Doctoral Program in Clinical Psychology The Graduate Center of the City University of New York

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1 Doctoral Program in Clinical Psychology The Graduate Center of the City University of New York Practicum IB: Interviewing and Personality Appraisal (Adult Intake) Course # Spring, 2011 Professor: Diana Diamond, Ph.D. ddiamonda@gmail.com Phone: Day & Time: Tuesday, 2:00-3:50 Office Hours: Tuesday 4:00-6:00 (or by appointment) Internet password for course: psyddiamond Course Description: This course is designed to introduce clinical psychology graduate students to the psychodiagnostic and therapeutic skills of the practicing clinical psychologist. The focus will be on mastering the art of interviewing and the initial phases of clinical processes. The aim of the course is to introduce clinical psychology graduate students to the psychodiagnostic and therapeutic skills of the practicing clinical psychologist. The course offers a comprehensive introduction to clinical interviewing and personality assessment including structured approaches to interviewing to determine the level of organization of the patient. Using the DSM-R and other texts, students will learn to recognize and evaluate the common disorders encountered in outpatient settings, including affective disorders, anxiety disorders, obsessive-compulsive, dissociative disorders, Post traumatic stress disorders (PTSD), and personality disorders including borderline, narcissistic, and antisocial disorders. The class will also address the issue of differential therapeutics; that is which therapeutic approaches (e.g. individual, family, couple), are appropriate for which conditions. Technical and boundary issues with patients, technical handling of difficult early problems in treatment; treatment planning; and initial stages of therapy will also be covered. Other topics to be covered include suicidal and homicidal ideation and behavior. Although there are readings assigned for each class, the course will revolve around having students present their intake interviews to the class with the goal of developing diagnoses and dynamic formulations. The course will also focus on identifying and assessing the particular socio-cultural as well as psychological factors that may be relevant to clinical formulations. In addition, students will be assigned an ongoing psychotherapy case, which will be presented in class. Patients who are deemed appropriate for our clinic will be assigned to student therapists by the clinic office. Students in the intake class should expect to complete four intakes; three of these should be used as long forms for the course; all intakes need a short form to be processed by the clinic.

2 Thus, students will be responsible for writing three in-depth intake reports. These Intake reports should be done only on completed intakes. The format for these reports will be distributed in class. No reports will be accepted after the last week of the semester. If all intakes are not turned in at that time, the grade will be lowered accordingly. The reports required for this class are long forms. The reports required for the clinic are short forms. The process for the writing and revising of the short forms will be covered and discussed during the first meeting of the evaluation team. If after presenting your intake patient in class or after consultation with your supervisor, the student determines that the patient needs a medication consult, please contact the consulting psychiatrist, Dr. David Ott to discuss the case. We have added a section to the psychology consult sheet where you can indicate whether a psychiatric consult has been done. Briefly, a psychiatric consult is in order when the patient has a history of or is currently suicidal or homicidal, depressed, psychotic, has had previous psychiatric hospitalization(s). In cases where it is extremely difficult to make a differential diagnosis, and/or to determine the patient's level of organization, it is possible to have the patient tested by one of the students in the testing course. Psychological testing should be introduced to the patient as part of the intake process that will enable us to determine how the patient might best be helped. If it is determined that the patient is not appropriate for the clinic, he or she should not be tested, even if the diagnostic issues remain unclear. Testing is usually done when we deem that the patient is appropriate for the clinic, but have questions about level of organization, underlying psychotic process, neurological or cognitive impairments--all of which may affect the therapy process. Feedback on the psychological testing process ought to be given by the tester and the intake interviewer, and ought to occur prior to the beginning of therapy if possible. The students conducting the intakes will pick up the patients they screen as individual psychotherapy patients as they have openings. When the intake therapist no longer needs therapy patients, s/he will continue to do the screenings, assigning patients as necessary. When the clinic has no more openings for therapy patients, the intake therapists will continue to screen people, but with a focus on helping them to find appropriate referrals outside The Psychological Center. In the latter cases, students will be responsible for completing a short intake report on each patient. Course Objectives: 1) Students will learn interview skills in order to evaluate patients presenting for psychotherapy 2) Students will learn the basics of diagnosing and assessing patients 3) Students will learn to use the DSM-IV-TR 4) Students will work with testers and integrate their findings 5) Students will learn to create treatment plans for new patients. 6) Students will learn about the initial phases of therapeutic work with patients including contract setting, issues about boundaries and the frame.

