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Psychoanalytic Case Formulation

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What kinds of questions do experienced therapists ask themselves when facing a new client? How can clinical expertise be taught? From the author of the landmark Psychoanalytic Diagnosis, this book takes clinicians step-by- step through developing an understanding of each client's unique psychology and using this information to guide and inform treatment decisions. McWilliams shows that while seasoned practitioners rely upon established diagnostic categories for record-keeping and insurance purposes, their actual clinical concepts and practices reflect more inferential, subjective, and intuitive processes. Interweaving illustrative case examples with theoretical insights and clinically significant research, chapters cover assessment of client temperament, developmental issues, defenses, affects, identifications, relational patterns, self-esteem needs, and pathogenic beliefs. Winner--Gradiva Award, National Association for the Advancement of Psychoanalysis

268 pages, Kindle Edition

First published March 1, 1999

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About the author

Nancy McWilliams

37 books174 followers
McWilliams is a psychoanalytic/dynamic author, teacher, supervisor, and therapist.

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5 stars
499 (60%)
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248 (30%)
3 stars
71 (8%)
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6 (<1%)
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Displaying 1 - 30 of 34 reviews
Profile Image for laura.
156 reviews176 followers
September 11, 2020
Nancy McWilliams is the GOAT. She is where I would point anyone looking for a solid, digestible, sufficiently in-the-weeds grasp of contemporary psychoanalytic practice and theory. As an overview, you could do worse than just starting here. NM pulls in most of the central concepts in the course of laying out the process of meeting a new client and formulating an initial set of working hypotheses re: who they are and what they need. Her book Psychoanalytic Psychotherapy: A Practioner's Guide is probably the more natural place to start, but I don't know, this book is pretty solid.

Just at the level of prose and organization, I found it extremely impressive. Each chapter is 18-22 pages, and lays out one dimension of assessment in terms precise enough for the most punctilious reader, unpacking each with sufficient examples to draw out the idea and make it digestible enough for almost anyone. These chapters stack up one, two, three, up to 10 little lessons, plus a nice (20p of course!) summary. No chapter feels rushed or ungainly. You may want more, and in each chapter she provides recommended further readings for those who do. But no chapter is so spare that you could fail to get the idea.

Great book. Great writer. Nancy McWilliams writing in general has been the perfect bridge for me between philosophy and psychodynamic practice.

(PS One thing this is not is a history of psychoanalytic figures/concepts. For that, I really liked Mitchell and Black's FREUD AND BEYOND.)
Profile Image for Claire.
104 reviews49 followers
April 9, 2013
Highly engaging, rich read. McWilliams writing is so easy to take in - personal and astute her experience is evident. Provides some map for making sense of and proceeding along the path that is therapy, with another. Speaks to the limitations of working from diagnosis over a broader case formulation. And from a two-person psychology framework notes understanding one's own psychology as central to working as a therapist.

