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정신분석적사례이해
작성자  simonshin 작성일  2017.02.02 11:42 조회수 838 추천 0
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 정신분석적 사례 이해에 대한 소개  
첨부파일 : f1_20170206122118.pdf
 

과목정신분석적 사례 이해

주제정신분석적 사례 이해에 대한 소개

강사신현근 박사

내용강의안

교재McWilliams, N. (1999). Introduction. In Psychoanalytic Case Formulation (pp. 1-8). New York: International Guilford Press.

 Introduction to Psychoanalytic Case Formulation

 

1.      OVERVIEW

1.1.   As succeeding editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association (1968, 1980, 1987, 1994) have become increasingly objective, descriptive, and putatively atheoretical, they have inevitably minimized the subjective and inferential aspects of diagnosis on which most clinicians actually depend.

1.2.   Operating more or less invisibly alongside the empirically derived categories of the DSM is another compendium of wisdom, passed down orally and in practice-oriented journals: clinical knowledge, complexly determined inferences, and consistent impressions made on the harnessed subjectivities of therapists.

1.3.   In any individual case, these data coexist somewhat uneasily with whatever formal diagnostic label the patient has been given.

1.4.   One aim I have here is to represent that invisible, shared set of procedures and reflections.

 

 

2.      ON THE SUBJECTIVE/EMPATHIC TRADITION

2.1.   From the perspective of an empirical scientist, human subjectivity is generally considered a detriment to accurate observation.

2.2.   From that of the clinician, subjectivity allows access to knowledge about human beings that one could never have of other subject matter (one presumes that physicists rarely “empathize” with particles).

2.2.1.      Many contemporary psychoanalytic writers (e.g., Kohut, 1977; Mitchell, 1993; Orange, Atwood, & Stolorow, 1997) essentially define psychoanalysis as the science of subjectivity, in which the analyst’s empathy is the primary tool of investigation.

2.2.2.      Much of what I cover in this book reflects this subjective/empathic orientation.

2.2.3.      There is an important place for clinical observations made from this perspective, especially when they are scrupulously amassed and repeatedly compared with those of colleagues.

2.3.   It is very difficult to do good research on conventional, long-term therapy, and few of us who feel the calling to be therapists also have the temperament of the dispassionate scientist.

2.4.   We are not, however, indifferent to science.

2.4.1.      At least since the time of Spitz (1945), analytic practitioners have been deeply influenced in their practice and in their development of theory by controlled research, especially research in developmental psychology.

2.4.2.      Another aim of this book is to show how experienced analytic practitioners apply relevant research findings to the demands of formulating a case.

 

 

3.      ON BEING A THERAPIST AND TEACHING PSYCHOTHERAPY AT THE TURN OF THE CENTURY

3.1.   It is an irony of our times that at the point when psychotherapy has almost completely lost its stigma, at least in the middle classes, and at the point when a respectable literature on its effectiveness has accumulated, we are experiencing political and economic pressures that are demoralizing practitioners, discouraging clients from seeking help, punishing clinicians who are able to accomplish something enduring, and redefining as “therapy” a nonconfidential relationship that may be summarily stopped at any point (cf. Barron & Sands, 1996).

3.2.   Becoming a good therapist is inherently arduous and time-consuming, but lately, the task has been complicated by anxieties among aspiring clinicians that they will not be able to practice the difficult art they have made so many sacrifices to master.

3.3.   There has essentially been a corporate takeover of the health care delivery system, and like most health care professionals, I am highly skeptical about the applicability of corporate and commercial models to the helping professions.

3.4.   These realities make it even more compelling for therapists to do their job conscientiously and effectively. If a client is restricted to a short-term therapy relationship, it is more important, not less, to operate from a sound diagnostic basis.

3.4.1.      If the job the patient wants done cannot be done under the conditions that a paying third party insists on, it is up to the therapist to be honest about that and to know how to convey to the client an understanding of that person’s particular psychology and its therapeutic requirements—to impart a dynamic formulation in ordinary language (cf. Welch, 1998).

3.4.2.      Communications of this nature can themselves be understood or misunderstood based on how astute the therapist is about the patient’s overall psychology.

3.5.   Complicating matters, the rift between academic psychologists and dynamically oriented practitioners, for which both groups bear some responsibility, has affected the undergraduate and graduate teaching of psychology.

3.5.1.      Notwithstanding a few friendly university departments, the settings hospitable to psychoanalytic scholarship have been freestanding institutes and hospitals outside the academic mainstream.

3.5.2.      Because most academic psychologists have had scant exposure to analytically informed practice, theory, and scholarly research, their comments to students about the nature of analytic treatment are often wildly misinformed.

3.6.   Despite the fact that every therapist with a general practice treats only a small number of individuals suffering from each of the major kinds of psychopathology, by sharing knowledge, the therapeutic community has accumulated a vast amount of information about many conditions.

3.6.1.      Clinical experience generates many researchable questions; research will suffer if practitioners neglect to make explicit the premises from which they operate.

3.7.   Clinical experience generates many researchable questions; research will suffer if practitioners neglect to make explicit the premises from which they operate.

3.7.1.      I am trying in this book to convey ideas that the psychoanalytic community has developed over a century of conversations about patients, ideas that may be researchable in spite of not being fashionable in the current health care climate.

3.7.2.      I have also drawn on the existing research tradition in psychoanalysis, a tradition more substantial than many critics of psychoanalysis admit.

3.8.   Given that market forces and academic politics are not always on the side of preserving complex and controversial truths, we can assume that therapists will continue to feel some isolation and will need to support one another in their shared knowledge and vision.

3.8.1.      I hope to contribute here to that supportive professional environment.

 
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