Psykoanalytisk diagnostik: Att förstå personlighetsstruktur

by Nancy McWilliams, Eva Björkander-Mannheimer (Översättare)

This acclaimed clinical guide and widely adopted text has filled a key need in the field since its original publication. Nancy McWilliams makes psychoanalytic personality theory and its implications for practice accessible to practitioners of all levels of experience. She explains major character types and demonstrates specific ways that understanding the patient's individual personality structure can influence the therapist's focus and style of intervention. Guidelines are provided for developing a systematic yet flexible diagnostic formulation and using it to inform treatment. Highly readable, the book features a wealth of illustrative clinical examples. New to This Edition Reflects the ongoing development of the author's approach over nearly two decades. Incorporates important advances in attachment theory, neuroscience, and the study of trauma. Coverage of the contemporary relational movement in psychoanalysis. *A number of the case examples are entirely new.

Genres: Psychology, Psychoanalysis, Nonfiction, Psychiatry, Counselling, Mental Health, Science

ebook

First published April 15, 1994

About the author

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

Reviews

[Thomas · Rating 3 out of 5]

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the distinct forms of functioning (e.g., neurotic, borderline, psychotic) and even though I find this form of diagnosis outdated, she makes strong cases for each conceptualization and provides reasonable therapy implications and differential diagnosis commentary.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.

[Jessica · Rating 5 out of 5]

As a training psychiatrist, I will summarize my analysis of this clinical compendium of personality structure through a clinical lens as follows:

Aghhhhhhhhhhhhh 😍😍😍😍😍😍😍💯💯💯💯💛💛💛🌈🌈🌈🌈🏆🏆🏆🥇🥇🥇🥇💯

[Elena · Rating 5 out of 5]

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.

[Jude St. Francis · Rating 5 out of 5]

یکی از بهترین کتاب‌هایی که در مسیر تبدیل شدن به یک بالینگر روان‌پویشی خوندم. (ترجمه‌ی افتضاح)

[Alan · Rating 5 out of 5]

One read on this is pointless, but there is no need to worry. I suspect I will have something to say about the book on my third or fourth read.

[Ugnė · Rating 5 out of 5]

Labai verta skaityti visiems, kurių darbas tiesiogiai susijęs su pagalba kitam žmogui. Gali padėti geriau suprasti, kodėl žmonės kartais elgiasi taip mums neįprastai ir įgauti daugiau empatijos visų (įskaitant ir save patį) atžvilgiu. Diagnozuoti visų iš eilės po to nepatarčiau (nebent išsilavinimas leidžia)

[Andrey Demidov · Rating 5 out of 5]

Unexpected turn in my summer 2021 reading plan. One of those 'why not give it a try' books. Worth every minute of it.

[Charlotte · Rating 5 out of 5]

Wow. This (for a book that's only available in the reference section of my public library!) was SUCH a pleasure to read...and extremely clarifying.

I wish I had read this much earlier, as it elucidated a lot of things that were confusing to me about certain psychoanalytic terms and concepts, and really brought them to life for me.

I particularly appreciated McWilliams's combination of warmth, humor, wit, compassion, and nuance in addressing extremely difficult topics.

One thing I thought was particular interesting was her note on terminology. I almost want to quote the whole section here, but as a "taste" (my bolds):

Language that was invented to be simply descriptive—in fact, invented to replace previous value-laden words—develops an evaluative cast and is applied, especially by lay people, in ways that pathologize. Certain topics seem inherently unsettling to human beings, and however carefully we try to talk about them in nonjudgmental language, the words we use to do so attain a pejorative tone over the years.

