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I know some people will reject this book because “psychoanalytic” is in the title. Others will reject it because “diagnosis” is in the title. However, this essential text is highly useful to all practitioners of any theoretical orientation, if they can get past the negative stereotyping. The term “diagnosis” as used in this book is in line with the original definition of the word derived from the Greek: to distinguish, to perceive, to know thoroughly. The second part of the book title explains that the point of diagnosing is to know how to help. As McWilliams clarifies, “The main object of this book is to enhance practice” (p. 1), and that is what this book does extremely well.
Nancy McWilliams never loses the person to the diagnosis. “Once I have a good feel for the person, the work is going well, I stop thinking diagnostically and simply immerse myself in the unique relationship that unfolds between me and the client… one can throw away the book and savor individual uniqueness” (p. 7).
McWilliams writes, “I want to stress that analytic theories emphasize themes and dynamics, not traits; that is why the word ‘dynamic’ continues to apply which is the appreciation of oscillating patterns…[rather] than the list of static attributes one finds…in the compendia like the DSM” (p. 40).
“Psychoanalytic” is in contrast to the behavioral assumption that personality is made up of additive behaviors and cognitions and that symptoms are functionally autonomous and may be diagnosed and treated independently of the rest of personality. I still find it hard to imagine that any astute observer of human nature could accept such insightless psychology. But, in fact, well-developed mentalization is uncommon even among very intelligent individuals, and thus behavioral simplicity is the dominant view; hence the importance of McWilliams's text.
The Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (DSM) and the International Classi