105A: Technique I: Basics of Clinical Psychoanalytic Diagnosis
Instructors
November 12, 2025 – January 7, 2026
Wednesdays, 7:00 – 8:20 pm
No class: 11/26, 12/24, 12/31
To attend this course remotely, please click here
Course Description
This course will explore how different approaches to psychoanalytic diagnosis can be used clinically, and how they differ from psychiatric diagnosis, with which the students may be more familiar. We will start with Freud’s 1916 writing on Character Types, paying particular attention to The Exception as an example of how a person’s whole mode of operating may be guided by a largely unconscious overarching idea. We then move on to review parts of the PDM and examine its focus on assessing a range of functioning, including mental life. We will make use of David Shapiro’s approach as outlined in Neurotic Styles to look at the whole person and the continuum from functional adaptations to neurosis to more severe pathology. We will also examine one or two syndromes by way of a case presentation, but we will not attempt to review all of the diagnostic categories.
Course Objectives
Upon completion of this course, participants should be able to:
- describe the historical development of psychoanalytic diagnosis, including the contributions of ego psychology and object relations points of view.
- differentiate between psychiatric and psychoanalytic diagnosis, paying attention to the differences in concepts of psychopathology as well as the use of the interaction between analyst and patient in psychoanalysis.
Evaluation Method
Each student’s participation in class discussion and demonstration of understanding of the course objectives, readings and clinical material is assessed in a written evaluation by the instructor(s).
Continuing Education
Psychologists
New York Psychoanalytic Society & Institute is recognized by the New York State Education Department’s State Board for Psychology as an approved provider of continuing education for licensed psychologists #PSY – 0073.
New York Psychoanalytic Society & Institute is approved by the American Psychological Association (APA) to sponsor continuing education programs for psychologists. New York Psychoanalytic Society & Institute maintains responsibility for this program and its content. DISCLOSURE: None of the planners and presenters of this CE program has any relevant financial relationships to disclose.
Social Workers
New York Psychoanalytic Society & Institute is recognized by the New York State Education Department’s State Board for Social Work as an approved provider of continuing education for licensed social workers #SW – 0317.
These articles are protected under relevant copyright regulations. They are available in the New York Psychoanalytic Society & Institute Electronic Reserve for your convenience, and for your personal use.
READINGS FOR 2025 ARE CONFIRMED.
To attend this course remotely, please click here
I. Overview of Psychoanalytic Diagnosis
CLASS 1: November 12, 2025
Study Questions:
- Can you think of any patient whom you’ve encountered who demonstrates seeing themself as an exception deserving of special treatment? You may also give an example from literature or of someone you’ve known in a non-clinical setting.
- What was an aspect of the rationale for developing the PDM?
- What have been two of the problems historically with psychodynamic diagnostic formulations?
- Can you think of any patient with depression in whom you can understand a narrative that is intertwined with their depression?
Freud, S. (1916). Some Character-Types Met with in Psycho-Analytic Work. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XIV (1914-1916): On the History of the Psycho-Analytic Movement, Papers on Metapsychology and Other Works, 309-333. [Read especially pp. 310-315]
Lingiardi, V. & McWilliams, N. (2017). Psychodynamic Diagnostic Manual (Second Edition). New York: Gillford Press. Introduction, 1-14 , Comparison of PDM-2 with other Diagnostic Systems, 68-74 .
Monti, M. R. & D’Agostino, A. (2018) Diagnosis or Diagnosing? From Symptoms to a Phenomenological-Psychoanalytic Stance on the Patient’s World. Psychoanalytic Review, 105:209-222.
II. Levels of Personality Organization
CLASS 2: November 19, 2025
REQUIRED READINGS
McWilliams, N. (1994). Psychoanalytic Diagnosis: Understanding personality structure in the clinical process. New York: The Guilford Press. [Read pp. 19-34]
Kernberg, O. (1984). Severe Personality Disorders. New Haven: Yale U. Press. [Read Chapter 1: Structural Diagnosis, pp. 3-26]
III. The Whole Patient and Case Presentation One
CLASS 3: December 3, 2025
These readings will be discussed in the context of a case presentation during this class.
REQUIRED READINGS
Shapiro, D. (1965). Introduction. In Neurotic Styles. New York: Basic Books, pp. 1-22.
Shapiro, D. (1965). Obsessive-Compulsive Style. In Neurotic Styles. New York: Basic Books, pp. 23-53.
IV. Impact of Race and Culture on Diagnosis
CLASS 4: December 10, 2025
We will discuss the possible influences of the culture and race of both analyst and patient in forming a diagnosis. We will also have a guest presenter who will present a relevant case.
REQUIRED READINGS
Wallerstein, H. Hunting the Real: Psychosis and Race in the American Hospital, 2020, Psychoanalytic Perspectives, (17)(3): 257-271
Spiegel, J. Cultural Aspects of Transference and Countertransference Revisited, 1976, J. Am. Acad. Psychoanal. Dyn. Psychiatr., (4)(4):447-467
V. Case Presentation Two
CLASS 5: December 17, 2025
As you read the Shapiro introduction and chapters, try to think of patients you’ve seen who demonstrate some of the key characteristics of each style. Also, be prepared to listen to the case presentations we will hear and to think about how they do or do not illustrate the “types” described in the chapters (Obsessional for class III, Hysterical for Class V.)
REQUIRED READINGS
Shapiro, D. (1965). Hysterical Style. In Neurotic Styles. New York: Basic Books, pp. 108-133.
VI. Thinking About Diagnosis via a Work of Literature
CLASS 6: January 7, 2026
The story is told from the viewpoints of each member of the Lambert family (parents Enid and Alfred and their adult children Gary, Chip, and Denise). The first chapter (not assigned) describes Alfred and Enid’s preparations for an upcoming cruise and a visit to Chip.
Thinking of Chip as your patient, imagine that Selection 1 is what he tells you at the first session. He returns and gives you more background, and we also learn about the arrival of Denise for the visit (Selection 2). In Selection 3, Chip tells you more about his life prior to the day you met him, and in Selection 4 he recounts a conversation he had with Denise a while back.
In the novel, in the months following the lunch, a series of entanglements has led Chip to travel to Eastern Europe as a participant in a corrupt money-making scheme. In Selections 5 and 6, we encounter him as he is fleeing from Lithuania to reach his parents’ house in the Midwest.
Study questions:
Please prepare answers to these questions to be discussed in class.
1. After reading Selection 1, what is your impression of Chip? What is your emotional reaction to him and what he tells you–countertransference?
2. As you continue reading, consider what might be causing his suffering. Think about family dynamics and how they are represented in his mind, sense of self, cultural factors, substance abuse, and anything else.
3. What is he feeling and trying not to feel? How does he avoid these feelings, consciously or unconsciously (defenses)?
4. What can you say about Chip’s identity? How stable or fluid is it?
5. What might the challenges in treatment be? How does what you know of Chip so far suggest how the transference might evolve?
REQUIRED READINGS
The Corrections, J. Franzen, Farrar, Straus, and Giroux, New York, 2001 (Paperback ed. 2021). Note that all the selections are part of one file.
Selection 1–pp. 15-24
Selection 2–pp. 32-34
Selection 3–bottom p.89 to top p.98
Selection 4–p.523 only
Selection 5–pp. 534-540
Selection 6–pp. 544-549
SUPPLEMENTAL READING
The rest of the book, if you enjoy reading fiction and when you have time.