Book Review
Psychotherapy
Love Relations: Normality and Pathology.
Otto F Kernberg. New Haven: Yale University Press; 1995. 203 p.
US$15.00.
Reviewer
rating*: Excellent
Review by Paul Ian Steinberg, MD, FRCPC
Edmonton, Alberta
This book largely comprises adaptations of Dr Kernberg’s previously
published writings on affect, love, sexuality, and the couple. Kernberg
notes that it is impossible to study the vicissitudes of love without
studying the vicissitudes of aggression in a relationship—that
“aggressive aspects of the couple’s erotic relationship
emerged as important in all intimate sexual relations.” Thus,
this is a book about aggression as well as love. It starts with
“The Sexual Experience,” which discusses the biological
roots of sexual experience and behaviour and continues with psychosocial
factors, determining core gender identity, gender-role identity,
dominant object choice, and intensity of sexual desire. Kernberg
here makes his usual incisive distinctions, defining terms and distinguishing
between different factors about which the literature is sometimes
vague. In “Sexual Excitement and Erotic Desire,” he describes
the particular place of sexual excitement among the affects, distinguishing
it from such primitive affects as rage, elation, sadness, surprise,
and disgust, indicating that in its cognitive and subjective constituents
it resembles such complex affects as pride, shame, guilt, and contempt.
He describes the relations between instincts, drives, affects, and
object relations and outlines erotic desire’s clinical and
genetic aspects.
Kernberg argues that
an effort to replace both drive and affect theory with an attachment
theory or an object relations theory that rejects the concept
of drives leads to reducing the complexity of intrapsychic life
by stressing only the positive or libidinal elements of attachment
and neglecting the unconscious organization of aggression. (p
59)
He concludes that we should not replace a drive theory by an affect
theory or an object relations theory of motivation, preferring to
consider affects as the building blocks of drives. Many contemporary
theoreticians might dispute this point of view.
“Mature Sexual Love” deals with erotic desire and tenderness,
identification with the other, idealization and mature sexual love,
and commitment and passion. For Kernberg, “an essential aspect
of the subjective experience of passion at all levels is crossing
the boundaries of the self, merging with the other.” He contrasts
this experience of merger and fusion with “regressive merger
phenomena which blur self-nonself differentiation: what is characteristic
of sexual passion is the simultaneous experience of merger and maintenance
of a separate identity.”
“Love, Oedipus, and the Couple” deals with the impact
of gender, falling in love and becoming a couple, and mature sexual
love and the sexual couple. Kernberg refers to the seminal work
of Henry Dicks (1), which he describes as the most comprehensive
psychoanalytic frame for the study of the characteristics of normal
as well as psychopathological love relationships. Unfortunately,
apart from Kernberg, the literature appears largely to neglect Dicks’
work. Dicks described 3 areas in which couples relate to each other:
their conscious, mutual expectations of what a marital relationship
should provide; the extent to which their mutual expectations
permitted harmonizing their own cultural expectations and also
integrating them in their cultural environment; and the unconscious
activation of their past pathogenic internalized object relations
in each partner and their mutual induction of roles complementary
to these past object relations.” Dicks concluded that couples
“established a compromise formation between their unconscious
object relations, which were often in sharp conflict with their
conscious wishes and mutual expectations. (p 59)
The study of psychopathology provides clinical illustrations of
how significant psychopathology interferes with the development
of mature love relationships. Kernberg uses relatively short case
examples that admirably illustrate his point of view to contrast
the consequences of borderline, narcissistic, and neurotic psychopathology.
“Aggression, Love and the Couple” describes the interplay
of love and aggression in the couple’s emotional relationship.
Kernberg claims that
if early conflicts around aggression were severe, the possibility
arises of re-enacting primitive, fantastically combined mother-father
images that carry little resemblance to the actual characteristics
of the parental objects. (p 82)
(One wonders to what extent Melanie Klein’s [2] notions of
inherent constitutional aggression still influence Kernberg.) This
chapter introduces the concept of discontinuity as described by
André Green and deals as well with triangulations, perversity
and boundaries, boundaries and time, and pathological role fixation.
