Psychoanalytic Diagnosis Understanding Personality Structure in the Clinical Process

by McWilliams, Nancy

• ISBN13: 9780898621990
• ISBN10: 0898621992
• Edition: 1st
• Format: Hardcover
• Copyright: 1994-04-15
• Publisher: The Guilford Press

Summary

This is the first text to come along in many years that makes psychoanalytic personality theory and its implications for practice accessible to beginning practitioners. The last book of its kind, which was published more than 20 years ago, predated the development of such significant concepts as borderline syndromes, narcissistic pathology, dissociative disorders and self-defeating personality. Contemporary students often react with bewilderment to the language of pioneering analysts like Reich and Fenichel and, since 1980, the various volumes of the Diagnostic and Statistical Manual of Mental Disorders (DSM) have reflected an empirical-descriptive orientation that deliberately eschews psychodynamic assumptions. Consequently, today's therapist in training may have little exposure to the rich clinical and theoretical history behind each disorder mentioned in DSM; to psychoanalytic expertise with widely recognized character patterns not mentioned in DSM, such as depressive and hypomanic psychologies, high-functioning schizoid personalities, and hysterical personalities; or to a comprehensive, theoretically sophisticated rationale that links assessment to treatment. Filling the need for a text that clearly lays out the conceptual heritage that psychoanalytic practitioners take for granted, this important new volume explicates the major clinically important character types and suggests how an appreciation of the patients' individual personality structure should influence the therapist's focus and style of intervention. Dispensing with the dense jargon that often discourages people from learning, Nancy McWilliams writes in a lucid, personal manner that demystifies psychodynamic theory and practice. Innumerable clinical vignettes are presented with humor, candor, and compassion, bringing abstract concepts to life. Comprehensive in scope, Psychoanalytic Diagnosis will be valued by seasoned clinicians and students alike. Psychodynamically oriented readers will find it an excellent introduction to psychoanalytic diagnostic thinking. For those identified with other approaches, it will foster psychoanalytic literacy, providing them with the capacity to better understand the approaches of their analytically oriented colleagues.

Author Biography

Nancy McWilliams, PhD, teaches psychoanalytic theory and therapy at the Graduate School of Applied and Professional Psychology at Rutgers\m-\The State University of New Jersey. A senior analyst with the Institute for Psychoanalysis and Psychotherapy of New Jersey and the National Psychological Association for Psychoanalysis, she has a private practice in psychodynamic therapy and supervision in Flemington, New Jersey. Her previous book, [ital]Psychoanalytic Diagnosis[/ital] has become a standard text in many training programs for psychoanalysts, both in the United States and abroad. She has also authored articles and book chapters on personality, psychotherapy, psychodiagnosis, sexuality, feminism, and contemporary psychopathologies.

