THE MASTERSON GROUP, P.C.

Psychoanalytic Psychotherapy
of the Personality Disorders

Descriptions of Books by James F. Masterson, M.D.

THE PERSONALITY DISORDERS: A New Look at the Developmental Self and Object Relations Approach - Theory, Diagnosis, Treatment

In this extraordinary book, James Masterson, M.D., pioneer of the developmental self and object relations approach to the personality disorders, has stopped to look both backward and forward - to appraise how ideas of his first set down a quarter of a century ago have stood the test of time, and to illuminate where the field still needs to go.

The book is divided into three broad sections: theory, differential diagnosis, and treatment. Throughout, case examples lend richness and clarity to the presentation. In the opening section, Masterson examines the role of the mother in the development of both the normal self and the Borderline Personality Disorder. Breakthroughs in infant development, attachment theory, and the neurobiology of the self are all brought to bear. How, Masterson asks, does minimizing or denying the role of the mother in the development of the borderline patient's intrapsychic structure affect treatment? Here, Masterson compares his own views with those of such theorists as Kernberg, Kohut, Adler, Gunderson, and Meissner.

In the middle section, Masterson looks at the diagnosis of the personality disorders, describing both the limitations of a descriptive approach, such as that found in the DSM-IV, and the advantages of his own psychodynamic approach. A chapter on differentiating personality disorders from other disorders is followed by a closer look at differential diagnosis in those cases in which the patient's primary defense is a focus on the object. Four case studies presented by faculty members of The Masterson Institute bring to life the nuances of diagnosis in these difficult cases where an incorrect diagnosis can easily lead to treatment failure.

In the final section, Masterson takes an in-depth look at the task of helping clients work through dissociative narcissistic defenses against a neurosis. A complete report of the six-year therapy with a patient with a closet narcissistic defense against a neurosis reveals both the important differences in content between a pre-Oedipal abandonment depression and a later Oedipal conflict and also the differing treatment demands. This section concludes with a broader look at the diagnosis and treatment of relationship dilemmas in patients notorious for their difficulties with intimacy.

Patients considered untreatable 50 years ago are now able to remake their lives," writes Masterson. "But still there is no universally accepted consistent dynamic definition of the disorders and their treatment." Aiming to finish the project he pioneered more than two decades ago, in his latest work, James Masterson attempts to fill that need for a coherent, focused, and contemporary definition of the personality disorders.

From the vantage point of almost a half century in the field, he reexamines his developmental self and object relations approach - showing where ideas of his first set down 25 years ago have stood the test of time - and where they have undergone revision in light of new discoveries. Among the provocative questions explored in The Personality Disorders:

How have views of the mother's role in the development of the normal self evolved over the last 25 years?

What is the basis of Stern and the attachment theorists' challenge to Margaret Mahler's theory - and, at the end of the day, is her theory to be modified or discarded?

How does the work of A.N. Schore on the neurobiology of the self contribute to this question?

And, finally, which developmental theorist's perspective is appropriate for the treatment of which personality disorder?

As we approach the millennium, this important work shows both the enormous progress made in the differential diagnosis and treatment of what were not so long ago the most intractable disorders of the self - and the work that remains to be done.

The Personality Disorders stands as a stunning testimony to the power of the Masterson approach to this difficult, but thanks in large measure to his own contributions, no longer intractable family of disorders. Readers throughout the field will benefit from Masterson's decision to pause at the quarter-century mark and reflect on his enduring contributions.


Quote from book:

"It doesn't seem fair. I had a perfectly stable childhood and yet I'm not able to deal with people." (--from p. 137) muses one patient diagnosed with a narcissistic personality disorder. Wryly observing in a later chapter that "the clinical picture is never as clear as our theories," (from p. 234) Masterson mines fresh insights from such core topics as the mother's role in personality development, self-activation, separation anxiety / abandonment depression, and defense mechanisms. In contrast to DSM-IV's 11 personality disorders, he identifies four categories - borderline, narcissistic, antisocial, and paranoid schizoid - whose subtypes range from "compulsive borderline" to "closet narcissist." Cases throughout, including a meticulously detailed one spanning three chapters, bring theoretical rumination to real life.

Behavioral Science Book Service Review

From the accomplished author of The Real Self, The Emerging Self, and Disorders of the Self, here is an immensely rewarding new book on personality disorders - theory, diagnosis and treatment.

Some 25 years since his pioneering paper on treating boarderline adolescents, James Masterson builds on an evolving developmental self and objects relations approach to personality disorders, or what Dr Masterson refers to as the "disorders of the self". "Making self the central focus," he explains, "provides an architecture of the patient's inner emotions, effective state, and the self and object representations linked with that effective state, while also defining the defense mechanisms and ego functions associated with that state. It tells you what emotion is on center stage."
--from p. 59

In sum, THE PERSONALITY DISORDERS exemplifies the unique potential of a psychodynamic approach for reaching beyond symptom resolution to achieve genuine intrapsychic change.