Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process / Edition 1

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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-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.

This book contains black-and-white illustrations.

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Editorial Reviews

From the Publisher

"Books by Nancy McWilliams used in unison make the best psychodynamic resources I have yet encountered in more than 60 years in the field."--Robert C. Lane, PhD, Department of Psychology, Nova Southeastern University

"The aim of Nancy McWilliams's excellent (and I believe essential) book is twofold: first, to present a psychoanalytically oriented view of individual differences in personality structure and then, secondly, to show how these differences can be clinically and therapeutically useful....Stylistically, the writing is clear and simple and jargon is, for the most part, avoided. The case examples and anecdotes, especially those illustrating the different personality types, are well-chosen and illuminating." --Scott Miller, Ph.D. in New Jersey Psychologist

"A successful attempt to bring together the many strands of contemporary psychoanalytic investigation of the nature and psychotherapeutic treatment of character pathology. Readable and informative, this book moves easily from one theoretical frame to another according to the usefulness of each frame for understanding a specific aspect of the character pathology....The result is a book that should be helpful to the psychoanalytically oriented psychotherapist of personality disorders as well as to the clinician in carrying out the differential diagnosis of these conditions....The thoughtful references, at crucial points, to literature that permits the reader to deepen his or her understanding in this field enriches and broadens the perspective opened by this excellent primer." --Otto F. Kernberg, M.D.

"Comprehensible and readable--lends itself to graduate studies." --Cathleen Adams, Ph.D., New School for Social Research, Graduate Psychology

"This is a clear, superbly written text. The author consistently develops the treatment implications of diagnostic statements." --Virginia Brabender, Ph.D., ABPP-Cl

"This book is so well written, and with such subtlety, sensitivity, and clarity, it gave me goosebumps to read it." --Garry Walls, Ph.D., Illinois School of Professional Psychology, Chicago IL; Course: Psychopathology I

"Psychoanalytic Diagnosis is a highly readable approach to character pathology that combines theoretical sophistication with clinical wisdom. Nancy Williams is an experienced, empathic, and intelligent therapist who succeeds in making clinical material come alive through her perceptiveness and her skill in writing. It isn't often that diagnosis is linked in a meaningful way to treatment, and McWilliams' schema allows this to happen. In addition, she shows an appreciation of all of the approaches to psychoanalytic theory without succumbing to a doctrinaire formulation. The integration that is achieved is an accomplishment in its own right, and students at all levels of training should benefit from this lucid presentation."
--George Stricker, Ph.D., Distinguished Research Professor, Adelphi University

"Finally, a current, lucid, and comprehensive psychoanalytic text on psychology. It takes into account all of the most recent developments in psychoanalytic thinking. It is an ideal text for serious students of psychoanalytic approaches to psychopathology." --Jonathan H. Slavin, Ph.D., Director, Counseling Center, Tufts University

"A superb, highly readable work on the understanding of character patterns in clinical practice....PSYCHOANALYTIC DIAGNOSIS will be of immense value to all students undertaking training in the psychodynamic tradition. Because this book is so broadly integrative in scope and so rich in clinical understanding, it will be of great interest to students and practitioners of other theoretical persuasions as well." --George E. Atwood, Ph.D.

"For the students of therapy, for the young practitioner, for those interested in a diagnostic model for the initial stage of analytic therapy, I recommend this book. The prose is lucid, lively, and very readable. The author demonstrates refreshing candor about therapeutic work, empathy toward patients, as well as invaluable knowledge and insights gleaned from the clinical setting. McWilliams writes about complex constructs in psychoanalytic theory in a clear and comprehensive way...." --Doris K. Silverman, Ph.D.

"This is diagnosis, not as labeling, but as making distinctions with consequences for treatment....This book sensitizes the therapist to differences that make a difference, and provides a conceptual bridge for using psychoanalytic knowledge to greatly increase the effectiveness even of brief psychotherapy, as well as longer-term treatments." --Bertram P. Karon, Ph.D.

