Psychoanalytic Diagnosis

Organization of class today Learn new definitions and information about theories to help you more fully understand the reading Analytic conceptualization 2 Axis Diagnosis (not the DSM type, but analytic) Defenses (Primary and Secondary) The developmental process Diversity issues Normal Character vs Traits vs Personality Disorder Conceptualization and Treatment

Analytic Conceptualization All people have a “style”, personality or temperament All people can be seen as falling into a few different types of styles, some have “traits” and others have Personality Disorders By understanding the style, level of functioning (Axis II), and Axis I Diagnosis (if one exists), we can use this conceptualization to understand an important aspect of most people. Never forget…this is one aspect of a whole person taught to help you in your future work. Never identify a person as a classification or Dx

2 Axis Diagnosis DSM thought Organization Therapy Cluster C Neurotic Uncovering Cluster B Borderline Expressive Cluster A Psychotic Supportive However, analytic theory understands that any personality disorder or style can have any organization. Thus an OCPD (cluster C) can be functioning at a Borderline level. We are looking at the person along the lines of both and therapy is conducted at their level of organization.

Secondary (More Mature) Primary vs. Secondary Defenses You will read about each defense mechanism in detail next week and we will discuss them then. Primary (Primitive) Primitive Withdrawal, Denial (by Itself), Omnipotent Control, Projection, Introjection, and Projective Identification, Splitting, and Dissociation Secondary (More Mature) Denial (as a part of the more mature defenses), Repression, Regression, Isolation, Intellectualization, Rationalization, Moralization, Compartmentalization, Undoing, Turning Against the Self, Displacement, Reversal, Reaction Formation, Identification, Acting Out, Sexualization, and Sublimation

All Development (give copy of Mahler Model) All development follows a similar pattern that can be seen in the development of the defenses from childhood thru adulthood Fusion- It is all one. Trouble separating what comes from inside and what comes from outside the self. (psychotic organization) I’m angry, therefore you are angry Dichotomies- It is one or the other. Trouble separating who you are from who they are. (borderline organization) I’m angry, therefore YOU made me angry and are bad OR It’s my fault, you are good and I am bad for getting angry. (BLAME) Integration- I am me and you are you and we are both ok, just different. (neurotic organization) I’m angry, I need to deal with my reactions. I feel angry when you walk out of a conversation because it makes me think I’m unimportant to you. The problem becomes outside of the people involved and is something to work with.

A Piece of Counselor Development Stage 1 Fusion: I know everything you know…I’m just here to get the piece of paper (omnipotence) Stage 2: Crisis: I don’t know what to do. I don’t know how to handle this! (anxiety) Stage 3 Dichotomies: I don’t know anything. I suck as these vary a therapist. (devalue self) session to Projection & devaluation: The client is difficult session (bad) Stage 4: I don’t know everything, My client is difficult. But, I’m in training, So it’s ok (rationalization) Stage 5 Integration: I know some things and don’t know others. It is ok to not always know, I am still valuable by virtue of being a person. My client has difficulties, but they also have strengths and are valuable by virtue of being a person.

Another Example Stage 1 Fusion: ( Primary Idealization): My supervisor knows all, thus I will know all Stage 2: Crisis: My supervisor does not know everything (anxiety) Stage 3 Dichotomies: (Primary Devaluation): My supervisor sucks! Denial and Idealization: Someone will know everything, who do I go to? (Withdrawal): I quit being a therapist, I’m more messed up than my clients. (Denial): my supervisor does know everything, how will I force them to tell me, there has to be a right way to work with this client (vs. a wrong way) Stage 4: Wait, my supervisor doesn’t know everything, but they can still be helpful at times. I didn’t really need a perfect supervisor, I know things too, and some things you just figure out along the way . (Rationalization) Stage 5 Integration: My supervisor is another person like me, just with more experience. We are both fallible and have strengths and weaknesses. Sometimes there is no “correct” way, but several ways that all have pros and cons

Now you do this for the beginning of your last or previous relationship Anytime you take on a new identity or role this can occur. This knowledge can help you cope during the process or choose to leave (which is different from running away in fear) Some people get stuck at certain levels and their personality develops around that level of viewing the world in a fixed way. Everyone does some of these things some of the time, this is healthy. Under stress we all regress. Can you identify healthy “splitting”?

For Example The Narcissist is likely to be stuck in the dichotomies and thus their self esteem is very fragile I’m good/Your bad or I’m bad/Your good Utilize Idealization and Devaluation The Antisocial is likely to be stuck in fusion, thus there is no “other” (I’m Omnipotent) I am the world (Power) Utilize omnipotent control, acting out, some dissociation and projective identification

Middle Age, White, middle to upper class client (ethnocentrism) Of course ALWAYS remember Diversity Issues were not a part of developing Analytic theory and most theory developed out of analytic theory Middle Age, White, middle to upper class client (ethnocentrism) Women and Power (sexism) Collective vs. Individual Identities (racism) Developmental process Effects of Oppression (racism) Effects of disability on development (ableism) Generational effects (ageism) Sexual Orientation and Gender Identity (heterosexism) Effects of Poverty (classism)

The Basic Systems approach

By W. Huitt

Expanding Mahler Mahler and Freud tend to focus on the early years. How can we make sense of this in today’s understanding of development and the isms?

Personality Disorder vs Normal Behaviors Give handout

Conceptualizing vs. Treating