'Most-Cited Psychoanalyst' Continues Pioneering Ways

At age 79, Otto Kernberg, M.D., has a glistening pate and a mischievous smile. His english is perfect, but occasionally his intonation is intriguing—is it German or Spanish? and he exudes a lot of gravitas in the worlds of psychoanalysis and psychiatry.

“He is, without a doubt, the most productive psychiatrist and psychoanalyst I've ever met,” Glen Gabbard, M.D., chair of psychoanalysis and professor of psychiatry at Baylor College of Medicine, told Psychiatric News. “He has an intellectual and clinical curiosity that has led him to be one of the leading thinkers in psychiatry and psychoanalysis. He is also the most-cited psychoanalyst in the world literature.”

“He is one of the most active and energetic people I've ever known,” Frank yeomans, M.D., a clinical associate professor of psychiatry at Cornell university Weill Medical College, said in an interview.“ It is astonishing how much he can do, how much he teach... in addition to all his writing and seeing patients. It is remarkable because a lot of people of his stature don't do direct patient work anymore.”

Added John Oldham, M.D., senior vice president of the Menninger Clinic:“ He is extremely committed, dedicated, hardworking—a very concerned professional educator with a giant of an intellect. He has been extremely influential in the field of psychoanalysis and increasingly in the broad field of clinical work with patients.”

Kernberg's professional odyssey started, most appropriately, in the city of Freud—Vienna—where he was born in 1928. After Hitler's annexation of Austria in 1938, Kernberg and his family fled first to Italy, then to Chile, where he attended high school, university, and medical school and where he became a psychiatrist. A fellowship at Rockefeller University brought him to the United States. After that, he worked at Johns Hopkins University and the Menninger Foundation. He then became a professor of psychiatry at Cornell University, where he is still working and researching.

Reputation Based on Series of Firsts

One of his major contributions, his colleagues believe, is that he integrated the object-relations theory of psychoanalyst Melanie Klein into American ego psychology, which was the reigning psychoanalytic model in the 1950s and for decades after that. “He largely made Kleinian thinking legitimate before most Americans knew about it,” said Gabbard.

“He was instrumental in identifying the borderline personality disorder as a major entity in psychiatry long before it appeared in the DSM,” Gabbard pointed out. “He was the first person to come up with a comprehensive psychodynamic understanding of what borderline psychopathology is. All of the subsequent contributions to the literature are indebted to him for that. We now think that borderline personality disorder may be present in as many as 20 percent of inpatients; before Kernberg, many of these patients were misdiagnosed.”

'His Most Important Contribution'

“His most important contribution, or at least the one that has meant the most to me, is that he excited an interest in, and an enthusiasm for, treating borderline patients by a whole generation of clinicians who previously had been both disinterested and unenthusiastic,” John Gunderson, M.D., said. In addition to being a professor of psychiatry at Harvard Medical School, Gunderson is director of the Borderline Treatment and Research Center at McLean Hospital.

Kernberg has also made tremendous contributions to the diagnosis and treatment of narcissistic personality disorder, his colleagues said.“ Many of his ideas about the diagnosis have shaped the DSM-IV category of narcissistic personality disorder,” Gabbard said.

Indeed, yeomans said, “Otto Kernberg helped psychoanalytic thinking move toward the whole population of personality-disordered patients.. .to make it extremely useful working with that population.”

From Object to Love Relations

However, he has not limited his interests to object relations and personality disorders. He has applied psychoanalytic understanding to large-group behavior and institutions, has written about couples and love relations, and is especially fascinated by aggression. Which brought up an amusing anecdote from yeomans: “A lot of analysts and psychiatrists say, 'Sure, Kernberg is very smart, but he's always talking about aggression!' So one day I asked him, 'Otto, are you really obsessed with aggression?' To which he replied (I loved his answer): 'Only to the extent that it inhibits libidinal love expression!'”

He Developed New Treatment

Kernberg is a doer as well as a thinker. He and his coworkers have established a psychoanalytic treatment for borderline personality disorder—transference-focused psychotherapy, have manualized it, and have subjected it to randomized, controlled trials. Results from one of their most recent trials—comparing transference-focused psychotherapy to dialectical-behavior therapy and to supportive treatment—were published in the june 2007 American Journal of Psychiatry.

The results showed that while subjects in all three treatment groups showed significant positive changes in depression, anxiety, global functioning, and social adjustment across one year of treatment, there were some differences. For example, whereas subjects getting the transference-focused psychotherapy or the dialectical behavior therapy showed significant improvement in suicidality, subjects getting the former or supportive treatment showed significant improvement in facets of impulsivity. Only transference-focused psychotherapy significantly predicted a change in irritability and in verbal and direct assault.

“That has been a major contribution and took a long time to do, a lot of effort,” Oldham said.

“Kernberg has been at the forefront of the need for psychoanalysts to validate the efficacy of their treatment with empirical research,” said Gabbard. “He has always warned analysts that they can't simply rely on their personal convictions that the treatment works [and] that they need to demonstrate it with well-done research.”

“He is one of the main figures to bring serious research to the psychoanalytic world and to the world of psychodynamic psychotherapy,” yeomans stated.

And in decades to come Kernberg's ideas and contributions will undoubtedly continue to impact the psychoanalytic and psychiatric worlds, his colleagues agreed.

Those ideas are influencing the development of DSM-V, observed Oldham, who is a member of the DSM-V work group.

“His contributions are so fundamental that anyone who wants to write about borderline or narcissistic personality disorder needs to position themselves in terms of Kernberg's views,” Gabbard asserted. “Also, his research will be very influential in persuading the public and third-party payers that borderline personality disorder is treatable and that the treatment should be reimbursed.”

“I think his most-enduring contribution will be his research,” Gunderson predicted. “By identifying a specific type of psychoanalytic therapy that can be tested as to whether clinicians are adherent or not, and by demonstrating that it is specifically needed for a certain patient group, this builds bridges from psychoanalytic treatments to psychiatry.... It is very far reaching.”

And as far as his present plans go, Kernberg told Psychiatric News, “they include continuing research on the treatment of severe personality disorders here at Cornell, treating patients, writing, and enjoying life with [my wife] Kay.” ▪