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“Otto Kernberg and the members of the Personality Disorders Institute at Weil Cornell Medical College have done more to elucidate pathological narcissism with this book than anyone else. Their work in uncovering and explaining the multiple meanings and ways to understand and treat narcissistic patients should be the gold standard by which all other work in this field should be judged. It is encyclopedic, clearly written, with numerous clinical examples that augment its categorization of the variety of narcissistic disorders. It is an example, par excellence, of how clinical acumen and research can be melded into a sophisticated, complex understanding of one of the difficult-to-understand categories of personality disorders.”

—Psychoanalytic Psychology (review by Fred Busch, PhD)


“This book provides the most integrated view of assessment and treatment of pathological narcissism to date. Detailed clinical strategies are furthered by many informative case vignettes. Connecting object relations and attachment theory with findings from neuroscience and social cognition, the book offers a much-needed, comprehensive understanding of the complex range of narcissistic personality functioning. The authors are especially attentive to systematic diagnostic assessment, nuances in relatedness between therapist and patient, and flexibility in treatment interventions. This is an outstanding guide for psychotherapists.”

—Elsa Ronningstam, PhD, Associate Professor (part-time), Harvard Medical School; Clinical Psychologist, McLean Hospital


“This extraordinary book is a landmark in our understanding of the development, diagnosis, and treatment of narcissistic pathology. Brilliantly lucid, it presents multiple perspectives and comprehensively reviews the relevant literature. Based on the pioneering work of Kernberg and his associates on transference-based psychotherapy (TFP), the book includes a variety of case material. Normal narcissism—healthy self-esteem, self-confidence, and ethical values—is contrasted with increasingly severe narcissistic psychopathology, characterized by grandiosity, psychopathy, entitlement, and lack of empathy. An invaluable resource for experienced clinicians, this book also merits inclusion in all curricula for training in psychoanalytic psychotherapy.”

—Harold P. Blum, MD, training and supervising analyst, Psychoanalytic Association of New York, affiliated with NYU Langone Health


“A masterpiece! Building on a wealth of prior work establishing TFP as an evidence-based treatment for borderline personality disorder, the authors have developed TFP-N, which they deliver in depth in this welcome volume. The object relations theoretical basis for TFP-N is well covered, but the home run of the book is the privilege to listen in, step by step, as therapists and patients navigate all stages of treatment. Narcissism abounds these days, but pathological narcissism can be especially devastating and hard to reach. Here’s a wise, much-needed guidebook for clinicians of all stripes and all levels of experience.”

—John M. Oldham, MD, MS, Distinguished Emeritus Professor, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine

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Table of Contents

Preface

1. Treating Pathological Narcissism with Transference-Focused Psychotherapy: An Introduction

I. Conceptualizing Pathological Narcissism

2. Self-Functioning in Pathological Narcissism

3. Interpersonal Functioning in Pathological Narcissism

4. An Overview of TFP-N

II. Treating Pathological Narcissism

5. The Assessment and Diagnosis of Pathological Narcissism

6. The Treatment Contract and Frame

7. TFP-N Early Phases

8. TFP-N Later Phases

9. TFP-N for Patients with Combined Narcissistic and Borderline Pathology

III. Pathological Narcissism in Intimate Relationships and Society

10. Malignant Narcissism: Clinical and Social Aspects

11. Narcissistic Love Relations

12. Epilogue

References

Index

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About the Authors

Diana Diamond, PhD, is Professor Emerita in the Doctoral Program in Clinical Psychology at the City University of New York and Senior Fellow at the Personality Disorders Institute at New York Presbyterian Hospital–Weill Cornell Medical College. She is also Adjunct Professor at the New School for Social Research and in New York University's Postdoctoral Program in Psychotherapy and Psychoanalysis. Dr. Diamond's primary interests are developing psychodynamic approaches to treating patients with personality disorders, and assessing changes in attachment, mentalization, and mental representation. Author or coauthor of numerous papers and several books, she is a recipient of the Research Award from Division 39 (Psychoanalysis) of the American Psychological Association. She serves on the editorial boards of Psychoanalytic Psychology and Psychoanalytic Inquiry, is Vice President of the Margaret Mahler Foundation, and has a private practice in New York City.

Frank E. Yeomans, MD, PhD, is Clinical Associate Professor of Psychiatry at Weill Cornell Medical College, Director of Training at the Personality Disorders Institute at New York Presbyterian Hospital–Weill Cornell Medical College, and Adjunct Associate Clinical Professor of Psychiatry at the Columbia University Vagelos College of Physicians and Surgeons. Dr. Yeomans is an Honorary Member of the American Psychoanalytic Association, President of the International Society for Transference-Focused Psychotherapy, and Chair of the Committee on Psychotherapy of the Group for the Advancement of Psychiatry. His primary interests are the development, investigation, teaching, and practice of psychotherapy for personality disorders. He has helped establish training programs in many countries and has published numerous articles and books.

Barry L. Stern, PhD, is Clinical Associate Professor of Psychology in Psychiatry at the Columbia University Vagelos College of Physicians and Surgeons and a faculty member at the Columbia University Center for Psychoanalytic Training and Research. Dr. Stern’s work centers on the study of personality and mental health and the application of transference-focused psychotherapy with patients across the spectrum of personality functioning, and with couples. Dr. Stern has been a lead investigator in the validation studies of the Structured Interview of Personality Organization (STIPO) and its revision (STIPO-R). His published empirical work focuses on the STIPO and the structural assessment of personality. He has a private practice in New York City.

Otto F. Kernberg, MD, is Professor of Psychiatry and Director of the Personality Disorders Institute at New York Presbyterian Hospital–Weill Cornell Medical College, Training and Supervising Analyst at the Columbia University Center for Psychoanalytic Training and Research, and Distinguished Visiting Professor of Psychiatry at the Albert Einstein College of Medicine. Dr. Kernberg is an Honorary Member of many international psychoanalytic institutes, past president of the International Psychoanalytic Association, and Distinguished Life Fellow of the American Psychiatric Association (APA). He is a recipient of the Distinguished Service Award from the APA, the first Sigourney Award for Distinguished Contributions to Psychoanalysis, the Edward A. Strecker Award from the Institute of Pennsylvania Hospital, and the Heinz Hartmann Award from the New York Psychoanalytic Institute, among other honors. Dr. Kernberg has conducted research and published seminal books and articles on psychoanalytic psychotherapy, psychoanalytic object relations theory, and severe personality disorders.

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Audience

Clinical psychologists, psychiatrists, psychoanalysts, clinical social workers, psychiatric nurses, and mental health counselors.

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Course Use

May serve as a supplemental text in graduate-level courses.