Since 1980, our official diagnostic systems have embraced a paradigm shift with unforeseen negative clinical effects. The “neo-Kraepelinian” DSM rejected inferential, dimensional, contextual, integrative diagnosis in favor of descriptive, categorical assessment with present-versus-absent criteria sets. Personalities that had been previously understood as organized at the borderline level became the category of Borderline Personality Disorder. Individuals who suffered states of madness were seen as “having” categorical illnesses such as schizophrenia. This construction, although welcome to some researchers, has deprived therapists of the clinically useful perspective of seeing borderline and psychotic psychologies as on a continuum, involving problems with which therapists can readily identify. It has contributed to policies of medicating and “managing” patients with psychotic problems rather than also offering them psychotherapies specific to their difficulties. This workshop will explore a dimensional view of borderline and psychotic conditions, with an emphasis on implications for psychotherapy.
Learning Objectives:
At the end of this workshop, participants will be able to:
(1) apply clinically relevant ways to conceptualize borderline and psychotic elements in personality structure;
(2) construct a synthesis of several approaches to borderline personality organization, including work by Kernberg, Linehan, Fonagy, Meares, Young, and others;
(3) contrast borderline personality organization with the DSM concept of BPD;
(4) conceptualize psychosis as dimensional as well as categorical;
(5) apply this knowledge to clinical intervention with borderline and psychotic patients.
Nancy McWilliams, PhD, ABPP, teaches at Rutgers University’s Graduate School of Applied & Professional Psychology and practices in Flemington, New Jersey. She is author of Psychoanalytic Diagnosis (1994, rev. ed. 2011), Psychoanalytic Case Formulation (1999), and Psychoanalytic Psychotherapy (2004). Her books have been translated into 20 languages, and she lectures widely both nationally and internationally. She is associate editor of the Psychodynamic Diagnostic Manual (2006, and forthcoming in 2016), a former president of Division 39 (Psychoanalysis) of the American Psychological Association, and an Honorary Member of the American Psychoanalytic Association. She has been featured in three APA videos of master clinicians, the most recent being “Three Approaches to Psychotherapy.”
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