Otto Friedmann Kernberg (born 10 September 1928) is an Austrian-born American psychoanalyst and professor of psychiatry at Weill Cornell Medicine.

He first came to the U.S. in 1959 on a Rockefeller Foundation fellowship to study research in psychotherapy with Jerome Frank at the Johns Hopkins Hospital.

[2] He was the Supervising and Training Analyst of the Topeka Institute for Psychoanalysis, and Director of the Psychotherapy Research Project of Menninger Foundation.

During this time, the insight of his colleague Herman van der Waals contributed in raising Kernberg's awareness and interest in narcissistic personalities.

BPO patients are described as experiencing so-called 'splits' in their affect and thinking, and the intended aim of the treatment is focused on the integration of split off parts of self and object representations.

In his model, these patients suffer from identity diffusion, primitive defense operations and unstable reality testing.

Defense operations often applied by BPO patients are splitting, denial, projective identification, primitive devaluation / idealization and omnipotence.

The putative global mechanism of change in patients treated with TFP is the integration of these polarized affect states and representations of self and other into a more coherent whole.

Regulation of self-esteem occurs through gratifications related to the age, which include or imply a normal infantile system of values, demands or prohibitions.

Otto Kernberg and Heinz Kohut can be considered to be two theorists that have markedly influenced past and current psychoanalytic thinking.

Taken as a whole, Kohut is regarded as a self theorist who radically departed from Sigmund Freud's conjectural conceptualizations, focusing mostly on people's need for self-organization and self-expression.

Kernberg in contrast, remained faithful to the Freudian metapsychology, concentrating more on people's struggle between love and aggression.

He identifies constitutional along with environmental factors as the source of disturbance for these individuals by stressing the important role of the mother surrogate who treats the child on the surface (callously) with little regard for his/her feelings and needs.

Kohut[citation needed] on the other hand, sees borderline personality as totally distinct from the narcissistic one and less able to benefit from the analytic treatment.

For Kohut, "grandiose self" reflects the "fixation of an archaic 'normal' primitive self" while for Kernberg it is a pathological development, different from normal narcissism.

For Kernberg,[citation needed] the goal of treatment should be to use confrontation strategies so as to help the patient integrate his/her internal fragmented world.

Specifically, he assumes that this type of personality mirrors adaptive narcissistic wishes, needs, and objectives that, nevertheless, have not been satisfied during childhood development by the parental environment.

In his explanation of pathological narcissism, he pays attention on the libidinal forces or charges in order to provide an etiology of how this disorder develops.

He allies more to the Freudian conceptualization, by proposing that narcissistic behavior results from pathological development in which aggressive drives play a central role.

Kohut departed from the classical Freudian view, which suggested that some patients could not be analyzed given that they lacked the ability to develop transferences.

His debate with Kernberg concerns mostly the idealizing transference, which, according to Kohut, relates to a fixation at an archaic level of normal development.

Otto F. Kernberg and Heinz Kohut regard the analytic process as well as the role of the analyst in quite different terms.

Kernberg requests a methodological and persistent interpretation of the defensive function of grandiosity and idealization as they emerge in transference.

"The analyst must be continuously focusing on the particular quality of the transference in these cases and consistently counteract the patient's efforts toward omnipotent control and devaluation".

To establish this, the analyst should be able to show empathic comprehension, which entails a receptivity to the narcissistic illusions and an avoidance at all costs of anything which would challenge them or suggest they are unrealistic.

In his opinion, "the more traditional approach to narcissism highlights the important ways in which the narcissistic illusions are used defensively, but misses their role in health and creativity and in consolidating certain kinds of developmentally crucial relationships with others.

The developmental-arrest approach (Kohut) had generated a perspective on narcissism which stresses the growth-enhancing function of narcissistic illusions, but overlooks the extent to which they often constrict and interfere in real engagements between the analysand and other people, including the analyst".

Mitchell recommends a "subtle dialectic between articulating and embracing the analysand's illusions on the one hand, and the provision of larger context in which they can be experienced, on the other".

A failure of the child to differentiate between self and other results in a psychotic personality organization; one has failed to accomplish the first developmental task and is stuck in stage II.

A failure of this results in a borderline personality organization; one has failed to accomplish the second developmental task and is stuck in stage III.