Table of Contents

Introduction	1	(1)
A Comment on Terminology	1	(3)
A Comment on Tone	4	(1)
I CONCEPTUAL ISSUES	5	(140)
Why Diagnose?	7	(12)
Treatment Planning	8	(1)
Prognostic Implications	9	(1)
Consumer Protection	10	(2)
The Communication of Empathy	12	(2)
Forestalling Flights From Treatment	14	(1)
Fringe Benefits	15	(2)
Limits to the Utility of Diagnosis	17	(1)
Suggestions for Further Reading	18	(1)
Psychoanalytic Character Diagnosis	19	(21)
Classical Freudian Drive Theory	21	(4)
Ego Psychology	25	(4)
The Object Relations Tradition	29	(5)
Self Psychology	34	(3)
Other Psychoanalytic Contributions to Personality Assessment	37	(1)
Summary	38	(1)
Suggestions for Further Reading	38	(2)
Developmental Levels of Personality Organization	40	(27)
Historical Context: Diagnosing Level of Character Pathology	42	(1)
Kraepelinian Diagnosis: Neuroses Versus Psychoses	43	(2)
Ego Psychology Diagnostic Categories: Symptom Neurosis, Neurotic Character, and Psychosis	45	(4)
Object Relations Diagnosis: Borderline Psychopathology	49	(4)
Specific Dimensions of a Neurotic-Borderline-Psychotic Spectrum	53	(12)
Summary	65	(1)
Suggestions for Further Reading	65	(2)
Clinical Implications of Developmental Levels of Organization	67	(29)
Psychoanalytic Therapy with Neurotic-Level Patients	69	(3)
Psychoanalytic Therapy with Psychotic-Level Patients	72	(8)
Psychoanalytic Therapy with Borderline Patients	80	(11)
Interaction of Maturational and Typological Dimensions of Character	91	(3)
Summary	94	(1)
Suggestions for Further Reading	94	(2)
Primary (Primitive) Defensive Processes	96	(21)
Primitive Withdrawal	100	(1)
Denial	101	(2)
Omnipotent Control	103	(2)
Primitive Idealization (and Devaluation)	105	(2)
Projection, Introjection, and Projective Identification	107	(5)
Splitting of the Ego	112	(2)
Dissociation	114	(1)
Summary	115	(1)
Suggestions for Further Reading	116	(1)
Secondary (Higher-Order) Defensive Processes	117	(28)
Repression	118	(2)
Regression	120	(2)
Isolation	122	(1)
Intellectualization	123	(1)
Rationalization	124	(1)
Moralization	125	(2)
Compartmentalization	127	(1)
Undoing	127	(2)
Turning Against the Self	129	(1)
Displacement	130	(1)
Reaction Formation	131	(2)
Reversal	133	(2)
Identification	135	(3)
Acting Out	138	(2)
Sexualization (Instinctualization)	140	(2)
Sublimation	142	(2)
Summary	144	(1)
Suggestions for Further Reading	144	(1)
II TYPES OF CHARACTER ORGANIZATION	145	(204)
Rationale for Chapter Organization	145	(2)
Character, Character Pathology, and Situational Factors	147	(1)
Limits on Personality Change	148	(3)
Psychopathic (Antisocial) Personalities	151	(17)
Drive, Affect, and Temperament in Psychopathy	152	(1)
Defensive and Adaptive Processes in Psychopathy	153	(2)
Object Relations in Psychopathy	155	(2)
The Psychopathic Self	157	(2)
Transference and Countertransference with Psychopathic Patients	159	(1)
Therapeutic Implications of the Diagnosis of Psychopathy	160	(5)
Differential Diagnosis	165	(2)
Summary	167	(1)
Suggestions for Further Reading	167	(1)
Narcissistic Personalities	168	(21)
Drive, Affect, and Temperament in Narcissim	171	(2)
Defensive and Adaptive Processes in Narcissim	173	(1)
Object Relations in Narcissism	174	(3)
The Narcissistic Self	177	(1)
Transference and Countertransference with Narcissistic Patients	178	(3)
Therapeutic Implications of the Diagnosis of Narcissim	181	(3)
Differential Diagnosis	184	(3)
Summary	187	(1)
Suggestions for Further Reading	188	(1)
Schizoid Personalities	189	(16)
Drive, Affect, and Temperament in Schizoid Personalities	190	(2)
Defensive and Adaptive Processes in Schizoid Personalities	192	(1)
Object Relations in Schizoid Conditions	193	(2)
The Schizoid Self	195	(2)
Transference and Countertransference with Schizoid Patients	197	(2)
Therapeutic Implications of the Diagnosis of Schizoid Personality	199	(3)
Differential Diagnosis	202	(2)
Summary	204	(1)
Suggestion for Further Reading	204	(1)
Paranoid Personalities	205	(22)
Drive, Affect, and Temperament in Paranold Personalities	207	(2)
Defensive and Adaptive Processes in Paranoia	209	(2)
Object Relations in Paranoia	211	(3)
The Paranoid Self	214	(2)
Transference and Countertransference with Paranoid Patients	216	(1)
Therapeutic Implications of the Diagnosis of Paranoia	217	(7)
Differential Diagnosis	224	(1)
Summary	225	(1)
Suggestions for Further Reading	226	(1)
Depressive and Manic Personalities	227	(30)
Depressive Personalities	228	(1)
Drive, Affect, and Temperament in Depression	229	(2)
Defensive and Adaptive Processes in Depression	231	(2)
Object Relations in Depression	233	(4)
The Depressive Self	237	(2)
Transference and Countertransference with Depressive Patients	239	(2)
Therapeutic Implications of the Diagnosis of Depression	241	(5)
Differential Diagnosis	246	(2)
Manic and Hypomanic Personalities	248	(1)
Drive, Affet, and Temperament in Mania	248	(1)
Defensive and Adaptive Processes in Mania	249	(1)
Object Relations in Mania	250	(1)
The Manic Self	250	(1)
Transference and Countertransference with Manic Patients	251	(1)
Therapeutic Implications of the Diagnosis of Mania or Hypomania	251	(2)
Differential Diagnosis	253	(2)
Summary	255	(1)
Suggestions for Further Reading	256	(1)
Masochistic (Self-Defeating) Personalities	257	(22)
Drive, Affect, and Temperament in Masochism	260	(1)
Defensive and Adaptive Processes in Masochism	261	(3)
Object Relations in Masochism	264	(3)
The Masochistic Self	267	(1)
Transference and Countertransference with Masochistic Patients	268	(3)
Therapeutic Implications of the Diagnosis of Masochism	271	(4)
Differential Diagnosis	275	(2)
Summary	277	(1)
Suggestions for Further Reading	277	(2)
Obsessive and Compulsive Personalities	279	(22)
Drive, Affect, and Temperament in Obsessive and Compulsive Personalities	281	(2)
Defensive and Adaptive Processes in Obsessive and Compulsive Personalities	283	(3)
Object Relations in Obsessive and Compulsive Personalities	286	(3)
The Obsessive Compulsive Self	289	(3)
Transference and Countertransference with Obsessive and Compulsive Patients	292	(2)
Therapeutic Implications of the Diagnosis of Obsessive or Compulsive Personality	294	(4)
Differential Diagnosis	298	(2)
Summary	300	(1)
Suggestions for Further Reading	300	(1)
Hysterical (Histrionic) Personalities	301	(22)
Drive, Affect, and Temperament in Hysteria	303	(1)
Defensive and Adaptive Processes in Hysteria	304	(4)
Object Relations in Hysteria	308	(2)
The Hysterical Self	310	(3)
Transference and Countertransference with Hysterical Patients	313	(3)
Therapeutic Implications of the Diagnosis of Hysteria	316	(2)
Differential Diagnosis	318	(3)
Summary	321	(1)
Suggestions for Further Reading	322	(1)
Dissociative Personalities	323	(26)
Drive, Affect, and Temperament in Dissociative Conditions	328	(1)
Defensive and Adaptive Processes in Dissociative Conditions	329	(3)
Object Relations in Dissociative Conditions	332	(2)
The Dissociative Self	334	(2)
Transference and Countertransference with Dissociative Patients	336	(2)
Therapeutic Implications of the Diagnosis of a Dissociative Condition	338	(4)
Differential Diagnosis	342	(4)
Summary	346	(1)
Suggestions for Further Reading	346	(3)
Appendix: Suggested Diagnostic Interview Format	349	(4)
Demographic Data	349	(1)
Current Problems and Their Onset	349	(1)
Personal History	349	(1)
Current Presentation (Mental Status)	350	(1)
Concluding Topics	350	(1)
Inferences	351	(2)
References	353	(28)
Author Index	381	(5)
Subject Index	386