Today’s “antisocial personality disorder,” as a case in point, was in 1835 termed “moral insanity.” Later it became “psychopathy,” then “sociopathy.” Each change was intended to give a descriptive, noncensorious label to a disturbing phenomenon. Yet the power of that phenomenon to disturb eventually contaminated each word that was invented to keep the concept out of the realm of moralization. Something similar occurred in the successive transformations of “inversion” to “deviation” to “homosexuality” to being “gay” to being “queer,” and yet people who are bothered by same-sex erotics still use the terms “gay” and “queer” to devalue. It will probably happen with the shift from “retarded” to “developmentally challenged.” Any phenomenon that tends to trouble people, for whatever reason, seems to instigate this futile chasing after nonstigmatizing language.
[...] One outcome of this doomed project to sanitize language is that the older a psychological tradition is, the more negative, judgmental, and quaint its terminology sounds. The swift consumption, distortion, and prejudicial application of psychoanalytic terms, within the mental health professions and outside them, have been a bane of the psychodynamic tradition.

McWilliams, Nancy. Psychoanalytic Diagnosis, Second Edition (p. 2). Guilford Publications. Kindle Edition.

As a woman, I certainly had a lot of trouble with digesting psychoanalytic work that used terms like "hysteria" and "histrionic" seriously, but now see things with a slightly different light (though I'm still aware of how all of this sounds to newcomers to psychoanalysis, which is often, Not Good).

I still think it's better to be considerate about using preferred words when we can, but this long view of the situation really changed my perspective, and helped me understand why those in older generations seem find efforts to say the "right" things excessive... as they might have been though several iterations of this already (though of course, it isn't always about that).

Anyways, throughout this book, I was really impressed with the combination of her scholastic dedication (y'all, I "finished" reading this book at 53%... and the rest of the book were references + indices—even her "Suggestions for Further Reading" sections had wonderful takes on how readable and clear or concise (or otherwise) certain works are)... and, once again, her nuanced and compassionate take on psychopathology and the suffering of other humans. She is always centering her work on understanding the inner experiences of patients, and I so appreciate that. (See below)

My own understanding of dissociation is still developing, and I suspect that much of what I say here will eventually be revised. It is less important to decide which experts to believe than to try to comprehend what patients experience.

McWilliams, Nancy. Psychoanalytic Diagnosis, Second Edition (p. 338). Guilford Publications. Kindle Edition.

This text was scholarly, illuminating, and enjoyable to read and just... full of humanity. My jaw is still partially on the floor from reading McWilliams's admissions of her early therapeutic blunders with patients. Her vulnerability in sharing these things (of course, with patients disguised) really helped to communicate important concepts.

I mean, this gem right here, she writes after explaining that her supervisor had strongly warned against being lenient with certain classes of patients:

As I seem to be constitutionally incapable of taking good advice until I make the mistake that illuminates its wisdom, I disregarded his warning [...]

McWilliams, Nancy. Psychoanalytic Diagnosis, Second Edition (p. 282). Guilford Publications. Kindle Edition.

Thank you Nancy McWilliams for writing this tome and lighting the path. I have a feeling I'll be coming back to this one.
...

[Deimantė Pruselaitytė · Rating 5 out of 5]

The saddest thing to happen was accidentally deleting all my notes :( the book is brilliant!

[Ahmed Hamad · Rating 5 out of 5]

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.

[Jordan Brooks · Rating 5 out of 5]

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.

[Psicologorroico · Rating 5 out of 5]

Un libro imprescindibile per ogni terapeuta di formazione analitica (e non). Scritto in maniera chiara e scorrevole, è un tipico testo di consultazione (che però io ho letto dall'inizio alla fine). Mi ha chiarito numerosi dubbi e lacune, soprattutto perché la mia conoscenza delle patologie era più da DSM. Il costo è notevole ma ne vale la pena!

[Оля · Rating 5 out of 5]

page-turner

[Jon Frederickson · Rating 5 out of 5]

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

[emre · Rating 5 out of 5]

Daha önce tanı koymanın danışanın ne düzeyde 'anormal' veya kriterlere ne kadar uygun olduğunu belirlemekten ibaret olmadığını, bütün bir terapi yolculuğunu etkileyen ilk adım olduğunu bu kadar net olarak anlatan bir kitap okumadım.

Özellikle Depresif, Şizoid ve Obsesif-Kompulsif kişiliklerin anlatıldığı kısımlar çok çok başarılıydı, yazarın terimlere boğmaktan özellikle kaçındığı dilinin de bu başarıda etkisi olduğunu düşünüyorum.

