The Institute for Clinical Social Work


Syllabi Archive

CLDL 731: Disorders of Adulthood I

Ph.D. Program - Distance Learning: spring 2012-13


Joan Servatius, PhD


Course Description

This course focuses on the disorders of adulthood, the treatment of the disorders and the intrinsic relationship to the development of psychodynamic theory from drive, object relations and self psychology perspectives. It explores the synergistic and dynamic relationship among the developments of psychoanalytic theories of the mind, theories of pathology, and clinical practice theories. We will be establishing a foundation for treating and understanding the neurotic, the character and the psychotic disorders. The class will build upon previous courses.

We will explore the ways in which Freud’s abandonment of the seduction theory in 1897 and the subsequent development in 1900 of the topographical model, followed by the theories on infantile sexuality, the theories on the types of neurosis, the dynamics of the structural model, and the theories of anxiety in 1926 make it possible to formulate a comprehensive theory of neurosis. We focus on the phobic neurosis, the obsessive neurosis, and the hysterical neurosis and consider the ways in which hysteria is used as a paradigm for all neuroses. We will think about disorders from the perspective of the drives, defenses, psychosexual development, anxiety, object relations, and the experience of the self. We will also consider approaches to treatment.

We will then shift to the character disorders. Melanie Klein’s concepts of the paranoid schizoid position and the depressive position enable us to conceptualize character disorders as a bridge between the neuroses and psychoses. We will look at intensification and expansion of symptom patterns in borderline personality disorder, the narcissistic personality disorder and the schizoid personality disorder. Character formation and disorders will be considered from the perspectives of Klein, Kohut, and Winnicott. We will think about these disorders from the perspective of drives, defenses, psychosexual development, anxieties, object relations and the experience of the self. We will also consider approaches to treatment.

As we move on to the psychotic disorders, we will consider Freud’s theories of psychosis. We will also return to Klein’s concept of the paranoid schizoid position. An effort will also be made to add Bion’s concept of projective identification and Ogden’s 4 phase model of the resolution of the schizophrenic conflict. We will use Ogden’s 4 phases not only to help understand the dynamics of psychotic disorders, but also to provide a model for treatment. Again, we will look at psychosis from the perspective of drive, defenses, psychosexual development, anxieties, object relations, and the experience of the self.


Goals

  1. Establish a psychodynamic understanding of the etiology of neurotic, psychotic, and character disorders in adulthood.
  2. Identify treatment techniques associated with specific disorders.
  3. Augment understanding of the dynamic and shifting relationships among theory, diagnosis, treatment and the contribution of historical content.
  4. Increase ability to convey diagnostic understanding in both written and oral communication.

Evaluation

Grades will be based 1/3 on class participation and 1/3 on each of 2 written assignments.

Class participation includes:

  1. Evidence of reading the assigned readings - this includes raising questions about the readings and the demonstration of an effort to relate clinical experience to concepts presented in the readings. You should choose 2-3 readings per class that are appropriate to your own comfort with the subject.
  2. Class attendance is mandatory, although it is understood that emergencies, illnesses, etc. happen. Please call me to make arrangements in the event that you are prevented from attending. More than one (1) absence will cause your grade to be lowered one level and missing more than two (2) classes will result in a Failing (F) grade. (In the event of personal emergency, a withdrawal may be recommended and the course may be re-taken.)

Written Assignments

Think about either character, Hilary or Jackie, from the movie “Hilary and Jackie”.
Using one of these characters, the class readings and discussions, please apply and discuss the diagnosis you feel is appropriate.

Assignment 1 --- Due at the beginning of the 4th class.
Imagine it is 1926. You would have been part of Freud’s inner circle since its beginning in 1895. The world famous cellist, Jacqueline DuPre, or her sister, Hilary, seeks your help for a variety of problems. Using the readings and class discussion write a diagnosis and explain it in terms of theory. You will need to reference the course material. Discuss the etiology and course of the illness. You must connect the theory with clinical understanding so you will need to use character examples to illustrate your points. This paper should be no more than 6 double-spaced pages long.

Assignment 2 --- Due the last day of class
It is now 1980. Freud has been dead for many years. Your studies have immersed you in the works of Klein, Winnicott, Kernberg and others identified with the object relations perspective. You are also intrigued by the works of Kohut and the disorders of the self. Once again Jacqueline or Hilary seeks your help. You must now reconsider the case, this time from the perspective of character disorders we have discussed in class. Choose the diagnostic category that you think fits best and explain why you think this and why rule out others. (This is a differential diagnosis.)
AGAIN, remember this is a course that connects theory and clinical understanding, so be sure to maintain a good balance. Use the character to illustrate your points.
This paper should be no more than 10 double-spaced pages.

Written work will be assessed as follows:

A - This is a paper that reflects a high degree of understanding and demonstrates creativity or critical thinking. It must be well organized, clear, and edited for correct grammar and spelling.

