Podcast
Questions and Answers
What does the Psychodynamic Diagnostic Manual aim to address?
What does the Psychodynamic Diagnostic Manual aim to address?
- Replace classical psychoanalytic theories.
- Fill in gaps left by previous theories. (correct)
- Offer a method for empirical measurement.
- Provide a comprehensive treatment framework.
How did classical psychoanalytic theory primarily approach personality in the era of Freud's original drive theory?
How did classical psychoanalytic theory primarily approach personality in the era of Freud's original drive theory?
- Through understanding defense mechanisms.
- In terms of cognitive functioning.
- Based on fixation and developmental phases. (correct)
- By analyzing relational models.
Which of the following theories added to Freud's original drive theory by focusing on defense mechanisms?
Which of the following theories added to Freud's original drive theory by focusing on defense mechanisms?
- Cognitive theory.
- Behaviorism.
- Ego psychology. (correct)
- Attachment theory.
What is a key aspect of personality as understood by relational models in psychoanalysis?
What is a key aspect of personality as understood by relational models in psychoanalysis?
Which of the following is NOT mentioned as a formulation that enriches understanding of personality?
Which of the following is NOT mentioned as a formulation that enriches understanding of personality?
What is a common misconception about the two approaches in classical psychoanalytic theory?
What is a common misconception about the two approaches in classical psychoanalytic theory?
What aspect of personality does the Shedler-Westen Assessment Procedure (SWAP) measure?
What aspect of personality does the Shedler-Westen Assessment Procedure (SWAP) measure?
Which of the following statements about psychoanalytic character diagnosis is true?
Which of the following statements about psychoanalytic character diagnosis is true?
What has current psychoanalytic writing emphasized regarding borderline dynamics?
What has current psychoanalytic writing emphasized regarding borderline dynamics?
Which anxiety is most prevalent for individuals in the psychotic range?
Which anxiety is most prevalent for individuals in the psychotic range?
What is a common theme that individuals with borderline personality organization focus on?
What is a common theme that individuals with borderline personality organization focus on?
Which instrument is mentioned as being used for diagnosing borderline character structure?
Which instrument is mentioned as being used for diagnosing borderline character structure?
What is a significant factor that differs across individuals with borderline conditions?
What is a significant factor that differs across individuals with borderline conditions?
What characterizes anxiety in neurotic individuals?
What characterizes anxiety in neurotic individuals?
What has influenced the paradigm shift in understanding personality organization?
What has influenced the paradigm shift in understanding personality organization?
Which system is activated in individuals experiencing separation anxiety?
Which system is activated in individuals experiencing separation anxiety?
What aspect of therapy do neurotic-level clients generally seek to improve?
What aspect of therapy do neurotic-level clients generally seek to improve?
What does Freud suggest is the primary goal of therapy for neurotic-level clients?
What does Freud suggest is the primary goal of therapy for neurotic-level clients?
How do therapists generally feel when working with neurotic-level clients?
How do therapists generally feel when working with neurotic-level clients?
Which statement best describes the behavioral adaptations of neurotic-level individuals as discussed?
Which statement best describes the behavioral adaptations of neurotic-level individuals as discussed?
How does the situation differ between neurotic-level and psychotic-level individuals?
How does the situation differ between neurotic-level and psychotic-level individuals?
Which development stage is notably referenced in the context of neurotic-level individuals?
Which development stage is notably referenced in the context of neurotic-level individuals?
What might a therapist expect regarding countertransference when working with neurotic-level clients?
What might a therapist expect regarding countertransference when working with neurotic-level clients?
What can be said about the behaviors of a deeply disturbed patient at the psychotic level?
What can be said about the behaviors of a deeply disturbed patient at the psychotic level?
What is a prominent emotional issue that borderline patients face?
What is a prominent emotional issue that borderline patients face?
How does identity confusion differ between borderline and psychotic individuals?
How does identity confusion differ between borderline and psychotic individuals?
What differentiates borderline patients from psychotic individuals in terms of their reaction to identity questions?
What differentiates borderline patients from psychotic individuals in terms of their reaction to identity questions?
What was Kernberg's recommendation regarding the assessment of patients for differential diagnosis?
What was Kernberg's recommendation regarding the assessment of patients for differential diagnosis?
What does the term 'primitive defenses' refer to in the context of borderline and psychotic individuals?
What does the term 'primitive defenses' refer to in the context of borderline and psychotic individuals?