İsminde 'Psikanalitik' ibaresi geçtiğinden ve psikanaliz pek benimsediğim bir yaklaşım olmadığından dolayı biraz tereddütle başlamıştım, fakat bildik psikanaliz katılığından çok daha esnek, çok daha çağdaş bir yerden anlatılmıştı, bu anlamda benimle aynı tereddüdü taşıyan okurlar olursa diye belirtmek istedim.

[Fulya TEZEL · Rating 5 out of 5]

Nancy McWilliams'ın Psikanalitik Tanı adlı kitabı özetle bir kitap değil, bir okul. Kişilik yapısı sınıflandırmasında psikanalitik yaklaşıma dair müthiş bir giriş düzey kitabı. Okuyucuyu teorik bilgiye boğmadan, yılların deneyiminin içinden süzülmüş ayırıcı tanıya yönelik ipuçlarıyla dolu, bir psikoterapistin her danışanına özgü benimsemesi gereken doğru teknik duruşu net bir şekilde anlatan başucu kitaplarından. Ayrıca türkçe baskısının son derece iyi bir çeviri olduğunu söyleyebilirim ve çeviride emeği geçen herkese ve Erkan Kalem'e okuyucu olarak teşekkür ederim.

[Sydney · Rating 3 out of 5]

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.

[Susanna · Rating 5 out of 5]

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.

[Christian Buckley · Rating 4 out of 5]

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.

[Sergey Kochergan · Rating 5 out of 5]

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

[Can Sabaner · Rating 5 out of 5]

Absolute must-read for a psychotherapist!

McWilliams’s extensive knowledge and experience, combined with her warm tone, makes this book both a treasure trove of information and actually pleasurable to read :)

I wish I could memorize every single page, but since that’s not possible, I know I will have to frequently come back and re-read chapters.

[Dovilė Stonė · Rating 5 out of 5]

Psichoanalitinės tradicijos privalumas - gebėjimas įvertinti skirtumą tarp simptomo, susijusio su stresine situacija, ir asmenybėje glūdinčios problemos. [...] Bulimija serganti moteris, kurios valgymo sutrikimas atsirado pirmame koledžo kurse ir kuri suvokia, kad jos elgesys yra perdėtas ir savidestruktyvus visiškai skiriasi nuo tos, kurios persivalgymo ir valymosi epizodai kartojasi nuo pradinės mokyklos ir kuri mano, kad jos elgesys visiškai pateisinamas. Joms vienodai tinka DSM bulimijos kriterijai, tačiau galime tikėtis, kad pirmosios pacientės elgesys gali keistis po kelių savaičių terapijos, tuo tarpi dirbant su antrąja realu tikėtis, kad valgymo sutrikimo žalą ir būtinybę keistis jis galės aiškiai suvokti maždaug po metų.

Klinikinė patirtis rodo, kad nors asmenybė psichoterapijoje gali reikšmingai keistis, jos neįmanoma transformuoti (varų teorija apie šį faktą mokė: “Galite keisti ekonomiką, bet ne dinamiką”). Kitaip sakant, psichoterapeutas depresiškam pacientui gali padėti sumažinti destruktyvų ir nelankstų depresiškumą, tačiau negali padaryti jo asmenybės isterine ar šizoidine. Žmonės išsaugo savo “vidinius darbinius modelius” (Fonagy, 2001): bazinius vidinius scenarijus, konfliktus, lūkesčius, afektus ir gynybas. Tačiau nauja patirtis ir įžvalga gali žymiai sustiprinti žmogaus kontrolės pojūtį ir tikrovišką savigarbą. Žmogaus laisvės pojūtis stiprėja atsiradus galimybei rinktis ir valdyti savo elgesį, ligi tol buvusį automatišką; supratimas, kaip susiformavo konkretus polinkių derinys, skatina savęs priėmimą. Nesvarbu, ar psichoterapiniu susitarimu buvo nuspręsta modifikuoti charakterį, ar ne - geras jo supratimas palengvina psichoterapijos procesą.

