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Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process

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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- 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.


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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- 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.

30 review for Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process

  1. 4 out of 5

    Thomas

    Starting with the pros of this therapy book, Nancy McWilliams writes with great intelligence about psychoanalytic diagnosis. She breaks down the distinct forms of functioning (e.g., neurotic, borderline, psychotic) and even though I find this form of diagnosis outdated, she makes strong cases for each conceptualization and provides reasonable therapy implications and differential diagnosis commentary. She also considers nuance in her conceptualization and remarks about how other therapeutic orie Starting with the pros of this therapy book, Nancy McWilliams writes with great intelligence about psychoanalytic diagnosis. She breaks down the distinct forms of functioning (e.g., neurotic, borderline, psychotic) and even though I find this form of diagnosis outdated, she makes strong cases for each conceptualization and provides reasonable therapy implications and differential diagnosis commentary. She also considers nuance in her conceptualization and remarks about how other therapeutic orientations view similar phenomena; this openness to other orientations suggests that she cares most about what would benefit clients over sticking to one form of treatment for the sake of it. She included some insights I found personally revelatory and important, such as how we have to mourn relationships we lose or the images of those people take up space in our minds in unhealthful ways, or how children will try to believe themselves as bad to justify why a parent figure would abuse them. I think two areas of this book left me wanting more. First, I found sociocultural awareness lacking in this book in several ways. I wrote down around five to ten examples but just to provide a few: for example, early on in the book she suggests that people trying to change stigmatizing terms is a futile endeavor, such as getting people to stop using the r-word or to stop describing gay people using the f-slur. I found this comment so insensitive and lacking of any nuance for systems of power and how those terms have been used explicitly to oppress marginalized groups, not just to call a phenomenon by a different name. At another point she states that schizoid people are often thin which means that they are removed from their own greed. This statement struck me as offensive because it implies that fat people are greedy, which is fatphobic. Third, she references Freud and hysteria a lot without really naming the sexism Freud enacts. She makes a defense of Freud and argues that Freud actually tried to empower women, and even if her argument possessed some merit, I think naming the damage he has done in regard to pathologizing women and also just the way the term hysteria came about to demean women would have been important. I’m also unsure how I feel about saying that people’s personalities are depressive, schizoid, borderline, etc. as opposed to acknowledging that people can have depression, have borderline personality disorder, etc. Basically, I feel like in some ways this form of diagnosis implies that people are their disorders or their mental health diagnoses, which may be stigmatizing, even if some can take comfort in acknowledging what they are dealing with. From my experience working in this field I also felt that people often experience components from each of these overarching personality areas as opposed to falling neatly into one of them. Though McWilliams I think suggests that people may inhabit more than one personality area, the framework she uses in this book may lead to binary conceptualizations of clients if not utilized with nuance. Overall an interesting book that I will take some insights from even though I’m not primarily a psychoanalytic or psychodynamic therapist. Yay for my first read of 2020 and onto the next.

  2. 4 out of 5

    Elena

    I read this book to learn more about bipolar as I have a friend with this diagnosis. This book was recommended to me by another friend and I was glad I could get my hands on it. Its written in professional language and sometimes it was hard to understand some things, because I'm not a doctor and psychology is just something of an interest of mine. But it answered all my questions. It is a very interesting reading, but be prepared to what you might find out, the author just puts the info out there I read this book to learn more about bipolar as I have a friend with this diagnosis. This book was recommended to me by another friend and I was glad I could get my hands on it. Its written in professional language and sometimes it was hard to understand some things, because I'm not a doctor and psychology is just something of an interest of mine. But it answered all my questions. It is a very interesting reading, but be prepared to what you might find out, the author just puts the info out there as this book is meant for professionals. I really liked the way the book is structured. It not only gives you the description of the outer signs of the diagnosis, but it also gives you the idea of inner life of the person with that diagnosis. Scary. After I finished reading about bipolar, I couldn't help myself and read the rest of the book. And then I read it again, this time with a highlighter and markers. A great read. I will definitely be rereading it from time to time. By the way, after reading this book I talked to a friend of mine, who is a practicing psychiatrist, to see if I understood the information right and to my surprise (I did mention its kinda hard to understand some things in the book) everything I read I understood spot on. It didn't make me feel better though as bipolar is a scary diagnosis, but at least now I understand what my friend is going through on daily basis and can if not help, but ease some of his pain or at least make it easier for him to go through what he's going through.