3 Requirements and Grading: Students will be required to present their intake cases on a rotating basis in class and to conceptualize their cases in relation to specific class readings and content. At the end of the semester students are expected to present at least one case that they have taken into psychotherapy and to evaluate their initial intake evaluation of the case in the light of the therapeutic work (40%). Students will be expected to write three intake reports following a standard format and to turn them in by the last week of the semester. (50%). Students will be expected to do an oral report on one article in the course of the semester (10%). Required Texts: Diagnostic and Statistical Manual--Four (DSM-IV-TR). (2000). Washington D.C.: American Psychiatric Association. Kernberg, O. (1995). Love Relations. New Haven: Yale University Press McWilliams, N. (2011). Psychoanalytic Diagnosis: Second Edition. Understanding Personality Structure in the Clinical Process. New York: The Guilford Press. McWilliams, N. (1999). Psychoanalytic Case Formulation. New York: The Guilford Press, McWilliams, N. (2004). Psychoanalytic Psychotherapy: A Practitioner s Guide. New York: the Guilford Press PDM task force (2006). Psychoanalytic Diagnostic Manual. Silver Spring, MD: Alliance of Psychoanalytic Organizations. LaBruzza, Anthony. (1994). Using the DSM-IV: A Clinician's Guide to Psychiatric Diagnosis. New Jersey: Jason Aronson. Sullivan, H.S. (1958). The Psychiatric Interview. New York: Norton Shapiro, D. (1965). Neurotic Styles. New York: Basic Books. Gabbard, G. (2010). Long Term Psychodynamic Psychotherapy: A Basic Text. Washington D.C. American Psychiatric Publishing. Weekly Reading Assignments and Class Topics:

4 Class 1: Introduction to Clinical Interviewing for Assessing level of Personality Organization Process. Appendix: Suggested Psychiatric Interview Format; Chapter 2: Developmental Levels of personality Organization: Chapter 3: Clinical Implications of Developmental Levels of Personality Organization.. Psychoanalytic Case Formulation. Chapter 1: The Relationship between Case Formulation and Psychotherapy; Chapter 2: Orientation to Interviewing. Class 2: Introduction to Clinical Interviewing cont. Psychoanalytic Diagnosis: Second Edition. Understanding Personality Structure in the Clinical Process. Chapters 1: Why Diagnose: chapter 2: Psychoanalytic Character Diagnosis. Psychoanalytic Case Formulation. Chapter 3: Assessing What Cannot Be Changed The Psychiatric Interview. Using the DSM-IV: A Clinician's Guide to Psychiatric Diagnosis. (pp. 1-85). Class 3: The Mental Status Exam and introduction to personality assessment and diagnosis Using the DSM-IV: A Clinician's Guide to Psychiatric Diagnosis. Chapter 10: The Mental Status Examination Psychodynamic Diagnostic Manual. Part II: Profile of Mental Functioning. Class 4: Assessing Structure and Defenses Psychoanalytic Diagnosis: Second Edition: Understanding Personality Structure in the Clinical Process. Chapter 4: Primary Primitive Defensive Processes: Chapter 5: Secondary (Higher Order Defensive Processes). Psychoanalytic Case Formulation. Chapters 4: Assessing Developmental issues: Chapter 5: Assessing Defense: Chapter 6: Assessing Affects. Kernberg, O. F. (1984). The Structural Interview. In: Kernberg, O.F.: Severe Personality Disorders: Psychotherapeutic Strategies. (pp ). New Haven: Yale University Press.

5 Class 5: The Psychodynamic Formulation Long Term Psychodynamic Psychotherapy: A Basic Text. Washington D.C. American Psychiatric Publishing, Chapter 2: Assessment, Indications and Formulation. Psychoanalytic Case Formulation. Chapter 7: Assessing Identifications; Chapter 8: Assessing Relational Patterns. Perry, S., Cooper, A. M., & Michels, R. (1987). The psychodynamic formulation: Its purpose, structure, and clinical application. American Journal of Psychiatry, 144, Class 6: Affective Disorders Psychoanalytic Diagnosis: Second Edition. Understanding Personality Structure in the Clinical Process. Chapter 11: Depressive and Manic Personalities DSM-1V-TR. Pp Psychodynamic Diagnostic Manual. Part I: Classification of Adult Mental Disorders (pp.44-46). Using the DSM-IV: A Clinician's Guide to Psychiatric Diagnosis Chapter 17: Mood Disorders Blatt, S. (2008). Polarities of Experience: Part III: Personality Organization and Psychopathology. Class 7: Personality Disorders Process. Part II: Types of Character Organization. Psychoanalytic Case Formulation. Chapters Using the DSM-IV: A Clinician's Guide to Psychiatric Diagnosis. Chapter 27: Personality Disorders DSM-IV-TR. Pp

