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Diamond, D. (2012). Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process, Second Edition, by Nancy McWilliams, New York, NY: Guilford Press, 2011, 426 pp., $60.. Psychoanal. Psychol., 29(4):494-504.
(2012). Psychoanalytic Psychology, 29(4):494-504
Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process, Second Edition, by Nancy McWilliams, New York, NY: Guilford Press, 2011, 426 pp., $60.
Review by: Diana Diamond, Ph.D.
The second edition of Nancy McWilliams's book Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process, is a timely update and expansion of this classic text on diagnosing and treating psychopathology from a contemporary psychoanalytic perspective. The book begins with a useful overview of psychoanalytic theories from classical drive theory to object relations to ego psychology to the relational turn in psychoanalysis. McWilliams evaluates the contributions and limitations of each perspective and shows how they are both continuous and discontinuous from each other, achieving the near-impossible task of taking a neutral stance about the contributions of each. McWilliams then interweaves these diverse psychoanalytical theoretical strands into a comprehensive and luminous tapestry of personality types, including the antisocial, depressive, narcissistic, paranoid, schizoid, obsessive-compulsive, self-defeating histrionic-hysterical, and dissociative pathologies. Her consideration of drive, object relations, self-formation, and relational patterns for each diagnostic category produces a much richer, more complex, and multitextured portrait of each personality type than one finds in texts written from a unified or unilateral theoretical perspective. The psychoanalytic pluralism evident in this volume very much reflects the current trends in clinical psychoanalysis(Wallerstein, 1995). In addition the second edition is greatly enriched by the integration of research on the neurobiological substrates of different forms of pathology, on the attachment patterns that may pose risk factors for the development of psychological disorders, and on the internal working models of attachment that are associated with them in adolescences and adulthood. Although there are some shortcomings in this integrative approach that will be delineated later, the result is a vast and coherent canvas that sketches out the broad details of personalitydevelopment and its pathological formations in a volume that has a broad appeal to clinicians and clinical scholars from a variety of theoretical perspectives.
Unlike most psychoanalytic theorists who tend to be relatively ahistorical about their own theory and technique, McWilliams begins with a trenchant statement about the
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