PSPP Winter 2009 Program: Helping People with Paranoid Dynamics: What the DSM Doesn’t Tell You

  • 31 Jan 2009
  • 8:45 AM - 3:30 PM
  • St. Joseph's University's Haub Center

A PSPP day long program with
Nancy McWilliams, Ph.D.

Cosponsored by the Counseling Center of St. Joseph’s University

Program Description

The constellation of processes that we label paranoia is particularly unsuited to representation by externally observable criteria sets like those of the DSM. Psychoanalysts have followed Freud in viewing paranoia as an intrapsychic process characterized by projection and disavowal. The term, whose roots suggest “a mind outside itself,” refers to states in which a person finds it difficult to distinguish what is inside from what is outside the self. Such confusion is the hallmark of several clinical syndromes, not just persecutory preoccupations. Etiologically, paranoid trends may represent inadequate psychological separation from a caregiver to whom the patient was anxiously attached; they seem to arise in contexts of humiliation. Fears of attack and seduction may infiltrate the shared therapeutic space, easily paralyzing both therapist and patient. Although most visible in psychotic conditions, paranoid states of mind are common in high-functioning people. Dr. McWilliams will critique descriptive diagnostic concepts, using paranoia as exemplary of their limitations; briefly review the Psychodynamic Diagnostic Manual as exemplifying inferential diagnostic concepts; and cover clinical and research findings on paranoia. Overall, she will keep the focus on the practical question of helping therapists to improve their work with their more paranoid clients. Case material will be presented in this context.

Learning Objectives

  • Contrast the inferential diagnostic traditions of psychoanalysis with contemporary descriptive psychiatric diagnosis, especially as to their clinical implications.
  • Identify not simply the more familiar persecutory paranoid dynamics (projection and denial of anger), but those involving projection and disavowal of other feelings (e.g., erotomania, paranoid jealousy, megalomania, paranoid hatred).
  • Summarize the suspected etiologies of paranoid dynamics, including experiences of being treated as a (projective) bad object by a caregiver and accordingly subjected to humiliation.
  • Avoid therapeutic attitudes that threaten paranoid patients (e.g., excessive sympathy, efforts to be neutral or abstinent to a degree that strikes the patient as inauthentic, efforts to prove one’s goodness).
  • Convey attitudes that allow paranoid patients to elaborate their experience and reduce the shame that underlies paranoid adaptations (e.g., unwavering respect, ruthless honesty, clarity about boundaries, and acknowledgment of the grain of truth in the patient’s projections

Nancy McWilliams, Ph.D.

Nancy McWilliams, Ph.D. teaches at Rutgers University’s Graduate School of Applied & Professional Psychology and has a private practice in Flemington, NJ. She is author of Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process (1994), Psychoanalytic Case Formulation (1999), and Psychoanalytic Psychotherapy: A Practitioner’s Guide (2004), all with Guilford Press, and is Associate Editor of the Psychodynamic Diagnostic Manual (2006). She is President of the Division of Psychoanalysis (39) of the American Psychological Association, and on the editorial board of Psychoanalytic Psychology.

Dr. McWilliams’s books have been translated into thirteen languages, and she has lectured widely both nationally and internationally. Her book on case formulation received the Gradiva Award for best psychoanalytic clinical book of 1999; in 2004 she was given the Rosalee Weiss Award for contributions to practice by the Division of Independent Practitioners of the American Psychological Association; in 2006 she was made an Honorary Member of the American Psychoanalytic Association, and in 2007 she was awarded the Robert S. Wallerstein Visiting Lectureship in Psychotherapy and Psychoanalysis. A graduate of the National Psychological Association for Psychoanalysis, she is also affiliated with the Center for Psychoanalysis and Psychotherapy of New Jersey and the National Training Program of the National Institute for the Psychotherapies in New York City. 

Program Schedule

8:45 – 9:15 Registration and continental break-fast
9:15 – 10:45 Presentation by Nancy McWilliams, Ph.D.
10:45 – 11:00 Break
11:00 – 12:30 Continuation of morning program with audience questions and discussion
12:30 – 1:30 Lunch (included)
1:30 – 3:30 Presentation of Clinical Material with additional time for Discussion.


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