Psychodynamic Formulation

How do our patients come to be the way they are?

What forces shape their conscious and unconscious thoughts and feelings?

How can we use this information to best help them?  

Constructing psychodynamic formulations is one of the best ways for mental health professionals to answer questions like these. It can help clinicians in all mental health setting understand their patients, set treatment goals, choose therapeutic strategies, construct meaningful interventions and conduct treatment.

Despite the centrality of psychodynamic formulation to our work with patients,  few students are taught how to construct them in a clear systematic way.  This book offers students and practitioners from all fields of mental health a clear, practical, operationalized method for constructing psychodynamic formulations, with an emphasis on the following steps: 

• DESCRIBING problems and patterns
• REVIEWING the developmental history
• LINKING problems and patterns to history using organizing ideas about development.

The unique, up-to-date perspective of this book integrates psychodynamic theories with ideas about the role of genetics, trauma, and early cognitive and emotional difficulties on development to help clinicians develop effective formulations.

Psychodynamic Formulation is written in the same clear, concise style of Psychodynamic Psychotherapy: A Clinical Manual  (Wiley 2011). It is reader friendly, full of useful examples, eminently practical, suitable for either classroom or individual use, and applicable for all mental health professionals. It can stand alone or be used as a companion volume to the Clinical Manual.

Deborah L. Cabaniss, M.D. is Clinical Professor of Psychiatry at the Columbia University College of Physicians and Surgeons and Director of Psychotherapy Training in the Department of Psychiatry at Columbia. She has won several teaching awards, including the Edith Sabshin award from the American Psychoanalytic Association. Dr Cabaniss is the lead author of Psychodynamic Psychotherapy: A Clinical Manual, has published numerous articles related to psychoanalytic and psychiatric education and gives talks and workshops on these topics across the country.

Sabrina Cherry, M.D. is Associate Clinical Professor of Psychiatry at Columbia University College of Physicians and Surgeons and practices psychiatry and psychoanalysis in New York City. She has been an active teacher and supervisor of both interpersonal and psychodynamic psychotherapy in the Columbia Residency program for twenty years.  She is now a Training and Supervising Analyst and an active teacher of psychoanalytic candidates at Columbia Center for Psychoanalytic Training and Research. Dr. Cherry is the recipient of awards from the American Psychiatric Association and from Columbia for her contributions to education and research.

Carolyn J. Douglas, M.D. is Associate Clinical Professor of Psychiatry at Columbia University College of Physicians and Surgeons, and Adjunct Associate Professor of Clinical Psychiatry at Weill Medical College of Cornell University. She served for many years as Director of the Residency Training Inpatient Unit at Columbia University Medical Center, and was co-Director of the Columbia Neuropsychiatric Service.   Dr. Douglas has taught and supervised residents in supportive dynamic psychotherapy for many years at Columbia and Payne Whitney/Cornell and has been the recipient of "Teacher of the Year" awards from residents at both programs. Dr. Douglas is the author of publications on teaching supportive psychotherapy to psychiatric residents, the psychotherapy selection process, and psychodynamic psychotherapy.

Ruth Graver, MD is Assistant Clinical Professor of Psychiatry at the Columbia University College of Physicians and Surgeons. She is also Chair of the Curriculum Committee at the Columbia University Center for Psychoanalytic Training and Research. She has taught and supervised psychiatry residents, and psychoanalytic candidates at Columbia for many years and has written about cross cultural issues in psychiatry as well as about psychoanalytic writing.

Anna R. Schwartz, M.D. is Assistant Clinical Professor of Psychiatry at the Columbia University College of Physicians and Surgeons. She is also Director of the Psychodynamic Psychotherapy Program at the Columbia University Center for Psychoanalytic Training and Research. She has taught and supervised psychiatry Residents, and psychoanalytic candidates at Columbia for many years, and received the Irma Bland Teaching Award from the American Psychiatric Association.

Introduction xi

PART ONE Introduction to the Psychodynamic Formulation 1

1 What is a Psychodynamic Formulation? 3

2 How do We Use Psychodynamic Formulations? 8

3 How do We Construct a Psychodynamic Formulation? 12

PART TWO DESCRIBE 17

4 Self 23

5 Relationships 32

6 Adapting 41

7 Cognition 52

8 Work and Play 61

Putting it Together – A Description of Problems and Patterns 69

PART THREE REVIEW 75

9 What We’re Born with – Genetics and Prenatal Development 81

10 The Earliest Years 90

11 Middle Childhood 101

12 Later Childhood, Adolescence, and Adulthood 113

Putting it Together – A Developmental History 123

PART FOUR LINK 135

13 Trauma 143

14 Early Cognitive and Emotional Difficulties 152

15 Conflict and Defense 163

16 Relationships with Others 173

17 The Development of the Self 182

18 Attachment 191

Putting it Together–A Psychodynamic Formulation 201

PART FIVE Psychodynamic Formulations in Clinical Practice 213

19 Psychodynamic Formulations in Acute Care Settings 215

20 Psychodynamic Formulation in Pharmacologic Treatment 222

21 Psychodynamic Formulation in Long-Term Psychodynamic

Psychotherapy: Revising Over Time 230

22 Sharing Formulations with Our Patients 238

Epilogue 247

Appendix – How to Use Psychodynamic Formulation: A Guide for Educators 249

Recommended Reading 253

Index 259

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