee
“Such an engaging, interesting and poignant interview: down to earth, richly educational with an impressive lightness of touch.”
– Interview attendee