In this in-depth interview, Otto Kernberg reflects on how the DSM-5 conceptualizes the severity of personality disorders through disturbances in self-functioning and interpersonal relationships. He explores why narcissistic patients often struggle in therapy, particularly due to rigid self-perceptions and difficulties with dependency and vulnerability. Kernberg discusses contemporary treatment approaches that integrate cognitive behavioral and psychodynamic methods, with special attention to complex and chronic delusional patterns. Drawing on his background and early aspirations as a neurologist, he shares insights from psychiatry and underscores the lasting value of psychoanalytic training. The interview also touches on the personal and professional challenges therapists face when working with severe personality pathology, and the ongoing need for effective, well-founded treatments. Learning objectives: -Understand DSM-5’s dimensional view on personality disorder severity -Gain insight into therapeutic challenges with narcissistic patients -Explore integrative treatment approaches combining CBT and psychodynamic therapy -Reflect on the role of psychoanalytic training in modern psychiatry

How does consciousness develop? And how do our neurobiological systems shape the way we experience ourselves and others? In this profound lecture, Otto Kernberg explores the evolution of consciousness through the lens of psychoanalytic theory and contemporary neuroscience. He contrasts classical Freudian drive theory with modern perspectives on affect systems, examining how neurobiological structures underpin psychic functioning and influence behavior. In this lecture, you will learn: -How consciousness evolves in relation to neurobiological affect systems -The differences between classical Freudian theory and contemporary object relations perspectives -How early experiences shape personality organization -The role of transference in treating personality disorders -Why mentalization is fundamental to human interaction and therapeutic change

After losing his job following escalating conflicts with a new manager, David is left questioning what went wrong. Once proud of his stable work history, he now finds himself overwhelmed by frustration and anger, not only professionally but also at home. Since the birth of their son, his relationship with his wife has grown increasingly tense. He experiences her as critical and distant, which fuels further resentment and emotional withdrawal. Patterns begin to emerge that connect his workplace conflicts with the dynamics in his marriage. In this clinical session, the therapist proposes a long-term treatment trajectory focused on improving interpersonal functioning. Through guided self-reflection, David is invited to examine his emotional responses, relational patterns, and underlying vulnerabilities.

In this session, psychotherapy unfolds through the classical technique of free association. The patient is encouraged to speak freely, allowing thoughts, feelings, and memories to surface without censorship. What emerges is a landscape shaped by fear of criticism, relational tension, and uncertainty about intimacy and parenting. The therapist listens closely, tracing emotional undercurrents beneath the narrative. Particular attention is given to the patient’s sensitivity to judgment and how this fear shapes interactions in close relationships. Themes of vulnerability, attachment, and self-doubt gradually take form. Through careful guidance, the therapist supports open emotional expression while addressing underlying conflicts. The session concludes with a reflective moment, highlighting both the patient’s fears and the unfolding therapeutic journey toward greater self-understanding.