Psychoanalytic diagnosis: understanding personality structure in the clinical process (2nd ed.)

This is the second edition of Nancy McWilliams' readable and accessible book which delineates her psychoanalytically informed approach to the diagnosis of personality patterns, an essential tool for the mental health professional working with personality pathology. McWilliams' is a rare achievement, offering a clear and understandable text in what is ultimately a textbook, the likes of which can oftentimes be rather dry and incomprehensible. She situates character disorder within a psychological and social context, on a continuum with normality, thereby shifting the focus of diagnosis from a stagnant set of behavioural characteristics, to a lively, interactional and developmental context which takes better account of the person as a whole. There are some parts of the book which stretch the notion of ‘psychoanalytic’ beyond the point with which many would agree, and this may relate to differing Anglo and American cultural perspectives.

The two words in the title designate the areas addressed by the text and show the conflicts and tensions the book tries to bridge. The term ‘psychoanalytic’ denotes the book as having its roots in a relational approach incorporating the unconscious and defence mechanisms, and the term ‘diagnosis’ indicates McWilliams' desire to speak to a wider audience within the mental health field. Bringing together these two worlds is a difficult and challenging task, but for the most part, McWilliams does this admirably. She achieves this by speaking a plain language, which is not only engaging and accessible, but also captures an underlying complexity.

The book will be of value to both mental health professionals who wish to deepen their understanding of personality pathology, and psychotherapists who want to improve their understanding of diagnosis. The book sits at the interface of generic mental health and psychoanalysis, drawing from and enriching both disciplines. Inevitably perhaps, the book is written more for one community than another. McW