DISTANCE LEARNING
CL713: CASE CONFERENCE IV
Fall 2009
Lynne Tylke Ph.D., Instructor
312- 201-8565 (Office)
312- 560-9204 (Cell)
lynnetylke@yahoo.com
tylke@aol.com (please use this email)
Course Description:
Goal: To expand the students clinical skills in treatment by use of process recordings. These presentations will take the form of both oral and written presentations. Mutual respect and curiosity will be required from all for students to feel safe in presenting the unfolding of their clinical material. None of us are experts and an awareness of that, will help to foster the atmosphere of collegiality.
In order to further understand the patient’s transference through our counter transference reactions we will need to examine how we see the patient diagnostically. This should help the student understand the difference in neurotic, characterological, and psychotic transferences We will use Nancy McWilliams’s books Psychoanalytic Case Formulation, Psychoanalytic Diagnosis; understanding personality structure in the clinical process, Psychoanalytic psychotherapy a practitioner’s guide.
The group process should aid the understanding of the transference/counter transference configurations thereby directing interpretations, movement, and progress or stall within the case. We will strive to understand the relevant theoretical formulations that direct our understanding of the patient and how treatment process can be understood. Unconscious communication will be tracked through associations, dreams, and covert communications and will be used to understand what the patient states and excludes. When the patient speaks we will contemplate the questions: who is speaking, to whom, about what? We will use Merton Gill’s view of transference interpretation and his book Analysis of Transference Vol.1 theory and technique.
Course Objectives:
- Contribute to creating an atmosphere of curiosity to create a safe environment to present
- Improve listening to the patient to include all forms of communication including their subjective perspective, contradictions, what is left out. And unconscious communications
- Improve the ability to track process, by noting patient reactions, resistances, in both verbal and nonverbal content.
- Improve an awareness of the patient’s self experience, how the patient sees the therapist, how the therapist sees the patient
- Improve the ability to understand the patient theoretically and use that theory to develop a strategy of how to proceed, and track how the process unfolds and either confirms the theoretical view or redirects it.
- Improve the patient’s ability to observe themselves without the interference of their own judgments or projections from a victim stance that disallows self understanding. This ability will help the patient accept and understand their behaviors, reactions, and feelings rather than encouraging the patient to discuss external problems in which they continue to see themselves as victims of another’s agenda rather than exploring how they internally react to external events and the meaning they make of their experience
- An improved ability to understand resistance, transference and counter transference development, and how to correct empathic ruptures,
Grades for the course will be Pass/Fail. Evaluations of the students will be based on:
1. Presentation of two separate case process recordings, examining how the student experiences the patient and how that leads to a potential transference interpretation. Interpretations will be “here and now” rather than genetic. If students fail to present two case process recordings they will be required to write a paper that is discussed with the professor.
2. Online discussions will start with each student taking responsibility for two of the readings and making a summary statement of the reading (5 -10 minute) and following with listing questions related to the reading and how this reading may impact the case presentation they are making that evening.
3. Students will sign up to summarize the articles (at least 2) for the same evening they have signed up for their case presentations. The case material is required by the THURSDAY prior to our TUESDAY online meeting. The process recording will be “he said, she said accounts” of the session. The sessions must be at least 45 minute sessions and a minimum of 5 pages of process. A page of history and presenting problem will precede the process recording. A statement (or paragraph) of how you see your patient diagnostically, and why will also precede the process. The diagnostic statement will follow Nancy McWilliams style of diagnosis.
4. As the class progresses we will establish an understanding of what we look at to determine diagnosis and progress in the student’s presentations will be assumed
5. Due to the heavy reading schedule we will not have a final paper unless it is determined that the student is having difficulty understanding the concepts of transference and counter transference. A final paper will be allowed to demonstrate their knowledge to ensure that they pass the class. This will be at the discretion of the instructor
6. No one will pass the class if they do not take responsibility for the summary of the article read on the night they are presenting their case presentations (twice).
7.. the quality of case presentations will determined by the student’s willingness to share their material as well as their own internal reactions in an open and forthright manner. The student’s thoughtfulness and curiosity of the process will also be considered in their grade.
8. A final paper (under 10 pages double spaced) regarding what they have learned about their patient, and the therapeutic process, will be included in their grade if they do not complete the presentations and summaries of the readings..
How grading will be formulated:
Specific presentations – ½ the grade.
Discussions in other case presentations - ¼ of the grade.
Discussion of readings - ¼ of the grade.
The final paper – if above is not completed ¼ of their grade.
How process recording will be organized:
Prior to presenting the process, information regarding the patient’s reason for coming into therapy and any relevant history should be given.
This form of process recording should emphasize a patient, therapist, patient configuration. Which would include the patient’s statement and any affect present, followed by the therapist (student) response (outward verbal and internal affective reaction), and the patient’s reaction in language, or none verbal communication.
The feeling the therapist has while sitting with the patient will be of particular importance.
The patient’s affect at any time should be noted as well as shifts in affect and what preceded the shift.
If dreams are presented, the process prior to the dream should be noted as well as the following session or response to the interpretation.
Discussion points:
- What theoretic view helps to understand this patient?