Obsesinę ir kompulsinę psichologiją turintys žmonės dažnai kelia klausimą: “Kokia nauda iš to, kad aš tai jausiu?” Atsakymas - kaip tik nejausdami jie kenkia sau. Emocijos leidžia pasijusti gyvam, energingam, žmogiškam, net jei jos išreiškia nuostatas, kurias pacientas išmokęs vertinti kaip “nelabai gražias”. Kompulsyviems pacientams naudinga akcentuoti jų sunkumą tverti buvimą užuot puolus kažką daryti.

[Mark · Rating 5 out of 5]

There aren’t many textbooks that you can sit and read (except, perhaps, my own), but this 1994 textbook was written for psychotherapists who trained without getting a basic foundation in the psychoanalytic model, and it has many features that made it an enjoyable read for me. It begins with a basic introduction to classical Freudian drive theory and some subsequent modifications, then the developmental levels of personality structure, and the levels of psychopathology that may occur within a particular type of character organization. The author then reviews the basic types of defensive processes, dividing them into primitive and higher-order. The second part of the book comprises a chapter for each of nine personality types, psychopathic, narcissistic, schizoid, paranoid, depressive and manic, masochistic, obsessive and compulsive, hysterical, and dissociative. Each chapter is organized into sections discussing drive, affect and temperament; defensives used; object relations; the self; transference and countertransference; therapy; and differential diagnosis. The author is unusually clear with frequent comments relating various older and more modern theories to each other. All of these comments are referenced. Finally, she includes many anecdotes about cases she has seen or heard of and diagnostic and therapeutic tips from her career and from other authorities.

[Anatolii · Rating 5 out of 5]

Надзвичайно фундаментальна книга. Шкода, що деякі джерела втратили свою актуальність.

[Melanie · Rating 5 out of 5]

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.

[Anton · Rating 4 out of 5]

одна из причин, по которой я таки решился обратиться к психоаналитику

[Lauren · Rating 5 out of 5]

Total game changer.

[Dilan Ayyıldız · Rating 5 out of 5]

Beni mesleki anlamda bolca besleyen kaynakların arasına yazdırdı ismini. Psikanalitik psikoterapi yönelimli çalışacak her meslektaşımın okuması gerektiğini düşünüyorum. Mcwilliams’ın her kişilik örgütlenmesi için kendi vakalarından verdiği örnekler, terapistin yapacağı karşı aktarımlar, hastanın yapacağı aktarımlar vs her kişilik tipi için ayrı ayrı belirtilmiş. Özellikle mesleğe yeni başlayan benim gibi kişiler için harika bir kaynak. Yapılabilecek olası hatalar ve bunların üstesinden nasıl gelinebileceğine dair de bir yol haritası sunuyor kitap.

Nevrotik, sınırdurum, psikotik yapılanmaların her biri için ayrı ayrı yaklaşım farklılıklarının verilmesi, her kişilik yapılanmasının hangi düzeylerde nasıl tezahür ettiğinin anlatılması, bu kişilik yapılarının birbirine benzeyenlerinin birbirine karıştırılmaması için farklılıklarının verilmesi gibi birçok özelliği kitabı bir başucu kitabına dönüştürüyor.

[Shaun Marais · Rating 4 out of 5]

I first came across Nancy McWilliams via an older episode of the IPA podcast which I recently listened to and I enjoyed how she spoke freely about some of her personal life experiences so I decided to read her best selling book.

This is a great summary and I am happy to own this book. What a great resource to have. I wish I had as a prescribed copy in my undergrad, albeit it is now a little bit outdated already.

It is also becoming clearer to me how psychodynamic psychology is limited in some scenarios where a neuro psychological approach may be better, for example. Overall I believe its value is in the unstructured format it provides and the acknowledgment of the impact of the past on the present which some approaches de-emphasise.

I appreciate and value this book.

[Hengameh · Rating 5 out of 5]

Wonderful introduction to psychoanalytic ways of understanding the mind.

I also loved the way she had specific sections to guide readers to other references based on their curiosities, needs and levels of understanding for each concept, in addition to the usual big reference section at the end.