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Welcome everyone! Really looking forward to getting into the text with you all. Today's discussion will include the following chapters of Psychoanalytic Diagnosis:
November 4th
- Brief introduction (p. 1-4, 5-6)
- Part 1, Chapter 1: Why Diagnose? (7-20)
- Chapter 2: Psychoanalytic Character Diagnosis (21-42)
You should have read the introduction and about the practice of psychoanalytic diagnosis, as well as a historical overview of how psychoanalytic practice has developed since Freud. I will be posting a podcast episode on Thursdays to help guide the readings each week and go over material/add from my own clinical experiences - click here for this week.
Discussion Questions:
Intro and Chapter 1: Why Diagnose?
- In the introduction, McWilliams discusses the "doomed project to sanitize language" that analysts have had to contend with. I'm curious about how reading this section was for others - I sense this is something you've seen, and McWilliams also discusses the use of the term trauma, which she claims "has lost its catastrophic overtones" - how "doomed" is this shift as you see it? (p. 2-3)
- There are various critiques of the DSM (the Diagnostic and Statistical Manual of Mental Disorders) very commonly used in North America, such as it including syndromes that are "artificially discrete and fail[ing] to capture patients' complex experiences" (p. 9). McWilliams also states that such categorical diagnosis may "contribute to a form of self-estrangement, a reification of self-states for which one implicitly disowns responsibility" - is this something you've also observed? (p. 11)
- Chapter 1 explores the various utilities of psychoanalytic diagnosis (though always a tentative frame) - its usefulness in treatment planning, prognostic implications, ideally aiding in communicating empathy, anticipating flights from treatment, and more. Was there anything that particularly stuck out to you that you'd like further illumination on, or interested you?
Chapter 2: Psychoanalytic Character Diagnosis
- How was reading about the historical development of psychoanalytic theories, and the various schools? Are there any schools of thought you are particularly drawn to?
- Ongoing tensions continue re: drive theory vs object relations/the interpersonal turn. How might clinicians integrate these into practice, or alternatively, how might we integrate them into the ways we understand human beings and ourselves?
Please feel free to ask your own questions as well in the comments!
So wonderful to hear from you! There was nothing incoherent at all in what you wrote.
I really do agree with you - if others have the references, I haven't read much on psychoanalytic readings of the internet and social media platforms, and their effects on patients - I feel that this is such a vital area to examine more in-depth. As you mention, the cultural diagnoses do fall away once you're in practice for the most part... though some clients at the borderline/psychotic levels have a greater need to cling to their labels. I worked a lot w those at the borderline level/some psychotic and was more of that gentle Kohutian with them.
Thank you so much for your comment! I'm with you all re: sanitizing language.
Mitchell writes well on object relations and the relational turn - I would recommend his work with Greenberg Object Relations in Psychoanalytic Theory and also Relational Concepts in Psychoanalysis
Winnicott also wrote a highly influential text, Hate in the Countertransference that I would recommend. I have an episode on Transference and Countertransference on the pod, as well as one on Erotic Transference/Countertransference (that one is on patreon). I personally work very relationally and was trained by relational analysts for which I'm quite grateful.
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Lacan is really rarely covered, I think even in Freud and Beyond by Mitchell & Black he may be briefly referred to... Many practicing analysts don't take Lacanian practice nearly as seriously, and it presents quite a stark turn from so much of how psychoanalysis developed re: object relations and the relational turn (which McWilliams is partial to).
There definitely IS Lacanian practice out there - Bruce Fink writes well on it (A Clinical Introduction to Lacanian Psychoanalysis), so I would recommend reading him to learn more about what it's like. It really diverges from how Freud himself practiced (eg, w Freud maintaining the frame and a set period of time for meeting was extremely important, as with many analytic practitioners today - Lacanians are taught to end the session when the analyst sees fit). One day you could be seeing your Lacanian analyst for 15 minutes, the next time closer to the hour... just an example of a practice.
Great final question - unfortunately the DSM-5 was meant to alleviate these concerns (given what the researchers involved w it were wanting from it, more dimensionality) but it resulted in similar categorization and very little actual change from the DSM-IV. Most therapists I know are quite unhappy with it.