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personality disorder is characterized, in fact, by the lack of identity integration or the syndrome of identity diffusion, the permanence of predominant primitive defensive operation centering around splitting, and certain limitations in reality testing in terms of deficits in the subtle aspects of interpersonal functioning. Psychoanalytic object relations theory proposes that the shift from borderline personality organization to neurotic and normal personality organization also corresponds to a shift from the predominance of primitive defensive operations to advanced defensive operations centering on repression and its related mechanisms, including a higher level of projection, negation, intellectualization, and reaction formations. This advanced level of development is reflected in a clear delimitation of a repressed, dynamic unconscious, or “Id,” constituted by unacceptable internalized dyadic relationships reflecting intolerable primitive aggression and aspects of infantile sexuality. The ego now includes the integrated, conscious self-concept, and the representations of significant others, together with the development of sublimatory functions reflected in the adaptive expression of affective, emotional needs regarding sexuality, dependency, autonomy, and aggressive self-affirmation. Internalized object relations that include ethically derived demands and prohibitions transmitted in the early interactions of the infant and child with his psychosocial environment, particularly the parents, are integrated into the “super – ego”. This latter structure is constituted by layers of internalized prohibitions and idealized demands, significantly transformed into a personified, abstracted, and individualized system of personal morality (Kernberg, 2012a, b; Kernberg, 2004)). Kernberg’s contemporary synthetic work (Kernberg, 2015) includes correlating neurobiological underpinnings of such developmental and pathogenic conflictual configurations. “A general conclusion relates to the parallel and mutually influential development of neurobiological affective and cognitive systems, ultimately controlled by genetic determinants, and psychodynamic systems, ultimately corresponding to both reality and motivated distortions of the internal and external relations…” (Kernberg, 2015, p. 38). The general assumption within this theory is that patients with borderline personality organization present with predominance of the aggressive, persecutory segment of early experience, whatever its origin, which prevents identity integration. An analytic treatment geared to achieve identity integration will permit the integration of the concept of self, thus increasing cognitive control; it would integrate the concept of others, thus normalizing social life, and integrate the experience of contradictory affects, leading to affect modulation and reduction of impulsivity. With these assumptions, the strategy of Transference Focused Psychotherapy consists in clarifying the object relations activated in the treatment situation (the transference), at each affectively dominant point, both regarding positive and negative experiences. This facilitates the patient’s tolerance and awareness of conflicting mental states. By means of clarification and ultimately interpretation of mental states, which have been dissociated under conditions of the dominant splitting operations, mentalization is fostered. In the treatment situation, the activation of split-off object relations tend to produce “role reversals” in the transference; in other words, interchange of roles of self and object in the patient’s experience of his relationship with the therapist. This process permits the patient
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