Psychodynamic Formulation PDF
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Psychodynamic Formulation Psychodynamic Formulation By Deborah L. Cabaniss and Sabrina Cherry Carolyn J. Douglas Ruth L. Graver Anna R. Schwartz ColumbiaUniversity,DepartmentofPsychiatry,NewYork,USA A John Wiley & Sons, Ltd., Publication Thiseditionfirstpublished2013,©2013byJohnWiley&SonsLtd. Wiley-BlackwellisanimprintofJohnWiley&Sons,formedbythemergerofWiley’sglobalScientific,Technicaland MedicalbusinesswithBlackwellPublishing. Registeredoffice: JohnWiley&Sons,Ltd,TheAtrium,SouthernGate,Chichester,WestSussex,PO198SQ,UK Editorialoffices: 9600GarsingtonRoad,Oxford,OX42DQ,UK TheAtrium,SouthernGate,Chichester,WestSussex,PO198SQ,UK 2121StateAvenue,Ames,Iowa50014-8300,USA Fordetailsofourglobaleditorialoffices,forcustomerservicesandforinformationabouthowtoapplyforpermissionto reusethecopyrightmaterialinthisbookpleaseseeourwebsiteatwww.wiley.com/wiley-blackwell. TherightoftheauthortobeidentifiedastheauthorofthisworkhasbeenassertedinaccordancewiththeUK Copyright,DesignsandPatentsAct1988. 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LibraryofCongressCataloging-in-PublicationData Psychodynamicformulation/byDeborahL.Cabaniss...[etal.]. p.;cm. Includesbibliographicalreferences. ISBN978-1-119-96234-2(cloth) I.Cabaniss,DeborahL. [DNLM:1.MentalDisorders–diagnosis.2.MentalDisorders–therapy.3.PatientCarePlanning.4.Psychoanalytic Therapy–methods.WM141] 616.89–dc23 2012047255 AcataloguerecordforthisbookisavailablefromtheBritishLibrary. Wileyalsopublishesitsbooksinavarietyofelectronicformats.Somecontentthatappearsinprintmaynotbeavailable inelectronicbooks. Coverimage:NickiAverillDesign&Illustration CoverdesignbyNickiAverillDesign&Illustration Setin10/12PalatinobyLaserwordsPrivateLimited,Chennai,India. 12013 For our families: Thomas, William and Daniel Marc, Rebecca and Ruth Jon, William and Ben Michael, Sam and Jacob Eric, Lena and Maia ThisbookmaybeseenasacompaniontoPsychodynamicPsychotherapy:Aclinical manual.Fordetails,seewww.wiley.comorscanthisQRcode: Contents Acknowledgments ix Introduction xi PART ONE Introduction to the Psychodynamic Formulation 1 1 What is a Psychodynamic Formulation? 3 2 How do We Use Psychodynamic Formulations? 8 3 How do We Construct a Psychodynamic Formulation? 12 PART TWO DESCRIBE 17 4 Self 23 5 Relationships 32 6 Adapting 41 7 Cognition 52 8 Work and Play 61 Putting it Together – A Description of Problems and Patterns 69 PART THREE REVIEW 75 9 What We’re Born with – Genetics and Prenatal Development 81 10 The Earliest Years 90 11 Middle Childhood 101 12 Later Childhood, Adolescence, and Adulthood 113 Putting it Together – A Developmental History 123 viii CONTENTS PART FOUR LINK 135 13 Trauma 143 14 Early Cognitive and Emotional Difficulties 152 15 Conflict and Defense 163 16 Relationships with Others 173 17 The Development of the Self 182 18 Attachment 191 Putting it Together–A Psychodynamic Formulation 201 PART FIVE Psychodynamic Formulations in Clinical Practice 213 19 Psychodynamic Formulations in Acute Care Settings 215 20 Psychodynamic Formulation in Pharmacologic Treatment 222 21 Psychodynamic Formulation in Long-Term Psychodynamic Psychotherapy: Revising Over Time 230 22 Sharing Formulations with Our Patients 238 Epilogue 247 Appendix – How to UsePsychodynamicFormulation: A Guide for Educators 249 Recommended Reading 253 Index 259 Acknowledgments Constructingapsychodynamicformulationisonething,buttryingtoteachsomeone elsetoconstructoneissomethingelseentirely.It’sliketryingtoteachsomeonetotiea shoe.Youknowhowtodoit,butwhatarethesteps?Howdoyouputthingstogether? Whatdoyouhavetoknowinordertodoit?ThisiswhatmycoauthorsandItried tofigureout.TheresultisourDESCRIBE/REVIEW/LINKmethodandacurriculum thathelpsstudentslearnwhypsychodynamicformulationsareimportantandhow to construct them from the bottom up. Along the way, Sabrina Cherry and I wrote formulationsanddiscussedourthoughtprocessovercountlessphonecalls;Carolyn Douglashelpedtokeepusbalancedbetweennatureandnurture;RuthGraverhelped to devise a wonderful, dimensional way to describe function; and Anna Schwartz reminded us of the centrality of trauma and the utility of formulations in multiple settings. Both Psychodynamic Psychotherapy: A