Focus solely on the patient's emotional expressiveness.
Focus solely on the patient's emotional expressiveness.
Which approach did Kernberg suggest for investigating a patient's self-presentation?
Which approach did Kernberg suggest for investigating a patient's self-presentation?
Which feature is commonly found in both borderline and psychotic individuals?
Which feature is commonly found in both borderline and psychotic individuals?
What might psychotic individuals feel towards their therapist who offers more than diagnosis and medication?
What might psychotic individuals feel towards their therapist who offers more than diagnosis and medication?
Which emotional response is commonly felt by therapists when working with psychotic patients as opposed to neurotic patients?
Which emotional response is commonly felt by therapists when working with psychotic patients as opposed to neurotic patients?
What is a concern therapists face when working with psychotic patients regarding their emotional dependence?
What is a concern therapists face when working with psychotic patients regarding their emotional dependence?
How do psychotic individuals typically respond to a therapist's sincerity?
How do psychotic individuals typically respond to a therapist's sincerity?
What behavior might therapists expect from psychotic patients due to their desperation for respect?
What behavior might therapists expect from psychotic patients due to their desperation for respect?
What risk is associated with the affectionate response therapists feel toward psychotic patients?
What risk is associated with the affectionate response therapists feel toward psychotic patients?
How are psychotic individuals compared to infants by therapists in terms of emotional needs?
How are psychotic individuals compared to infants by therapists in terms of emotional needs?
What aspect of psychotic patients can evoke a sense of positivity in therapists?
What aspect of psychotic patients can evoke a sense of positivity in therapists?
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Study Notes
Psychoanalytic Character Diagnosis: Classical Approaches
- Classical psychoanalytic theory viewed personality through two lenses: fixation at early developmental stages and characteristic defense styles.
- Ego psychology added to drive theory by focusing on how individuals develop adaptive and defensive patterns.
- Relational models (British object relations, American interpersonal psychoanalysis, self psychology) enrich the understanding of character organization.
- The author's understanding of personality is also informed by Jungian archetypes, Murray's personology, Tomkins's script theory, control-mastery theory, and empirical research (attachment, cognitive and affective neuroscience).
Diagnostic Paradigms in Psychoanalysis
- The author utilizes multiple, potentially contradictory, psychoanalytic paradigms in diagnosis.
- Empirical findings on infant development, attachment, and trauma have challenged the notion of fixation at normative developmental phases.
- Despite varied etiologies, a consensus exists on the clinical manifestations of borderline personality organization.
- Structured interviews (e.g., Kernberg's structural interview, STIPO) aid in the diagnosis of borderline character structure.
Developmental Levels of Personality Organization
- Individuals vulnerable to psychosis may be preoccupied with early symbiotic phase issues (trust).
- Borderline personality organization is characterized by a focus on separation-individuation themes.
- Neurotic structures involve more internalized conflicts (Oedipal).
- Central anxieties differ across levels: fear of annihilation (psychotic), separation anxiety (borderline), unconscious conflict (neurotic). These anxieties relate to activation of specific brain systems (FEAR, PANIC).
Characteristics of Neurotic-Level Personality Structure
- Neurotic individuals have generally successfully navigated Erikson's first two stages (basic trust, autonomy).
- They seek therapy due to conflicts between desires and perceived self-imposed obstacles.
- The therapeutic alliance is typically strong, with therapist and patient united against problematic aspects of the patient's personality.
- Countertransference is usually manageable, neither overwhelmingly positive nor negative.
Characteristics of Psychotic-Level Personality Structure
- Psychotic individuals exhibit internal desperation and disorganization.
- They may lack a strong sense of separate existence.
- Therapists may experience positive countertransference (omnipotence, protectiveness, empathy).
- Psychotic patients may be appreciative of sincerity, educational efforts, and normalization of their preoccupations.
- The countertransference resembles maternal feelings toward infants.
Characteristics of Borderline-Level Personality Structure
- Borderline patients struggle with affect tolerance and regulation, often expressing anger where others might feel other emotions.
- Their sense of self is inconsistent but not marked by the existential terror of psychotic individuals.
- They are more likely to react with hostility to questions about identity.
- Borderline individuals, despite symptoms, demonstrate an understanding of reality (adequate reality testing).
- To differentiate borderline from psychotic, assessing their appreciation of conventional reality is key (e.g., by commenting on unusual behaviors).
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