Psychoanalytic Disorders: A Case Study

1157 Words 5 Pages
Reaction Paper #2
The third chapter of Psychoanalytic Diagnosis captures the evolution of the classifications of character organization within psychoanalysis over the last several centuries. McWilliams (2011) discussed the rich history behind developmental levels of personality organization from Emil Kraepelin’s concept of neurosis versus psychosis, to the neurotic-borderline-psychotic spectrum. Each character structure within the spectrum was described in depth with regards to several aspects including the client’s ability to reality test, his/her defense mechanisms, and the ability to integrate one’s identity (McWilliams, 2011). This paper will discuss the characteristics of each personality structure within the neurotic-borderline-psychotic
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Clients who were referred to as general mental health would be classified within the neurotic range of organization. The majority of these individuals were high-functioning and only requested a therapist when they experienced an increase in stress or had a particular problem. As a case manager and a substance abuse specialist, I predominantly worked with individuals classified as Seriously Mentally Ill (SMI). Most of these clients had personality organizations that were psychotic or borderline. When I worked in community mental health I did not consider transference or countertransference at all when working with my clients. Thankfully, this program has raised my awareness of the importance of introspection and taking note of possible transference and countertransference. Furthermore, after reflecting on my experiences with the SMI population I found that McWilliams’ (2011) description of the how a therapist might experience both transference and countertransference with the psychotic and borderline clients very …show more content…
I read articles and books and thought I was prepared to handle anything that came my way. Unfortunately, after being assigned my first individual with borderline personality disorder, I realized I was wrong. McWilliams (2011) stated that intense transference and countertransference may occur with borderline clients. She was absolutely right; this individual’s personality organization was borderline, and I experienced intense countertransference and transference with her. At the time I was unaware of what these negative feelings were and did not know what to do with them. After a few sessions with this client I staffed the case with my supervisor and we processed the negative emotions I was experiencing; however, I was never able to talk about the transference with the client. As suggested by McWilliams (2011), the next time I experience this type of transference with a borderline client I intend on using unique techniques to address the

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