  3. 5 out of 5

    Deimantė Pruselaitytė

    I took this book from my uni’s library. While reading, I was trying to take in every. single. word. I realised it was impossible so I started taking notes on my phone, which meant rewriting basically every other sentence. Keep in mind that the book itself is HUGE. And so today I was proudly finishing the book when suddenly my phone froze which resulted in my PERMANENTLY deleting thousands of quotes. I had a panic attack and literally wanted to kill myself. This is how good the book is.

  4. 4 out of 5

    Sergey Kochergan

    I read this book to get more knowledge about different types of psychological disorders. This book was recommended at the Personality Profiling training.

  5. 5 out of 5

    Jordan Brooks

    I love Nancy’s writing style. It is completely accessible to clinicians and those not in the field. She takes care to define the context of her thinking and how she defines important diagnostic labels. This is THE reading that helped me solidify my understanding of organization of functioning (differentiating between neurotic, borderline, and psychotic). It just didn’t click until her explanation. I read the 1994 edition and the chapter on paranoia is extremely dated regarding same-sex relations I love Nancy’s writing style. It is completely accessible to clinicians and those not in the field. She takes care to define the context of her thinking and how she defines important diagnostic labels. This is THE reading that helped me solidify my understanding of organization of functioning (differentiating between neurotic, borderline, and psychotic). It just didn’t click until her explanation. I read the 1994 edition and the chapter on paranoia is extremely dated regarding same-sex relationships and I wonder if the 2011 is less pathologizing.

  6. 4 out of 5

    Christian Buckley

    While I may not agree with many aspects of this book, I do recognize that individuals lead with certain personality traits -- and understanding your own individual traits, and learning to recognize the traits of others, is the beginning of personal connection and communication. Good leaders are able to recognize and communicate with each personality trait.

  7. 5 out of 5

    Melanie Kirdasi

    I had ordered this book to write a paper for a class but the book never arrived, luckily I came across the book several months later in the school library. Though it appears studious it is not a dry read. It is a thoughtful and reflective book that shows insight into the patient counselor relationship in a very humanistic way. The disorders that are covered in the book are of the more well known categories that a therapist is likely to encounter with patients but the authors understanding of the I had ordered this book to write a paper for a class but the book never arrived, luckily I came across the book several months later in the school library. Though it appears studious it is not a dry read. It is a thoughtful and reflective book that shows insight into the patient counselor relationship in a very humanistic way. The disorders that are covered in the book are of the more well known categories that a therapist is likely to encounter with patients but the authors understanding of the cognitive framing and emotional processing that her patients experience branch out into a deeper study of the psyche than the table of contents hints at. A very valuable read for anyone in counseling,clinical psychology,or interested in communication with a more refined awareness.

  8. 5 out of 5

    Sydney

    I don't nessecarily agree with everything in this book and I often think that this form of diagnosis is outdated. However, McWilliams is humble, considerate of complexities and nuance, intuitive and insightful in her writing. Admittedly, she writes from her own experience, both personally and with clients. I found her clinical insights and narratives helpful and I loved the chapter that broke down the psychological defenses. I've always loved Anna Freud and McWilliams interpretations really brin I don't nessecarily agree with everything in this book and I often think that this form of diagnosis is outdated. However, McWilliams is humble, considerate of complexities and nuance, intuitive and insightful in her writing. Admittedly, she writes from her own experience, both personally and with clients. I found her clinical insights and narratives helpful and I loved the chapter that broke down the psychological defenses. I've always loved Anna Freud and McWilliams interpretations really bring them to life.

  9. 4 out of 5

    Susanna

    This book is a treasure trove of concepts and ways of understanding the not always logical human mind. And has a warm tone of voice throughout. A bit surprised at how seriously the connection to one’s butt (anal) is taken. The take on hysteric women is also anachronistic, it belongs in the age of cave men, and definitely not in 1996. How can swearing and/or crying while wearing a skirt still be a diagnosis in 2020 (under DSM-V)? However, the book is so rich in empathetic insights that it’s defin This book is a treasure trove of concepts and ways of understanding the not always logical human mind. And has a warm tone of voice throughout. A bit surprised at how seriously the connection to one’s butt (anal) is taken. The take on hysteric women is also anachronistic, it belongs in the age of cave men, and definitely not in 1996. How can swearing and/or crying while wearing a skirt still be a diagnosis in 2020 (under DSM-V)? However, the book is so rich in empathetic insights that it’s definitely worth reading even if you don’t agree on all of it.

