The Empty Core: An Object Relations Approach to Psychotherapy of the Schizoid Personality

This book is about the psychodynamics and treatment of schizoid disorders. These patients are pervasive in psychotherapeutic practice, but are often misdiagnosed as neurotic, borderline, or narcissistic. Far more attention is devoted in the literature to the narcissistic and borderline conditions than to this most common of the personality disorders.
Schizoid patients go through the motions of daily living, but superficially, like robots, without any zest or enthusiasm. They may be involved in ongoing relationships and social situations, but they do not experience the joy or pain of living because a crucial part of their feelings has been radically repressed and isolated from their central personality. They have split off the emotional hunger for love, care, and contact, and at the heart of the personality there is a core of emptiness. The hunger for love, first felt as a vital, fleeting need, becomes a constant state of mind as it remains unmet. This state of mind is split off from the remaining personality, and gradually its needs are extinguished. The active emptiness of hunger becomes a frozen, static, lifeless emptiness. Thus, schizoid patients experience a death-in-life and a pervasive, compulsive conflictual hunger for things: food, drugs, sex, money, admiration, or tyranny over others to fill the empty core. They go through life as the living dead, hungering for things, as the vampire thirsts for blood to keep itself going.
In treatment, these patients go through the motions of therapy without genuine involvement. Initially, therapists often mistake them for easy patients because they do not make inordinate demands. The therapist may forget to discuss the patient in supervision or never think of him between sessions. Dr. Seinfeld poignantly describes the apathy that gradually pervades the therapeutic relationship. A profound fear of rejection and merger underlies the patient's seeming indifference to the therapist, and the patient may drop out after a small mistake or a therapeutic lapse in empathy.
Dr. Seinfeld shows how the therapist can engage these patients while avoiding the common therapeutic pitfalls. The book delineates the phases of the treatment process and presents clear guidelines for intervention, which requires exquisite timing and precision. With extensive clinical vignettes, Dr. Seinfeld guides the reader in reaching the lost, empty heart of the schizoid personality.