In “Superego Functions,” Kernberg suggests that “the
couple as an entity also activates both partners’ conscious
and unconscious superego functions, resulting in the couple’s
acquiring, over time, a superego system of its own in addition to
its constituent ones.” In a section on mild superego pathology,
Kernberg mechanically and without apparent evidence (to me, at least)
introduces into the case history of a couple the notion of a wife’s
oedipal guilt, as opposed to considering her unconscious awareness
of what underlay her idealization of her father. In concluding that
her husband “felt that a bad marriage was a fair price to pay
for that success, which unconsciously represented triumph over his
father,” Kernberg again takes oedipal guilt for granted. Perhaps
this presumption of the existence of oedipal factors is consistent
with Kernberg’s preference to retain drive theory.
“Love and the Analytic Setting” is densely theoretical.
Kernberg here deals with transference love and countertransference
and concludes with an extended clinical illustration. He states
that
the analyst’s tasks include refraining from communicating
his or her countertransference to the patient so as to ensure
his internal freedom to fully explore his feelings and fantasies,
and integrating the understanding of his countertransference he
has gained with the formulation of transference interpretations
in terms of the patient’s unconscious conflicts. (p120)
Kernberg offers an excellent case example to illustrate how his
use of his countertransference elucidates the patient’s difficulties:
My fantasies about sadomasochistic sexual interactions also replicated
mens’ aggressive behaviour towards her, which she had unconsciously
tended to induce in them. My fantasies culminated in the clear
recognition that she would relentlessly provoke situations that
frustrated her dependency needs and angry recriminations, escalating
to violent interactions and public displays of depression and
rage. She would present herself as my victim, which would unfailingly
destroy our relationship. (p 124)
Kernberg adds that he
realized in retrospect that my resistance to exploring countertransference
fantasies had prevented me from following them in a direction
that would have clarified the masochistic self-destructiveness
of Ms. A’s erotic wishes towards me. (p 125)
He continues,
My unconscious counter-identification with her seductive father
interfered with my freedom to explore my erotic countertransference
and thereby to perceive more clearly the masochistic pattern in
the transference. I also think that my resistance against unconscious
sadomasochistic impulses of my own role responsiveness to Ms.
A played a part. (p 125)
“Masochistic Pathology” provides a general overview of
masochism, distinguishes between masochism in men and in women,
and elaborates on masochistic love relationships, ending with a
section on transference developments. “Narcissism” describes
the characteristics of narcissistic love relations and provides
2 clinical illustrations. Kernberg expands on the dynamics of narcissistic
pathology:
Of central importance in the unconscious conflicts is preoedipally
determined envy—that is, a specific form of rage and resentment
against a needed object that is experienced as frustrating and
withholding developing in response to this suffering is a conscious
or unconscious wish to destroy, to spoil, to appropriate by force
what is being withheld—specifically, what is most admired
and wished for. The tragedy of the narcissistic personality is
that angry appropriation and greedy extraction of what is denied
and envied do not lead to satisfaction because the unconscious
hatred of what is needed spoils what is incorporated; the subject
always ends up feeling empty and frustrated.
(p 151)
This is a good example of Kernberg at his most lucid and terse.
“Latency, Group Dynamics, and Conventionality” deals
with the couple and the group. Kernberg comments on mass psychology
and mass culture, the conventional film, erotic art in film, and
the pornographic film. Regarding eroticism, what he concludes from
film is particularly interesting. “The Couple and the Group”
deals with adolescent groups and couples and adult couples’
external challenge from the environment.
To summarize, this book was not always easy to read, but given
its brevity, it contains a wealth of theoretical and clinical wisdom
and merits rereading. I recommend it to all psychiatrists and other
mental health professionals with an interest in psychodynamic psychotherapy
and psychoanalysis.
References
1. Dicks HV. Marital tensions. New York: Basic Books;
1967.
2. Kernberg OF. Melanie Klein. In Kaplan MI, Freedman
AM, Sadok BJ, editors. Comprehensive Textbook of Psychiatry. Volume
III. Baltimore (MD): Willaims and Wilkins; 1980. p 82.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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