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In the world of psychoanalytic education, any contribution that promotes diagnostic rigor and the importance of a comprehensive psychodynamic formulation is a boon. In this respect, Nancy McWilliams's Psychoanalytic Case Formulation has the potential to be a worthwhile addition to the armamentarium of books for students of psychoanalysis. The book is an ambitious attempt to outline the areas that psychoanalytic practitioners should address in order to most fully understand their patients' dynamics. Her outlines are often cogent, and her attempt to integrate psychoanalytic theory with other frameworks such as cognitive and biological theories is laudable. However, the book's many oversubjective notions may make educators want to read it carefully before assigning it to students.
McWilliams has organized her book around different areas for assessment, including what cannot be changed, developmental issues, defense, identifications, relational patterns, self-esteem, and pathogenic beliefs. She is to be commended for including several areas, such as affect, ego strength, and temperament, that are sometimes given short shrift in psychoanalytic formulations. Welcome, too, is her inclusion of ideas generated by cognitive science, infant research, and neuroscience.
Many of McWilliams's overviews are strong and could be used with various sorts of students. Her straightforward language, as illustrated in her title choices, makes the book user-friendly for even the most junior student. Her introductory chapter, with its excellent overview of the goals of psychoanalytic therapy, could be a very useful section for teachers, particularly of psychiatric residents. Her review of developmental theory in chapter 4 is comprehensive and easy to digest. The entire book has an informal, chatty style reminiscent of a seminar, and McWilliams generously includes examples drawn from her life and practice.
The book is nevertheless problematic in several important ways. While McWilliams never hes