  10. 5 out of 5

    Jessica

    As a training psychiatrist, I will summarize my analysis of this clinical compendium of personality structure through a clinical lens as follows: Aghhhhhhhhhhhhh 😍😍😍😍😍😍😍💯💯💯💯💛💛💛🌈🌈🌈🌈🏆🏆🏆🥇🥇🥇🥇💯

  11. 4 out of 5

    Ahmed Hamad

    A brilliant book that sheds light on the different personality structures and personality disorders from a psychodynamic perspective. While it has definitely helped me understand my patients at least a little bit more, it still made me intensely feel like I still need A LOT more experience -perhaps even more than knowledge- before I can truly begin to emotionally comprehend this book and the patients' inner worlds. I'll probably come back to this book and its suggested reading lists and referenc A brilliant book that sheds light on the different personality structures and personality disorders from a psychodynamic perspective. While it has definitely helped me understand my patients at least a little bit more, it still made me intensely feel like I still need A LOT more experience -perhaps even more than knowledge- before I can truly begin to emotionally comprehend this book and the patients' inner worlds. I'll probably come back to this book and its suggested reading lists and references very often, with the hope that it will guide me in my attempts to explore these worlds and develop better therapeutic approaches.

  12. 4 out of 5

    Patricia Azevedo

    This is an excellent book to enter the world of Psychoanalysis from scratch. It will help you to understand the fundamentals of Neurotic, Borderline and Psychotic structures of personality and to familiarize with each type of personality: the self, the object relations, the implication in the therapy. Wonderfully written.

  13. 5 out of 5

    Melany Vilchynska

    This book is a journey to everyone's inner self. Through the dark forest of psychological defenses and deep sea of a large number of personalities, one's lonely boat can make its way to self-discovery, empathy and better understanding of the surroundings. This book helps to find a solid piece of land in the huge swamp of psychological matters. This book is a journey to everyone's inner self. Through the dark forest of psychological defenses and deep sea of a large number of personalities, one's lonely boat can make its way to self-discovery, empathy and better understanding of the surroundings. This book helps to find a solid piece of land in the huge swamp of psychological matters.

  14. 5 out of 5

    Teriteriri

    A must-read for everyone interested or working in the field of clinical psychology or psychotherapy. Excellent book, one of my favourites.

  15. 4 out of 5

    Lou Danner

    Outstanding resource for understanding personality organizations.

  16. 4 out of 5

    Bedirhan

    Definetely one of the best books for therapists who want to learn more about psychodynamic approach

  17. 4 out of 5

    Melissa

    The best

  18. 4 out of 5

    Yookyung Eoh

    One of my favorite book for psychotherapy. Must-read book for students.

  19. 4 out of 5

    Sarah Sata

    Read it 5-6 times. So useful and well written for psychologists. Over the time, I've recommended to a few friends who are not familiar with the litterature in psychology and they all enjoyed it. Read it 5-6 times. So useful and well written for psychologists. Over the time, I've recommended to a few friends who are not familiar with the litterature in psychology and they all enjoyed it.

  20. 4 out of 5

    Jill Sumi

    Nancy McWilliams case conceptualization for diagnosis using a psychoanalytic lens is incredibly helpful.

  21. 4 out of 5

    Ignatius Vonnegut

    Brilliant writing. Meat for the skeleton!

  22. 5 out of 5

    Kathryn Kline

    The best book I have ever read to help me conceptualize peoples' personalities. It is my clinical bible. The best book I have ever read to help me conceptualize peoples' personalities. It is my clinical bible.

  23. 4 out of 5

    Jon Frederickson

    In an era devoted to phenomenological diagnosis (listing observable symptoms), how refreshing it is to find a book like this which helps to explain what actually causes those symptoms so you know what to treat! A list of symptoms tells us what the problem is but not what causes those symptoms, what we actually have to treat in psychotherapy. McWilliams does a wonderful job helping the reader understand the patterns of human behavior that generate different symptom pictures. Further, she shows ho In an era devoted to phenomenological diagnosis (listing observable symptoms), how refreshing it is to find a book like this which helps to explain what actually causes those symptoms so you know what to treat! A list of symptoms tells us what the problem is but not what causes those symptoms, what we actually have to treat in psychotherapy. McWilliams does a wonderful job helping the reader understand the patterns of human behavior that generate different symptom pictures. Further, she shows how to talk to and help patients who suffer from those automatic patterns of behavior called character structure. She distill complicated theory into a usable and readable format from which any therapist can readily benefit. This book will deepen the thinking and refine the responsiveness of therapists from any theoretical orientation. Co-Creating Change: Effective Dynamic Therapy Techniques

