105A: Technique I: Basics of Psychoanalytic Diagnosis
Instructors
Lisa Deutscher, M.D.
December 4, 2024 – January 8, 2025
Wednesdays, 7:00 – 8:20 pm
No class: 12/25, 1/1
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 for Physicians
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 ARE CONFIRMED.
I. Overview of Psychoanalytic Diagnosis
CLASS 1: December 4, 2024
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: December 11, 2024
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 18, 2024
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). Hysterical Style. In Neurotic Styles. New York: Basic Books, pp. 108-133.
SUPPLEMENTAL READINGS
Kernberg, O. (2018). Commentary on the Psychodynamic Diagnostic Manual, 2nd Edition: What Does the PDM-2 Add to the Current Diagnostic Panorama? Psychoanalytic Psychology, 35(3):294-295.
McWilliams, N., Grenyer, B., Shedler, J. (2018). Personality in PDM-2: Controversial Issues. Psychoanalytic Psychology, 35(3):299-305
IV. Case Presentation Two
CLASS 4: January 8, 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 (Hysterical for class III, Obsessional for Class IV).
REQUIRED READINGS
Shapiro, D. (1965). Obsessive-Compulsive Style. In Neurotic Styles. New York: Basic Books, pp. 23-53.