Treatment of Severe Personality Disorders by Otto F. Kernberg

Author:Otto F. Kernberg
Language: eng
Format: epub
ISBN: 9781615371884
Publisher: American Psychiatric Association
Published: 2018-02-26T16:00:00+00:00

THE PATIENT’S RESPONSIBILITIES

A central aspect of SPP is the establishment of specific goals that focus on improving the patient’s functioning in the major areas of his or her life: work and profession, love and sex, social life, and creativity. Realistic goals derive from the patient’s potential, from his or her external reality, and, very importantly, from the therapist’s expectations and confidence in what this patient might achieve if he or she were not limited by his or her characterological illness. These overall objectives may translate into complex tasks that must be fulfilled for their achievement, such as the patient returning to work, obtaining additional education or training, or completing or returning to school. In the interpersonal realm, treatment goals might involve, for example, the patient learning to function independently, learning ways in which serious conflicts in the relationship with a partner can be managed and crises avoided. The therapist’s own life experience and his or her technical expertise and full, detailed assessment of the patient’s present personality are crucial determinants in setting up concrete treatment goals and tasks for which the patient has to take responsibility. Supportive psychotherapy, therefore, is always a joint effort, a joint task, and not something that the therapist is doing while the patient is the passive recipient of it.

For example, one adolescent patient with an infantile personality disorder, less than average intelligence, chronic school failure, sexual promiscuity, and drug abuse assumed that her limited intellectual capacities would never get her through college. She was interested in becoming a nurse but thought she would never be able to achieve that. After discussing with her the nature of her intellectual difficulties and the fact that this meant that her efforts would have to be much greater than those of people for whom intellectual tasks came much easier, I insisted that she might be able, if she worked hard, to achieve a college education. She did enter college with the financial support of her parents, and during the treatment managed to do the very hard work that permitted her to successfully complete a college education. The confidence of the therapist that, given the right motivation, she would be able to do the very hard work necessary to keep up with college demands despite her intellectual limitations seemed a crucial feature in this case.

At the same time, it became clear that the sexual promiscuity of this patient involved an infantile effort to obtain a boyfriend, a dependent wish to fight off loneliness. We addressed, without exploring the profound masochistic features of her personality, how she would have to proceed about finding a boyfriend who might be interested in her beyond simply having sex on a few occasions. This became possible by “forcing her” to carry out hard studies while stimulating her openness and freedom in relating to men, which helped her to develop better criteria about who would be more acceptable and thus improved both of these areas of major difficulties. In the process, I also obtained her compliance

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