Clinical Manual and Psychodynamic Formulationwouldnotbewhattheyareifnotforthisincredibleteamofwomenwho are outstanding clinicians, educators, and writers. I am, as ever, grateful for their time,effort,creativity,andfriendship. The beta version of this book was road-tested by our terrific Columbia residents, and I thank them for putting up with early drafts riddled with typos. Having the opportunity to teach them day in and day out, year after year, keeps us asking the importantquestionsabouteducation.IowemanythankstoJustinRichardson,who helped me to conceptualize new ways of teaching formulation and with whom I taughtfor5years.DavidGoldberg,DeborahKatz,andVolneyGayareworld-class psychodynamics educators whom I have come to rely on for their wisdom and guidance–eachofthemcarefullyreadtheentiremanuscriptandgaveusinvaluable comments that helped us to shape the final product. Sarah Paul offered insightful commentsaswell.StevenRoosekeptmeontracktothinkaboutfunctionratherthan disorders,andRogerMacKinnonmadesurethatpsychodynamicformulationwould alwaysbeacentralpartofpsychiatrictrainingatColumbia.JoanMarsh,oureditor atWiley,hasbecomeafriendandIamgratefulforherenthusiasmaboutourwork. MariaOquendoandMelissaArbucklecontinuetosupportourteachingatColumbia, withoutwhichnoneofthiswouldbepossible. I’d also like to thank the many students and educators who are using and enjoy- ing Psychodynamic Psychotherapy: A Clinical Manual. The overwhelmingly positive response we got to the Manual energized us write this companion volume. We are delightedthatithashelpedtomakepsychodynamictechniquemoreunderstandable, andwehopethatthisbookdoesthesameforpsychodynamicformulation. x ACKNOWLEDGMENTS Olderandwiserthantheywerewhenwewrotethefirstbook,mychildrenWilliam andDanielarenowresignedtotheideathattheirmomlikeswritingonnightsand weekends.IknowthattheyareproudofmeandoftheworkI’mdoing.Theywillbe readytoeditthenextbook.And,onceagain,Thomasreadeveryword–sometimes twice–andkeptthefaithevenwhenIdidn’t.Icouldn’tdoanyofitwithouthim. DeborahL.Cabaniss NewYork September2012 Introduction WhenwelookupattheRockyMountains,weseesomeofthemostbeautifulscenery onEarth.Ifaskedtodescribeit,wecouldwaxpoeticaboutthesnowcappedpeaks, alpinemeadows,andcraggyravines.That’swhattheyarenow–that’swhatwesee. But how did the Rockies get to be the Rockies? How did they form? To figure that out, geologists have used information gathered from the rocks themselves, as well as theories about plate tectonics, to hypothesize that the Rockies arose when two continentalplatescollided.NooneonEarthsawthishappen–infact,noonehasever seenatectonicplate.However,theevidenceisgoodthatforcesmovingbeneaththe Earth’ssurfacemillionsofyearsagoledtotheformationofoneofthemostbeautiful places on the globe. These subterranean forces, in addition to millions of years of rain, snow, ice, and wind, made the Rockies what they are today. This hypothesis helps us understand the history of our planet and predict the way the Earth will continuetochangeinresponsetoforcesworkingbelowandabovethesurface. When we meet adult patients, we see what they are like now. We hear their speech, observe their behaviors, and listen to their ideas. But how did they come to be the way they are? What forces shaped them? Like geologists, psychodynamic psychotherapists look beyond the surface for answers to these questions. They hypothesize that people are shaped by forces working both beneath and above the surface over time, and they believe that thinking about how that happened is important for understanding a person’s past, present, and future. Their hypotheses aretheirpsychodynamicformulations,andtheseformulationsareessentialtoevery aspectofthewaytheytreattheirpatients. Students and clinicians are often needlessly daunted by the prospect of creating psychodynamic formulations, wondering how they can learn about subterranean forcesthateventheirpatientscannoteasilyaccess.Whileittakestimeandthought, everycliniciancanlearntoconstructpsychodynamicformulationsusingthreesteps: 1. DESCRIBINGthepatient’sproblemsandpatterns 2. REVIEWINGthepatient’sdevelopmentalhistory 3. LINKING the problems and patterns to the history using organizing ideas aboutdevelopment
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