Dear Colleagues,
On March 15, 2025, the 4th workshop of Module II in the One-Year Training Program: Personality Disorders led by Otto Kernberg, MD took place.
This workshop focused on Obsessive-compulsive disorder and included:
1. Two lectures with a total duration of 2 hours and 30 minutes. Key topics included:
- Obsessive-Compulsive Personality Disorder: Key Concepts and Clinical Perspectives
- Definition of obsessive-compulsive personality disorder (OCPD)
- Differetiation between obsessive-compulsive disorder (OCD) and obsessive-compulsive personality structure
- Typical symptoms of OCD
- Behavioral patterns and maladaptive thought processes in OCD
- Underlying mechanisms in OCD patients:
- Repetitive behaviors
- Rituals
- Obsessive thoughts
- Collecting and hoarding
Clinical case examples illustrating these behaviors
- Differential diagnosis of OCD from Tourette syndrome, onychophagia, and trichotillomania
- Why it is crucial to differentiate OCD from OCPD
- Freud’s perspective on obsessive-compulsive personality disorder
- Core characteristics of OCPD:
- Functioning of the Superego
- Interpersonal Dynamics
- Affective Experience
- Emotional Expression
- Moral Standards and Ethical Rigidity
- Additional Psychological and Behavioral Characteristics
- Differentiating Obsessive-Compulsive Personality Disorder from Narcissistic Personality Disorder: A Clinical Case from Dr. Otto Kernberg’s Practice
- Interpersonal Relationships in Obsessive-Compulsive Personality Disorder
- Attitudes Toward Time and Financial Matters in OCPD
- Freud’s Perspective: Typical Stages of OCPD
- Etiology of OCPD Symptoms: Clinical Example
- Characteristics of Sexual Impulses in OCPD
- The Importance of Analyzing Patient Fears
- Transference Dynamics in Narcissistic Personality Organization (NPD) and Obsessive-Compulsive Personality Disorder (OCPD)
- Manifestations of OCPD in Transference
- Treatment of OCPD: Simple and Complex Cases
- Differences in the Treatment of NPO and OCPD
- Differentiating OCPD from:
– Narcissistic Personality Disorder
– Histrionic Personality Disorder
– Schizoid Personality Disorder
– Hypochondriacal Personality Disorder
– Histrionic Personality Disorder
- Clinical Cases Illustrating the Differential Diagnosis of OCPD
- Prognosis of OCPD Treatment
Dr. Otto Kernberg provided a clear and precise distinction between obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD), outlining the defining characteristics of each. His structured approach enhances the clarity of differential diagnosis, making the distinction between these conditions more comprehensible.
By presenting clinical cases from his own practice, Dr. Kernberg reinforced participants’ understanding of OCPD, offering concrete examples that illustrate its manifestations and diagnostic complexities.
2. Practical Section – Public Clinical Supervision with a total duration of 1 hour and 30 minutes:
During the supervision, we reviewed one of two cases of prolonged therapy, which allows workshop participants to learn the key aspects of psychotherapeutic work through clinical examples. The supervision illustrates all the technical aspects of effective psychotherapy, such as:
– Technical neutrality
– Containment
– Clarification technique
– Interpretation, etc.
These are fundamental psychotherapeutic techniques that Dr. Otto Kernberg uses in his work with patients and teaches our participants during the workshops.
Dr. Otto Kernberg teaches us to explore every aspect of our patients' lives and precise interventions on how to tactfully yet directly clarify key issues with the patient during therapy.
This time, Dr. Otto Kernberg’s interventions focused on:
- Analyzing the patient's personal and sexual life
- Examining the patient’s professional relationships
- The patient's motives for therapy
- The therapist's motives for conducting treatment
- Assessing the patient's transference dynamics
Analysis of dominant object relationship dyads
Additionally, he discussed strategies for shifting away from a structured dialogue format—where the therapist directs the conversation through questions—toward an approach based on free association.
3.Question and Answer Session:
This part of the workshop brings together the most interesting and diverse questions from participants, along with thorough responses from Dr. Otto Kernberg, who often enriches his answers with clinical examples from his over 70 years of practice.
This time, the participants asked Dr. Otto Kernberg the following questions:
– What role does differential diagnosis of personality disorder types play in the psychotherapy process?
– Do you always share the patient's diagnosis after conducting a structural interview?
– Post-supervision question: Since narcissistic clients are deeply afraid of humiliation and shame and consistently avoid exposure, could such a direct interpretation of their actions by the therapist be unbearable and evoke intense shame? Could this, in turn, lead to the client discontinuing therapy or failing to attend subsequent sessions?
– Is self-destructive behavior characteristic of a patient with obsessive-compulsive personality disorder as a way of reacting to repressed emotional feelings? In other words, it is acceptable to cause harm to oneself, but not to others, because that is not allowed, it is not socially acceptable, or it is considered wrong, etc.
– Will an obsessive-compulsive therapist be able to conduct psychotherapy with hysterical patients and vice versa.
–Can a patient with Obsessive-Compulsive Disorder (OCD), understood as a neurosis, be treated effectively exclusively with therapy, without medication?
– How can we determine when a patient with Obsessive-Compulsive Disorder (OCD) requires medication and when therapy by itself is sufficient?
– When a patient with obsessive-compulsive disorder begins psychotherapy, how can the therapist determine whether to refer them to a psychiatrist for medication in addition to therapy? What is the threshold for prescribing medication, and in which cases might it not be necessary?
– Therapists sometimes have to conduct sessions online. Do you have any recommendations for online sessions to ensure a proper therapeutic relationship and that transference and countertransference are used correctly?
– and other questions.
This time, there were an exceptionally large number of questions, but this did not prevent Otto Kernberg from providing deep and structured answers to each of them.
This workshop is part of Module II of the training program and is already available for viewing in video recording.
Sincerely,
Ukrainian Institute for Personality Disorders Studies