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Contents

About the Author

Acknowledgments

Introduction

A Comment on Terminology

A Comment on Tone

PART I. CONCEPTUAL ISSUES

1 Why Diagnose?

Psychoanalytic Diagnosis versus Descriptive Psychiatric Diagnosis

Treatment Planning

Prognostic Implications

Consumer Protection

The Communication of Empathy

Forestalling Flights from Treatment

Fringe Benefits

Limits to the Utility of Diagnosis

Suggestions for Further Reading

2 Psychoanalytic Character Diagnosis

Classical Freudian Drive Theory and Its Developmental Tilt

The Object Relations Tradition

Self Psychology

The Contemporary Relational Movement

Other Psychoanalytic Contributions to Personality Assessment

Suggestions for Further Reading

3 Developmental Levels of Personality Organization

Historical Context: Diagnosing Level of Character Pathology

Overview of the Neurotic–Borderline–Psychotic Spectrum

Suggestions for Further Reading

4 Implications of Developmental Levels of Organization

Therapy with Neurotic-Level Patients

Therapy with Patients in the Psychotic Range

Therapy with Borderline Patients

Interaction of Maturational and Typological Dimensions of Character

Suggestions for Further Reading

5 Primary Defensive Processes

Extreme Withdrawal

Omnipotent Control

Extreme Idealization and Devaluation

Projection, Introjection, and Projective Identification

Splitting of the Ego

Acting Out (Defensive Enactment)

Sexualization (Instinctualization)

Extreme Dissociation

Suggestions for Further Reading

6 Secondary Defensive Processes

Isolation of Affect

Intellectualization

Rationalization

Compartmentalization

Turning against the Self

Reaction Formation

Concluding Comments

Suggestions for Further Reading

PART II. TYPES OF CHARACTER ORGANIZATION

7 Psychopathic (Antisocial) Personalities

Drive, Affect, and Temperament in Psychopathy

Defensive and Adaptive Processes in Psychopathy

Relational Patterns in Psychopathy

The Psychopathic Self

Transference and Countertransference with Psychopathic Patients

Therapeutic Implications of the Diagnosis of Psychopathy

Differential Diagnosis

Suggestions for Further Reading

8 Narcissistic Personalities

Drive, Affect, and Temperament in Narcissism

Defensive and Adaptive Processes in Narcissism

Relational Patterns in Narcissism

The Narcissistic Self

Transference and Countertransference with Narcissistic Patients

Therapeutic Implications of the Diagnosis of Narcissism

Differential Diagnosis

Suggestions for Further Reading

9 Schizoid Personalities

Drive, Affect, and Temperament in Schizoid Psychology

Defensive and Adaptive Processes in Schizoid Psychology

Relational Patterns in Schizoid Psychology

The Schizoid Self

Transference and Countertransference with Schizoid Patients

Therapeutic Implications of the Diagnosis of Schizoid Personality

Differential Diagnosis

Suggestions for Further Reading

10 Paranoid Personalities

Drive, Affect, and Temperament in Paranoia

Defensive and Adaptive Processes in Paranoia

Relational Patterns in Paranoid Psychology

The Paranoid Self

Transference and Countertransference with Paranoid Patients

Therapeutic Implications of the Diagnosis of Paranoid Personality

Differential Diagnosis

Suggestions for Further Reading

11 Depressive and Manic Personalities

Depressive Personalities

Drive, Affect, and Temperament in Depression

Defensive and Adaptive Processes in Depression

Relational Patterns in Depressive Psychology

The Depressive Self

Transference and Countertransference with Depressive Patients

Therapeutic Implications of the Diagnosis of Depressive Personality

Differential Diagnosis

Hypomanic (Cyclothymic) Personalities

Drive, Affect, and Temperament in Mania

Defensive and Adaptive Processes in Mania

Relational Patterns in Manic Psychology

Transference and Countertransference with Manic Patients

Therapeutic Implications of the Diagnosis of Hypomanic Personality

Differential Diagnosis

Suggestions for Further Reading

12 Masochistic (Self-Defeating) Personalities

Drive, Affect, and Temperament in Masochism

Defensive and Adaptive Processes in Masochism

Relational Patterns in Masochistic Psychology

The Masochistic Self

Transference and Countertransference with Masochistic Patients

Therapeutic Implications of the Diagnosis of Masochistic Personality

Differential Diagnosis

Suggestions for Further Reading

13 Obsessive and Compulsive Personalities

Drive, Affect, and Temperament in Obsession and Compulsion

Defensive and Adaptive Processes in Obsession and Compulsion

Relational Patterns in Obsessive and Compulsive Psychologies

The Obsessive–Compulsive Self

Transference and Countertransference with Obsessive and Compulsive Patients

Therapeutic Implications of the Diagnosis of Obsessive or Compulsive Personality

Differential Diagnosis

Suggestions for Further Reading

14 Hysterical (Histrionic) Personalities

Drive, Affect, and Temperament in Hysteria

Defensive and Adaptive Processes in Hysteria

Relational Patterns in Hysterical Psychology

The Hysterical Self

Transference and Countertransference with Hysterical Patients

Therapeutic Implications of the Diagnosis of Hysterical Personality

Differential Diagnosis

Suggestions for Further Reading

15 Dissociative Psychologies

Drive, Affect, and Temperament in Dissociative Conditions

Defensive and Adaptive Processes in Dissociative Conditions

Relational Patterns in Dissociative Conditions

The Dissociative Self

Transference and Countertransference with Dissociative Patients

Therapeutic Implications of the Diagnosis of a Dissociative Condition

Differential Diagnosis

Suggestions for Further Reading

Appendix. Suggested Diagnostic Interview Format

Demographic Data

Current Problems and Their Onset

Personal History

Current Presentation (Mental Status)

Concluding Topics

Author Index

Subject Index

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