This video presents a close exploration of three psychotherapy sessions between Dr. Otto Kernberg and a mock client with a personality disorder, with commentary and exploration of important issues facilitated by Victor Yalom. The premise and definition of personality disorders is established to set the tone for the psychotherapist’s focus toward the client’s motivations, distortions in close relationships and view of the self within those relationships through an approach called Transference-Focused Therapy.
The video explores the projections that are driven by such clients’ recurrent fears of being traumatized and provides a clear picture of the manner in which those with identity diffusion struggle to hold a balanced perspective. In these cases, emotion overwhelms them, creating the split view of the self or others as either completely idealized or utterly negative. Focusing on the interpersonal experience of the here and now, the conscious meanings are illuminated through an intensive approach to exploring the interpersonal experience through structural interviewing. The interview, as Victor Yalom points out, moves from a traditional interview toward examination of the interpersonal exchange between the client and the therapist.
The interview process exemplifies an exploration of symptoms, personality, and normal or diffused identity, then reality testing to draw out the fullness of the interaction transference and exploration. Dr. Kernberg illuminates the concept of identity diffusion. Continued discrepancy exploration uncovers the client’s levels of paranoia, suspicion, anger and controlling behavior as this video presents a client who seeks to protect himself from fear of further discomfort or rejection. By interpreting the client’s difficulty with reality openly, a counselor can determine the level of reality acceptance versus the presence of paranoia toward others. The video later demonstrates how to move the interview toward exploring how the client may begin to understand the transference between client and counselor.
The video provides effective commentary by Dr. Kernberg and a continued dialog between Victor Yalom and Dr. Kernberg throughout the mock sessions to emphasize his focus and methods. Dr. Kernberg is respectful, honest and direct with his client while also pointing to the discrepancies he experiences. The video moves through three sessions to show the client’s further exploration of his areas of denial along with his progress toward integrating his inner concept of self.
One limitation of the video is that the first session is lengthy and the second is quite short, which may leave the learner wondering how to structure typical 50-minute sessions with these clients. There are times when the diagnosis is unclear as to whether the client is showing borderline personality disorder or being a borderline patient, which can be confusing to those learning to diagnose clients. Reference to the DSM-5 would be helpful to clarify the diagnosis and the symptoms displayed by the client.
Strengths of this video include the demonstration of continuing assessment if the client presents a new issue, such as potential substance abuse, while maintaining the continued focus on transference. Dr. Kernberg is artful in exemplifying an approach that remains open and honest but neutral in tone, whether the client feels willing to share more information or seeks to control the topic or shift the focus from the most important areas of assessment or counseling. By appealing to the trustful part of the client’s personality, Dr. Kernberg skillfully shows how to draw out this side of the client in order to help gain commitment to the treatment process. The potential for overcoming the problem of distrust and suspicion is modeled to show therapists how to appeal to the part of the client that does trust in order to create more balance in personal responses toward others.
Finally, this video reminds counselors of ways to engage in the therapeutic process through a grounded response to clients, trained awareness of client unconscious projections, and their own well-developed self-awareness in order to manage counter-transference. This video successfully explores the issues vital to understanding the therapeutic relationship through a psychodynamic and psychoanalytic process that helps clients to reconcile polarities by achieving a more integrated view of others. With a video scrolling script format that is easy to understand and follow, counselors can learn effective methods for addressing challenging client issues.
Psychotherapy.net (Producer). (2013). Psychoanalytic psychotherapy with Otto Kernberg, MD. (Available in DVD and video streaming from http://www.psychotherapy.net/video/psychoanalytic-psychotherapy-otto-kernberg)
Available in DVD and streaming format as part of video subscription at www.psychotherapy.net/subscriptions.
Reviewed by: Adele Logan O’Keefe, Walden University, Minneapolis, MN.
The Professional Counselor