"There has been a great need for a comprehensive book to address the relationships between character and therapy. McWilliams not only succeeds in writing a scholarly text, but brings each character type to life with clinical vignettes which make this a real page-turner. It offers a foundation to the beginner, and the more experienced psychotherapist will come away with a deeper understanding of people and the therapeutic process. I think it is destined to become a classic in psychotherapy literature." --Jean Ciardiello, Ed.D.

Presents psychoanalytic personality theory and its implications for beginning practitioners. Explains the major clinically important character types and suggest how an appreciation of individual personality structure should influence the therapist's style of intervention. Covers conceptual issues such as developmental levels of personality organization, primary and secondary defensive processes, types of character organization, borderline syndromes, and dissociative disorders. Annotation c. Book News, Inc., Portland, OR (
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Product Details

  • ISBN-13: 9780898621990
  • Publisher: Guilford Publications, Inc.
  • Publication date: 4/15/1994
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 398
  • Product dimensions: 6.21 (w) x 9.22 (h) x 1.24 (d)

Meet the Author

Nancy McWilliams, PhD, teaches psychoanalytic theory and therapy at the Graduate School of Applied and Professional Psychology at Rutgers--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, Psychoanalytic Diagnosis 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.
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Table of Contents

I Conceptual Issues 5
1 Why Diagnose? 7
2 Psychoanalytic Character Diagnosis 19
3 Developmental Levels of Personality Organization 40
4 Clinical Implications of Developmental Levels of Organization 67
5 Primary (Primitive) Defensive Processes 96
6 Secondary (Higher-Order) Defensive Processes 117
II Types of Character Organization 145
7 Psychopathic (Antisocial) Personalities 151
8 Narcissistic Personalities 168
9 Schizoid Personalities 189
10 Paranoid Personalities 205
11 Depressive and Manic Personalities 227
12 Masochistic (Self-Defeating) Personalities 257
13 Obsessive and Compulsive Personalities 279
14 Hysterical (Histrionic) Personalities 301
15 Dissociative Personalities 323
Appendix: Suggested Diagnostic Interview Format 349
References 353
Author Index 381
Subject Index 386
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Sort by: Showing all of 6 Customer Reviews
  • Posted July 13, 2010

    more from this reviewer

    A must!

    I purchased this book for my Techniques of Psychotherapy II class at Carlos Albizu University. This is a very easy to read book that help you understand very good the schools of Psychoanalitic Theory. Very easy to follow and understand... it is a very good book to get a real good overview about that Psychoanalysis is all about.

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  • Posted April 27, 2010

    I Also Recommend:

    Must Read for Beginning Dynamic Therapists

    This is a very clear, concise, and relevant introduction to dynamic views of personality structure. One of McWilliams' strengths is that she makes psychodynamic ideas readable and relevant (as opposed to esoteric and opaque, like many other dynamic authors). I used a lot of the ideas from the book in my oral C examinations for graduate school, and they were very useful in helping me pass. Particularly useful for me was the idea that borderline personality structure is less like the diagnosis in DSM, so much as a level of personality organization (which is in between neurotic and psychotic) organization. Clinically, this makes it a lot easier for me to understand borderline dynamics in session and tailor my interventions. Overall, a very worthwhile read, particularly for beginning therapists.

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  • Anonymous

    Posted October 17, 2005


    Wordy and pompously written. Material is outdated and does not mention modern trends in current Psychoanalytic practic. Overall, a boring read.

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  • Anonymous

    Posted October 3, 2004

    A must read.

    This book is a classic. A primer in the taxonomy of personality disorders, it lays out the dynamics of defense mechanisms at the roots of catagorization. It looks at clusters of symptoms and presents interpretations of differential diagnosis that are valuable. As psychotherapy embraces the neuroscience of the brain, this book may establish the foundation for a paradigm shift. It is one huge part of a puzzle in articulating the spectrum of human pathology. Although focused on defense mechanisms, to the exclusion of faith, sense of belonging and security, this book provides a scaffold for integration of neuro-circuitry as the science unravels. A book you may want to give to friends searching to understand the dynamics of human interaction.

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  • Anonymous

    Posted January 22, 2000


    It was an outstanding book full of wonderful insight! If you are a psychologist or psychotherapist, I plead you to get this book.

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  • Anonymous

    Posted December 23, 2009

    No text was provided for this review.

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