In dit verdiepende interview bespreekt Otto Kernberg hoe de DSM-5 de ernst van persoonlijkheidsstoornissen beschrijft vanuit het functioneren van het zelf en interpersoonlijke relaties. Hij gaat in op waarom narcistische patiënten vaak vastlopen in therapie, onder andere door een rigide zelfbeeld en moeite met afhankelijkheid en kwetsbaarheid. Kernberg belicht recente behandelvormen waarin cognitief-gedragstherapeutische en psychodynamische benaderingen worden geïntegreerd, met bijzondere aandacht voor chronische en hardnekkige wanen. Vanuit zijn achtergrond en oorspronkelijke ambitie om neuroloog te worden deelt hij inzichten uit de psychiatrie en benadrukt hij het blijvende belang van psychoanalytische scholing. Daarnaast staat hij stil bij de persoonlijke en professionele uitdagingen in het werken met ernstige persoonlijkheidsproblematiek en de noodzaak van effectieve, goed onderbouwde behandelingen. Leerdoelen: -Inzicht krijgen in de DSM-5 benadering van ernst bij persoonlijkheidsstoornissen -Begrijpen waarom narcisme specifieke therapeutische uitdagingen kent -Kennismaken met geïntegreerde behandelmethoden (CGT en psychodynamisch) -Reflecteren op de rol van psychoanalytische training binnen de hedendaagse psychiatrie

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.