  24. 4 out of 5

    Patricia

    his is a must have primer for all who practice psychotherapy, counseling, etc. It was written to be such. Each and every Axis II diagnosis is analyzed from the simply neurotic to the full blown personality disorder. and the good news is that she tells you what to do about it; how to approach each presentation, how to help each presentation. so read it and find yourself, cringe, move on and read about your clients in a really refreshing and intelligent (not unreadable intellectual) format. Nancy Mc his is a must have primer for all who practice psychotherapy, counseling, etc. It was written to be such. Each and every Axis II diagnosis is analyzed from the simply neurotic to the full blown personality disorder. and the good news is that she tells you what to do about it; how to approach each presentation, how to help each presentation. so read it and find yourself, cringe, move on and read about your clients in a really refreshing and intelligent (not unreadable intellectual) format. Nancy McWilliams knows her stuff, she's a professor who imparts this information to the lucky students where she teaches; and she's humble about it....it's actually a very entertaining, as well as informative read.

  25. 5 out of 5

    Jessica

    What a wonderful and clear picture of modern day psychoanalytic and psychodynamic approaches to understanding and treating the individual! McWilliam's conceptualization of different personality organizations (e.g., Obsessive-compulsive, depressive, anti-social, etc.) demonstrates a non pathological way of understanding how individuals operate in the world, as well as how these personality organizations can become pathological when their defining characteristics move too far along the spectrum to What a wonderful and clear picture of modern day psychoanalytic and psychodynamic approaches to understanding and treating the individual! McWilliam's conceptualization of different personality organizations (e.g., Obsessive-compulsive, depressive, anti-social, etc.) demonstrates a non pathological way of understanding how individuals operate in the world, as well as how these personality organizations can become pathological when their defining characteristics move too far along the spectrum to more borderline or severe modes of operation. Overall, an EXCELLENT, and fairly easy read. One of the most helpful psychology books I have read to date.

  26. 5 out of 5

    David

    Nancy McWilliams does a wonderful job of filling in the psychopathological gaps left in the DSM with psychodynamic theory. She explains the rich history of psychodynamic theory as well as the development of the disorders listed in the DSM. Her writing style is erudite yet down to earth. She comes across as having a delightful sense of humor which is no small task in a book covering this subject matter. I would highly recommend that all students of psychopathology read this book in addition of th Nancy McWilliams does a wonderful job of filling in the psychopathological gaps left in the DSM with psychodynamic theory. She explains the rich history of psychodynamic theory as well as the development of the disorders listed in the DSM. Her writing style is erudite yet down to earth. She comes across as having a delightful sense of humor which is no small task in a book covering this subject matter. I would highly recommend that all students of psychopathology read this book in addition of the Psychodynamic Diagnostic Manual. They may very well change your thinking on psychodynamic theory!

  27. 4 out of 5

    Jajabo

    A much deeper understanding of diagnostics. This book simply doesn't get outdated. I've read it years ago, and have been consulting it occasionally. Dr. McWilliams fluently integrates three major views in classic and contemporary psychodynamic thinking, while explaining diagnostics with such an ease. Her examples and comments are delightful. A practical, intelligent and intuitive book to accompany any clinician who thinks beyond the DSM. A much deeper understanding of diagnostics. This book simply doesn't get outdated. I've read it years ago, and have been consulting it occasionally. Dr. McWilliams fluently integrates three major views in classic and contemporary psychodynamic thinking, while explaining diagnostics with such an ease. Her examples and comments are delightful. A practical, intelligent and intuitive book to accompany any clinician who thinks beyond the DSM.

  28. 5 out of 5

    Ian Felton

    Fantastic introduction to the general conceptualizations of personality from the psychoanalytic perspective. Covers clues in transference and countertransference to point toward the personality type your clients may have. The importance of this guide is that it helps you get closer to the subjective experience of your clients which means they are more likely to benefit from the relationship you can forge.

  29. 5 out of 5

    Sara

    Absolutely the best and most referred to explanation of personality structure I own (and I own a many). Clinically, it needs to be used as a supplement to more involved material but the case studies and personal anecdotes included in the book are quite helpful in illustrating concepts found elsewhere.

  30. 4 out of 5

    Brooke

    If I must continuously read psychoanalytic theory for my licensing exam, than McWilliams is the author of choice. Her words flow effortlessly and her passion for her work is most palpable. I groan at some of the texts I've been referred to during my PsyD, however, this is one to which I frequently return to with great pleasure. If I must continuously read psychoanalytic theory for my licensing exam, than McWilliams is the author of choice. Her words flow effortlessly and her passion for her work is most palpable. I groan at some of the texts I've been referred to during my PsyD, however, this is one to which I frequently return to with great pleasure.

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