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108 Assessment of Pathologies Part I and Part II – 4 seminars

Seminar Leaders: M.K. O’Neil and G. Fogarty

Course Description

These four seminars will enable candidates to diagnose and assess patients for psychoanalytic treatment as well as their suitability as control cases. Candidates will learn to differentiate psychosis, neurosis and border-line conditions with focus on the main neurotic conditions (hysteria, obsessions, perversions, character disorders, narcissistic disorders) including severity and combinations.  Attention will also be given to post-traumatic disorders and character disorders. Consideration of the analytic interview will include taking a personal history; levels of personality organization; mode of relating; object relationships; and psychological mindedness (capacity for verbal expression, self-reflection, transference and symbolization). Preparation and engagement of a first analytic patient will be discussed, including how to gain informed consent, explaining confidentiality, risk of harm to patient, limits of confidentiality, and when to refer a patient to another health care professional. Candidates will also learn how to use their cognitive and affective responses to a prospective patient and countertransference issues will be touched on. The final decision about a patient’s suitability for analytic treatment with a particular candidate is to be based on discussion with the prospective supervisor.  Required readings are meant to stimulate candidates’ thinking about how to decide treatment of choice, find control cases and how analyst and analysand engage each other to begin a unique analytic process.  Referral to other qualified therapists of patients found unsuitable for analysis, or wishing to try other therapies will be discussed.

Course Objectives

Candidates will be able to:

  1. Conduct analytic interviews to assess suitability for psychoanalytic treatment as a control case; apply (1.3) major diagnostic categories.
  2. Take into consideration diagnostic issues as well as contra-indications (potential for regression, suicide, impulsive behavior, addiction and life circumstances); apply (1.3) major diagnostic categories.
  3. Make an informed judgment about a person’s ability to engage in the analytic process; (2) formulate an assessment; (4.5) individualize goals and objectives for each patient
  4. Assess ego strengths including specific risks, especially, capacity for reality testing; (4.4) to assess for specific risks as indicated. Learn how to conduct a risk assessment and develop a safety plan with patients at risk (4.4; 4.4.1)
  5. Make an informed judgment of the candidate’s suitability to analyze a particular patient; (4.4) to assess for specific risks as indicated.
  6. Learn how to obtain informed consent; explain patient rights to privacy and confidentiality and the limitations imposed upon them by law. Explain analyst’s education, qualifications and role. Explain advantages and disadvantages of patient participating in psychoanalytic treatment (4.1, 4.1.1; 4.1.3; 4.1.4; 4.1.5; 4.1.6; 4.1.7)
  7. Recognize the benefits, limitations, and contraindications of psychotherapeutic approaches, including psychoanalysis. Make an appropriate referral when analysis is not indicated; (1.2, 1.4) recognize the benefits, limitations, and contraindications of differing psychotherapeutic approaches (4.1, 4.1.2; 4.4.2)

Seminar 1

Focus will be on assessment of psychotic, neurotic and borderline factors, including severity and combinations in order to develop a working diagnosis.   Attention will be given to the differentiation between neurotic and psychotic depression and assessment of suicidal ideation or attempts, addiction, object relations, social supports and reality testing.

Required Readings

Etchegoyen, H. (1991). Indications and contraindications according to the diagnosis and other particulars. In The Fundamentals of Psychoanalytic Technique (Chapter 2, pp.14-26). Rev. Ed. (1999) Trans. Pitchon, P. London: Karnac.

Freud, S. (1924). Neurosis and psychosis. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. 19, 149-153.

McWilliams, N. (2011). Chapters 1–3. In Psychoanalytic Diagnosis. New York, NY: The Guilford Press.

Seminar 2

Focus will be on assessment of indications of hysterical, obsessional, and borderline neuroses and their suitability for psychoanalytic treatment.

Required Readings

Grand, S. (2006). Some reflections on the concept of analyzability. Psychoanalytic Review, 93, 817-825.

Rothstein, A. (1994). A perspective on doing a consultation and making the recommendation of analysis to a prospective analysand. Psychoanalytic Quarterly, 63, 680-695.

Seminar 3

Further discussion of indications of hysterical, obsessional, borderline neuroses, and indications for diagnoses of post-traumatic disorders and character neuroses.

Required Readings

Grand, S. (1995). A classic revisited: Clinical and theoretical reflections on Stone’s widening scope of indications for psychoanalysis. Journal of the American Psychoanalytic Association. 43, 741-76.

Jacobs, T. (2013). On beginnings: The concept of the therapeutic alliance and the interplay of transferences in the opening phase. In The Possible Profession: The Analytic Process of Change (pp.23-34). New York, NY: Routledge.

Seminar 4

Focus will be on the analyst’s suitability, collaboration, and supervisory consultations in assessing analyzability and referrals.

Required Readings

Cabaniss, D. & Roose, S. (1997). The control case: a unique analytic situation. Journal of American Psychoanalytic Association. 45, 189-199.

Karon, B.P. (2002). Analyzability or the ability to analyze. Contemporary Psychoanalysis, 38, 121-140.

Supplementary Reading

Lingiardy, V. and McWilliams, N. (Eds.) (2017). Psychodynamic Diagnostic Manual Second Edition (PDM 11). New York, NY: Guildford Publications.

Recommended Readings

Bachrach, H. (1998). The analyst’s thinking and attitude at the beginning of an analysis: The influence of research data at the beginning of an analysis. In Jacobs and Rothstein (Eds.) On Beginning An Analysis (pp. 3-26). Madison, CT: International Universities Press.

Blum, H. (1998). The influence of trauma on the opening phase of analysis. In Jacobs and Rothstein (Eds.) On Beginning An Analysis. Madison, CT: International Universities Press.

Bornstein, R.F. (2010). Psychoanalytic theory as a unifying framework for 21st century personality assessment. Psychoanalytic Psychology27, 133-152.

Brenner, I. (1994). The Dissociative character: A reconsideration of ‘multiple personality’. Journal of the American Psychoanalytic Association, 42, 819-846.

Fenichel, O. (1945). Character disorders. In The Psychoanalytic Theory of Neurosis (pp. 463-540). New York, NY: WWW Norton & Co.

Frayn, D.H. (2005). Premature termination issues in psychoanalytic control cases. Canadian Journal of Psychoanalysis, 3, 17-41.

Freud, S. (1913). On beginning treatment. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. 12, 123-124.

Freud, S. (1913). Recommendations to physicians practicing psychoanalysis. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. 12, 111-120.

Glover, W.C. (2000). Where do analysands come from? A candidate’s experience in recommending psychoanalysis. Journal of Clinical Psychoanalysis, 9, 21-37.

Kantrowitz, J., Singer, J. & Knapp, P. (1975). Methodology for a prospective study of suitability for psychoanalysis: the role of psychological tests. Psychoanalytic Quarterly, 44, 371-39.

Peebles-Kleiger, M. J. (2006). Psychological testing and analyzability: breathing new life into an old issue. Psychoanalytic Psychology, 23(3), 504-526.

Person, E. & Cooper, A. & Gabbard, G. (2005). Textbook of Psychoanalysis. Washington, DC; London: American Psychiatric Publishing.

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