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These are times when we speak of psychoanalytic theories rather than psychoanalytic theory, and psychoanalytic techniques rather than technique. We also have empirical research findings to illuminate our understanding or perhaps to confuse us. An individual clinician must select and integrate the relevant factors in each case he or she sees. No wonder case formulation can be daunting to even the most experienced psychoanalytic psychotherapist. Thanks to Nancy McWilliams we have a readable text to teach students psychodynamic case formulation, one well sprinkled with clinical ‘pearls’ gained from the author's own extensive experience doing psychotherapy and psychoanalysis.
McWilliams aims to teach what is usually passed on through supervision. She writes to instruct the reader how to sail through the narrow strait between the Scylla of DSM diagnosis called for by third-party payers and the Charybdis of an irresponsible subjectivity that claims case formulation is unnecessarily academic. A professor of psychology, McWilliams also hopes to bring psychoanalytic ideas into classrooms where they have not been welcome previously. She is mindful of the limitations of assessment and treatment. She takes the position that part of a dynamic formulation is recognising those patients who cannot be treated with even the most encompassing psychodynamic approaches.
McWilliams believes that ‘it is more important for the clinician to understand people than to master specific treatment techniques’ (p. 9). One might think that she is thereby placing an empathic bartender on a par with a well-trained analyst. Her target is actually ‘empirically validated treatments’, the manualised treatments designed for specific diagnoses that take no heed of a patient's individual and highly personal concerns. Consequently McWilliams sees treatment objectives for a given patient as enhancing his or her sense of agency, solidifying a sense of identity, increasing realistically based self-esteem, develop