Psychoanalytic diagnosis: understanding personality structure in the clinical process

449 Pages·2011·1.881 MB·English

by  McWilliams, Nancy

Psychoanalytic Diagnosis

Psychoanalytic
Diagnosis
Understanding Personality structure
in the clinical Process
second edition
nancy McWilliams
The Guilford Press
new york london
© 2011 The Guilford Press
A Division of Guilford Publications, Inc.
72 Spring Street, New York, NY 10012
www.guilford.com
All rights reserved
No part of this book may be reproduced, translated, stored in
a retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, microfilming, recording,
or otherwise, without written permission from the Publisher.
Printed in the United States of America
This book is printed on acid-free paper.
Last digit is print number: 9 8 7 6 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
McWilliams, Nancy.
Psychoanalytic diagnosis : understanding personality structure in the clinical
process / Nancy McWilliams. — 2nd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-60918-494-0 (hardcover : alk. paper)
1. Typology (Psychology) 2. Personality assessment. 3. Personality
development. I. Title.
[DNLM: 1. Personality Disorders—diagnosis. 2. Personality Assessment.
3. Personality Disorders—therapy. 4. Psychoanalytic Therapy.
WM 460.5.P3]
RC489.T95M38 2011
616.89′17—dc22
2011002833
In grateful memory
Howard Gordon Riley
Millicent Wood Riley
Jane Ayers Riley
vi
about the author
Nancy McWilliams, PhD, teaches in the Graduate School of Applied
and Professional Psychology at Rutgers, The State University of New
Jersey, and has a private practice in Flemington, New Jersey. She is a
former president of the Division of Psychoanalysis (39) of the American
Psychological Association and is on the editorial board of Psychoana-
lytic Psychology. Dr. McWilliams’s books have been translated into 14
languages, and she has lectured widely both nationally and internation-
ally. She is a recipient of honors including the Rosalee Weiss Award for
contributions to practice from the Division of Independent Practitioners
of the American Psychological Association; Honorary Membership in
the American Psychoanalytic Association; and the Robert S. Wallerstein
Visiting Scholar Lectureship in Psychotherapy and Psychoanalysis at
the University of California, San Francisco. A graduate of the National
Psychological Association for Psychoanalysis, Dr. McWilliams is also
affiliated with the Center for Psychoanalysis and Psychotherapy of New
Jersey and the National Training Program of the National Institute for
the Psychotherapies in New York City.
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Preface
W
hen I originally wrote Psychoanalytic Diagnosis, I knew
from my experience as a teacher that students and early-career psycho-
therapists needed exposure to the inferential, dimensional, contextual,
biopsychosocial kind of diagnosis that had preceded the era inaugurated
by the 1980 publication of the third edition of the Diagnostic and Statis-
tical Manual of Mental Disorders (DSM-III) of the American Psychiat-
ric Association. In particular, I wanted to keep alive the sensibility that
represented decades of clinical experience and conversation, in which
human beings have been seen as complex wholes rather than as collec-
tions of comorbid symptoms. I also saw how confusing it was, even to
psychodynamically oriented students, to try to master the bewildering
diversity of language, metaphor, and theoretical emphasis that comprises
the psychoanalytic tradition. The need for a synthesis of the sprawling
and contentious history of analytic theory, as it pertains to understand-
ing one’s individual patients, was evident.
In the early 1990s I was also nourishing a faint hope that the book
would have some influence on mental health policy and on our cultur-
ally shared conception of psychotherapy, which were beginning to be
transformed in disturbing ways. No such luck: The breadth and depth of
change since then have been stunning. For a host of interacting reasons,
psychodynamic—and even broadly humanistic (see Cain, 2010)—ways
of understanding and treating people have become devalued, and the
likelihood that a patient with significant character pathology, the hall-
mark of most psychodynamic treatment, will find genuine, lasting help in
the mental health system has, in my view, plummeted. As the cognitive-
behavioral movement continues to develop, some of its practitioners have
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