B - This is a paper that shows a high degree of accuracy in understanding and application of concepts. It must be well organized and edited for correct spelling and grammar.

C - This is a paper that is written with insufficient depth and demonstrates only an adequate understanding of the material. This grade may also be given for poorly organized material, lack of clarity or insufficient editing.

F - This grade will be given to papers that reflect major conceptual misunderstandings.

All papers must conform to the ICSW Style Manual.


Texts

Gabbard, G. (1994). Psychodynamic Psychiatry in Clinical Practice. Washington: American Psychiatric Press.

McWilliams, N. (2011) OR (1994 if you already have it). Psychoanalytic Diagnosis. New York: Guilford Press


Classes and Assignments

Class 1: NEUROSIS AND NEUROTIC DISORDERS

McWilliams, N. (2011). Why Diagnose? In Psychoanalytic diagnosis (pp. 7 -18) New York: Guilford Press.

Freud, S. (1912). Types of onset of neurosis. In J. Strachey (Ed and Trans.) The standard edition (Vol. 12, pp. 227-239). London: Hogarth Press. (Original work published in 1912). PEP

PDM Task Force (2006). Symptom Patterns: The Subjective Experience. In Psychodynamic diagnostic manual (pp. 93 -141). Silver Springs, Maryland: Alliance of Psychoanalytic Organizations.

Class 2:

Freud, S. (1961). The Ego and the Id. In J Strachey (Ed and Trans.) The standard edition (Vol 12, pp. 123 – 180). London: Hogarth Press. (Original work published in 1912) PEP

McWilliams, N. (2011). Developmental Theories of Personality Organization. In Psychoanalytic diagnosis. (Chapter 3, pp. 40 – 66). New York: Guilford Press.

Class 3:

Greenberg, J. and Mitchell, S. (1983). Melanie Klein. In Object relations in psychoanalytic theory (Chapter 5, pp. 119 – 150). Cambridge, Mass: Harvard University Press.

Gabbard, G. (1994). Anxiety disorders. In Psychodynamic psychiatry in clinical practice (pp. 249 – 289). Washington: American Psychiatric Press.

Class 4: CHARACTER DISORDERS

Gabbard, G. (1994). Cluster B personality disorders: Hysterical and Histrionic. In Psychodynamic Psychiatry in Clinical Practice. (pp. 555 – 588).Washington: American Psychiatric Press.

Winnicott, D. (1958). The Depressive Position in Normal Emotional Development (pp. 262-277). Through pediatrics to psychoanalysis. New York: Basic Books. PEP

Class 5

Bollas. (1999). Borderline desire. In The mystery of things (pp.127-135). London: Routledge.

Gabbard, G. (1994). Cluster B personality disorders: borderline AND Cluster B personality disorders: narcissistic. In G. Gabbard, Psychodynamic psychiatry in clinical practice, (pp. 449-526). Washington: American Psychiatric Press.

McWilliams, N. (2011). Narcissistic Personalities. In Psychoanalytic diagnosis. (Chapter 8, pp. 168 – 188). New York: Guilford Press.

Meissner, W. (1979). Narcissistic personalities and borderline conditions: A Differential Diagnosis. Annual of Psychoanalysis. 7: 171-203. PEP

Summers, F. (1994). The Work of D. W. Winnicott. In Object relations theories and psychopathology (pp. 137 – 190). Hillsdale, NJ: The Analytic Press.

Class 6

Bollas, C. (2000). The characters of psychoanalysis. In Hysteria (pp. 4 – 12). New York and London: Routledge

Clark, Karla R. (1996). The beginning phases of treatment of the schizoid disorder of the self: a developmental, self, and object relations perspective. In J. Edwards and J. Sanville (Eds.) Fostering healing and growth; a psychoanalytic social work approach (pp 125-151). New Jersey: Jason Aronson.

Gabbard, G. (1994). Cluster A personality disorders: paranoid, schizoid and schizotypal. In G. Gabbard, Psychodynamic psychiatry in clinical practice, (pp. 419 – 448). Washington: American Psychiatric Press.

Summers, F. (1994). The Work of Heinz Kohut. In Object relations theories and psychopathology (pp. 247 – 310). Hillsdale, NJ: The Analytic Press.

Class 7: Psychoses

Freud, S. (1962). Neurosis and Psychosis, In J. Strachey (Ed and Trans.) The standard edition (Vol. 19, pp. 147-155 ). London: Hogarth Press. (Original work published in 1924) PEP

Ogden, T. (1980). The Nature of Schizophrenic Conflict. International Journal of Psychoanalysis, 61: 513-534. PEP

Winnicott, D. (1974). Fear of Breakdown. International Journal of Psychoanalysis, 61:513-534. PEP

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