- Note how patient responds verbally and otherwise. Who is speaking (when the patient speaks), to whom, and about what?
- Who and what is being reenacted in the patient therapist dyad. Or how does the patient see the therapist?
- What is the patient saying or communicating including both conscious and unconscious content? What is not being said?
- How does the patient’s narrative fit the therapist’s understanding of their story?
Class #1: Introduction (a video of a lecture will be down loaded for this first class) I am sorry I will not be able to meet in person,. Please email me the schedule that students have signed up for.
Nancy McWilliams (1994). Why Diagnose? (Chapter 1) P7-18, (Chapter 3) p 40- 66 in Psychoanalytic Diagnosis Understanding Personality Structure in the Clinical Process. Written summaries (of 1 page for each reading) that EVERYONE will submit in an email to the instructor prior to the first meeting. That email address is Tylke@aol.com. (if there is a problem with this email send it also to Lynnetylke@yahoo.com. Sign up for presentations and article summaries for the rest of the semester.
Class #2 Student Case Presentation and Discussion
Nancy McWilliams (1994). Chapter 4 Clinical Implications of Developmental Levels of Organization p67-95, and Chapter 5 Primary (Primitive) Defense Processes P 96-116 in Psychoanalytic Diagnosis Understanding Personality Structure in the Clinical Process. Students who sign up for these two chapters should present a patient that they feel is primitively organized, or explain how they are not according to Nancy McWilliams definition.
Written summary is expected with the process recording on the Thursday in the week prior to the presentation in the following week. If the student is late in submitting the process and article summary they have to contact the instructor for an extention to Saturday am prior to our meeting on Tuesday evening
Class #3 Student Case Presentation and Discussion) Chapter 6, Secondary (Higher-Order) Defensive Processes p117-144 in Nancy McWilliams (1994) Psychoanalytic Diagnosis Understanding Personality Structure in the Clinical Process. Students who sign up for this presentation should have students they feel use more neurotic defensive structure according to Nancy McWilliams definition found in this chapter. If the patient is not neurotic the student must explain how their patient does not fit this diagnostic category
The written review of the article and process is due on the Thursday prior to the following Tuesday’s presentation
Class # 4 Student Case Presentation and Discussion and Chapter 8, Narcissistic Personalities p168-188 in Nancy McWilliams, Psychoanalytic Diagnosis Understanding Personality Structure in the Clinical Process. A student that signs up for this presentation should have a process recording of a patient that they feel fits this diagnosis and the summary of the chapter. If they do not have a narcissistic personality disorder they should explain how their patient does not fit this diagnostic category
Pay attention to the kinds of transference that is expected in this kind of patient and try to pick process recordings that include that kind of transference/counter transference configuration. Again written material of both chapter 8 summary and process recording is required on the Thursday prior to the week we meet on line
Class # 5 Student Case Presentation and Discussion and Chapter 9 Schizoid Personalities, p189-204 and Chapter 10 Paranoid Personalities p205-226 in Nancy McWilliams Psychoanalytic Diagnosis Understanding Personality Structure in the Clinical Process. The student that signs up for this presentation should present a patient who fits the schizoid or paranoid personality disorder as defined by Nancy McWilliams .
Pay attention to the kinds of transference that is expected in this kind of patient and try to pick process that includes that kind of transference/counter transference configuration. Again written material is to be sent the Thursday prior to the week you are presenting
Class #6 Student Case Presentation and Discussion and Chapter 11 Depressive and Manic Personalities p 227-256 in Nancy McWilliams Psychoanalytic Diagnosis Understanding Personality Structure in the Clinical Process. Written summaries of chapters 11 is required to be submitted the Thursday prior to the week we are meeting on line. Students who sign up should feel that they are presenting a depressed or manic personality or why their patient is not.
Written chapter summary and process recording is required on the Thursday prior to the week we meet on line
Class #7 Student Case Presentation and Discussion and Chapter 12 Masochistic (self-defeating personalities) p257-278 and chapter 14 Hysterical (Histrionic) Personalities. In Nancy McWilliams Psychoanalytic Diagnosis Understanding Personality Structure in the Clinical Process.
Students who sign up for this presentation should have either a self defeating personality or Hysterical personality to present or explain how their patient does not fit either of these diagnostic categories.
Written presentations of the chapters 12 and 14 and process recording is required on the Thursday prior to the week we meet online.
Class # 8 (Final class) Two Student Case Presentations and Discussion. Chapter 15 Dissociative Personalities p 323-347 and Chapter 13 Obsessive and Compulsive Personalities p279-300. Each student who signs up for this last class should present a patient and their process that fits either a dissociative personality or OCD patient. Reviews of Chapters, and process recordings from each of the students are required to be submitted to all by the Thursday prior to the week we meet on line.
Chapter reviews and process recordings are required earlier (On the Monday the week prior to our last meeting) as we will be emailing our discussion to each other prior to the class. All students are required to email at least one statement regarding the chapters and/or the written summaries. .
Each student should present a patient that fits the category of the chapter they have summarized. Have a happy break and look forward to our next semester in when we will be discussing more transference and counter transference reactions more specifically.