I'd recommend this to any helping professional regardless of orientation (indeed she graciously makes links between psychoanalytic approach and various other schools of thought).
Profile Image for Ugnė.
653 reviews158 followers
August 7, 2018
Įdomi, naudinga ir žmogiškai parašyta knyga. Verta pasiskaityti ir ketinantiems eiti pas psichologą/psichoterapeutą - kad būtų lengviau pradėti kalbėti.
Profile Image for Psicologorroico.
468 reviews45 followers
January 31, 2020
La scrittura della McWilliams è chiara, fluida e comprensibile. Un libro consigliato agli appassionati di psicoanalisi.
Profile Image for Samara Serotkin.
Author 1 book1 follower
November 2, 2007
My supervisor recommended this book last semester as a way for me to get a better handle on case formulation. While I almost got scared away by the term "psychodynamic" with regards to case formulation...and had visions of dissertation-style case formulations full of lost of jargon I'd have to go research to understand, this book is actually relatively easy reading. It's really helpful for any orientation, really.
Profile Image for Andrea.
57 reviews2 followers
October 2, 2021
Piccola nota della traduzione italiana: nel capitolo "credenze patogene" è riportato di un paziente che per lamentarsi usava la frase "la vita ancora succhia"; sono abbastanza sicuro che sia una traduzione ridicola dell'inglese "life still sucks", che significa "la vita fa ancora schifo".
Ho riso molto.
Profile Image for Chris.
56 reviews
October 22, 2016
it's quite amazing how well McWilliams explains the necessary elements of a successful dynamic formulation. she offers coherent examples from her own clinical and personal experience, which really makes the process come alive.
Profile Image for Sam.
346 reviews10 followers
Read
March 27, 2023
part of an ongoing project to figure out what my shrink is doing in my head
Profile Image for Rimgaudas.
61 reviews5 followers
November 17, 2018
Must read book for the beginners psychotherapists and psychology consultants.
Profile Image for Mindora.
18 reviews
February 3, 2025
Nancy Mcwilliams si presenta come una psicoanalista estremamente valida e competente e con un'empatia di spicco. Consigliatissimo come primo approccio alla pratica psicoterapeutica.
Profile Image for Alishia S..
16 reviews
July 29, 2018
This is a wonderful and updated perspective to psychoanalytic theory that allows a deeper conceptualization of client distress and defense. McWilliams offers a profoundly refreshing view that has versatility for integration into others theories and models of psychology.
Profile Image for Brent.
127 reviews5 followers
October 10, 2019
One would never think that a book with this title could be enjoyable, but it is insightful, reader friendly, and candid. It is one of the more enjoyable books in the genre of text books.
Profile Image for Vita Mikuličiūtė.
190 reviews15 followers
August 25, 2025
Perskaičiau, nes reikėjo. Nesakyčiau, kad labai sužavėjo, ar kad geriausia McWilliams knyga. Tokia idealoginė, bandanti atspindėti psichodinaminę filosofiją. Kita vertus (o tai, mano galva, labai didelis pliusas) į žmogaus problemas skatina pažvelgti plačiau ir įvairiapusiškiau nei griežtieji psichodinamistai nurodo.
9 reviews
February 11, 2020
L'impressione che ne ho ricavato è quella di un libro indirizzato a terapeuti professionisti scritto con amore e compassione nei riguardi della disciplina e di chi la pratica. Molto utile e reso concreto dai plurimi esempi. Qualche dubbio mi resta sulla scorrevolezza della traduzione.
Profile Image for Luke.
27 reviews52 followers
September 17, 2024
A sophisticated book about the art of patient assessment and case formulation. McWilliams is an inspired therapist whose compassion is balanced by her lucid intellect. Her writing is a reflection of the same precision and clarity that distinguishes her as a clinician. Brilliant! 5/5
Profile Image for Sebastian.
100 reviews
June 24, 2025
McWilliams beskriver på ett pedagogiskt och medryckande sätt hur terapeuten kan lägga upp de första samtalen för att inhämta tillräckligt med information för att kunna göra en psykodynamisk fallformulering. Jag skulle säga att denna är mer hands-on jämfört med hennes tidigare bok om diagnostik som är mer teoretisk. Jag upplever att båda dessa böcker har hjälpt mig avsevärt i min förståelse av psykodynamisk terapi.
Profile Image for Ellen.
2 reviews
April 2, 2018
It provides a great foundational knowledge about psychodynamic psychotherapy. Very well written and can be easily read!
Profile Image for Mihail.
13 reviews2 followers
October 4, 2019
For every beginning practitioner that would like to get deeper into the psychological evolution - this is a wonderful choice.
Profile Image for Dovilė Stonė.
187 reviews86 followers
November 9, 2020
"Pirmiausia - saugok kliento savigarbą" - turbūt geriausias Hipokrato principo "Pirmiausia nepakenk" vertimas į psichoterapeutų kalbą."
Profile Image for Felicia Romano.
27 reviews
September 29, 2022
Nancy does it again! Love her theories, clinical suggestions, and vantage point for approaching clients on the circumplex model of psychodynamic personality structures.
Profile Image for Caroline.
42 reviews
August 25, 2023
A necessary read for any therapist in training! She is able to cover dense topics with an easy to read prose.
Profile Image for Jemma.
72 reviews13 followers
August 31, 2023
Nancy is hard not to idealise; a brilliant book.
Profile Image for m_arti.
11 reviews
May 10, 2025
nancy io pensavo di leggerti e capire meglio in che scuola di psicoterapia andare e ancora non riesco a scegliere..o forse volerti leggere è già una scelta? non so più niente
Profile Image for David.
18 reviews
December 19, 2007
In Psychoanalytic Case Formulation, Nancy McWilliams gets to the meat of why a dynamic case formulation is desirable. She voices her dismay at the encroachment of insurance companies into the therapeutic relationship, and she examines the American trend toward "empirically validated treatment" in light of the influence of insurance companies. Dr. McWilliams illustrates how a dynamic case formulation addresses the subjective areas of the client's experience that a case formulation based strictly upon the DSM leaves out. Highly recommended!
Profile Image for Simone.
29 reviews2 followers
August 6, 2022
Secondo libro utilissimo dell’autrice. Qui entra nella formulazione psicodinamica che è fondamentale per curare una persona, anche se, per quanto precisa e raffinata possa essere, non descriverà mai l’individuo nella sua complessità (e per fortuna). Sono presenti molti casi clinici. Lo uso nella mia professione.
71 reviews2 followers
August 5, 2012
Just wonderful. So much rich information that connected bits and pieces I had learned elsewhere. And yet so easy to read and approachable to those new to psychodynamic theory and are both very interested yet intimidated by it.
7 reviews20 followers
May 7, 2009
fantastic for all professionals involved in therapy.
Profile Image for Catherine Woodman.
5,812 reviews118 followers
July 29, 2011
Very practical approach to formulations, which is useful for the beginner
Displaying 1 - 30 of 34 reviews

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