Psychopathology I: Neurotic-Level Character and Symptom Disorders

Second Year Adult Psychoanalytic Training (APT)
2022-23, 3rd Trimester — Fridays, 1:45-3:15pm
Michael Pauly, MD
Kelly Lippman, LMHC

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Introduction

Welcome to Psychopathology I: Neurotic-Level Personality and Symptom Disorders.

I have chosen to organize this course to first convey an understanding of the developmental underpinnings of neurotic character organization and to then explore the related intrapsychic and interpersonal (including transferential-countertransferential) manifestations of neurotic-level psychopathology.

The following are the types of questions I hope to explore throughout the course:

• What is implied by the term neurotic character?
• What is it that one looks for in the consultation period that differentiates between neurotic and the less organized structures that underlie borderline / narcissistic / psychotic characters or states?
• What are the developmental relational experiences that may have facilitated or hindered the psychic achievements that characterize a neurotic level organization?
• What are the predominant conflicts and / or defenses that characterize the various diagnostic categories within neurotic-level symptom or character presentations?

Discussion of clinical material is essential in bringing to life and making personally relevant the concepts we will be exploring. I strongly encourage you to bring vignettes and short process-notes to class. 

Learning Objectives

1. At the end of this course the candidate will be able to identify patient characteristics that differentiate neurotic from non-neurotic structural organizations, thereby improving their clinical diagnostic precision.
2. Equipped with the ability to better identify patient characteristics of a neurotic structural organization the candidate will have a greater ability to tailor their psychoanalytic technique to improve the odds of establishing an empathic resonance with the patient’s experience, thereby increasing the odds of patient retention and a deepening of the analytic process.
3. At the end of this course the candidate will have an improved understanding of the symbolic and defensive functioning of neurotic symptoms and character structure. Thus, they will be able to offer interventions that increase the odds of positive change and positive clinical outcomes.
4. The candidate will be able to consider the effects of race, class and gender on their intrapsychic and interpersonal conceptualizations of patients, increasing their capacity to work effectively with a broader demographic range.

March 24, 2023 — What constitutes Neurosis?

[35 pages]

Sugarman emphasizes that neurosis is defined in terms of a mental organization based on the achievement of certain capacities (self-reflective capacity, capacity for affect regulation, capacity for narcissistic regulation, and internal conflict) rather than the manifest content of the patient’s verbal material.

Ogden & Gabbard explore the pull towards symptom-focused treatments and encourage the analyst to resist this in exchange for a truth-focused treatment aimed at helping the patient dream themselves more fully into existence.

Auchincloss E.; Samberg, E. (2012), “Neurosis”, in Psychoanalytic Terms and Concepts, pp167-169.

Sugarman, A. (2007). Whatever Happened to Neurosis? Who are we Analyzing? And How? Psychoanal. Psychol., 24:409-428.

Ogden; Gabbard (2010) The Lure of the Symptom In Psychoanalytic Treatment, JAPA, 58:533-544.