6 Widiger, T. A. Integrating normal and abnormal personality structure: A proposal for DSM-V in Journal of Personality Disorders. 25(3), Jun, 2011, pp Class 8: Hysteria, Dissociative Disorders, and Somatoform Disorders Process. Chapter 14: Hysterical (Histrionic) Personalities; Chapter 15: Dissociative Personalities. Neurotic Styles. Chapter 4: Hysterical Style DSM-IV-TR. Pp Using the DSM-IV: A Clinician's Guide to Psychiatric Diagnosis. Chapter 11: Issues in the Assessment of Puerto Rican and other Hispanic Clients, Including Attaque de Nervos (Attack of Nerves). Class 9: Anxiety and Obsessive-Compulsive Disorders DSM-IV-TR. Pp Process. Chapter 12: Masochistic (Self-Defeating Personalities); Chapter 13: Obsessive and Compulsive Personality. Using the DSM-IV: A Clinician's Guide to Psychiatric Diagnosis. Chapter 18: Anxiety Disorders Neurotic Styles. Chapter 2: Obsessive-Compulsive Style. Class 10: Paranoid, Schizoid Disorders and Psychotic States Process. Chapter 9: Schizoid Personality; Chapter 10: Paranoid Personality DSM-IV-TR. Schizophrenia and Other Psychotic Disorders, pp Using the DSM-IV: A Clinician's Guide to Psychiatric Diagnosis. Chapter 16: Schizophrenia and Other Psychotic Disorders. Pp

7 Trierweiler, S.J., Muroff, J.R., Jackson, J.S., Neighbors, H.W., Munday, C. Clinican Race, Situational Attributions, and Diagnosis of Mood Versus Schizophrenia Disorders. Cultural Diversity and Ethnic Minority Psychology. 11:4, Class 11: Assessing Pathological Narcissism DSM-IV-TR. pp Psychodynamic Diagnostic Manual. pp Diamond, D. (2005). Narcissism as a Psychological and Social Phenomenon. In J. Auerbach, K. Levy and C. Schaeffer (Eds.). Relatedness, Self-Definition and Mental Representation: Essays in Honor of Sidney J. Blat, (pp ). Hove and New York: Brunner-Routledge Press. Ronningstam, E.F. (2010). Proposal to the DSM-V Axis II committee regarding diagnosis of pathological narcissism and narcissistic personality disorder. Unpublished manuscript. Ronningstam, E. F. (2005): Identifying pathological narcissism. In: Ronningstam E.F. Identifying and Understanding the Narcissistic Personality. New York: Oxford University Press. Class 12: Assessing for Psychopathy, Impulse Disorders and Addictions Neurotic Styles. Chapter 5: Impulsive Styles; Chapter 6: Impulsive Styles: Variant. Process. Chapter 7: Psychopathic (Antisocial Personality). D. Yalisove. Introduction in Essential Papers on Addiction (New York: NYU Press, 1997), pp CAGE: SMAST: O'Brien, C. Addiction and Dependence in DSM-V in Addiction, Vol 106(5), May, 2011, pp

8 Caetano, R. There is potential for cultural and social bias in DSM-V in Addiction, Vol 106(5), May, 2011, pp Class 13: Assessing for Sexual Disorders and Pathology of Love Relations Love Relations. Chapter 1: The Sexual Experience; Chapter 2: Sexual Excitement and Erotic Desire; Chapter 3: Mature Sexual Love; Chapter 4: Love, Oedipus and the Couple; Chapter 5: Psychopathology. Using the DSM-IV: A Clinician's Guide to Psychiatric Diagnosis. Chapter 22: Sexual and Gender Identity Disorders DSM-IV-TR. Pp Class 14: Introduction to Psychotherapy: Setting up the Frame. Psychoanalytic Psychotherapy: A Practitioner s Guide. Chapter 5: Chapter 6: Chapter 7 Long Term Psychodynamic Psychotherapy: A Basic Text. Washington D.C. American Psychiatric Publishing. Chapter 3: The Nuts and Bolts of Psychotherapy: Getting Started. Class 15: Psychotherapy: Beginning Phases Pine F. (1988). The four psychologies of psychoanalysis and their place in clinical work. J Am Psychoanal Assoc. 36(3), Loewald, H. (1960). On the therapeutic action of psychoanalysis. International Journal of Psycho-Analysis. 41, Chodorow, N. A different universe: Reading Loewald through 'On the therapeutic action of psychoanalysis in The Psychoanalytic Quarterly, Vol 78(4), Oct, 2009, pp