CPD Credits
Event Type
Live Online Event
Zoom & Recording for 365 days
2:00 pm - 5:30 pm
Book Tickets
Friday, January 24, 2025

Diagnosis and Its Clinical Implications

With Nancy McWilliams, PhD & ABPP

Ever since the 1980 revision of the Diagnostic and Statistical Manual of the American Psychiatric Association, descriptive and categorical taxonomies such as the DSM and the ICD (International Classification of Diseases) have aimed at facilitating better research and providing a common language for categories of psychopathology. Every edition of the DSM since DSM-III has warned, however, that descriptive psychiatric diagnosis is insufficient to guide clinical treatment, and that for purposes of psychotherapy, clinicians must develop more nuanced case formulations.

Despite such caveats, it has become common for researchers to create manualized treatments for specific DSM-defined disorders, to test them on individuals who meet criteria for the chosen disorder without reported comorbidities, and to argue that such empirically tested treatments constitute the “gold standard” for clinical practice.

Dr. McWilliams notes that our current taxonomies reflect the influences of insurance companies particularly in the US, pharmaceutical corporations, governmental cost-cutters, and some academics more than the needs of patients and clinicians to mitigate psychological suffering in the most humane and effective ways. She will put the DSM and ICD taxonomies in historical context, mention several alternative approaches to diagnosis, and emphasize the value, with clinical examples, of a dimensional, inferential, contextual understanding of personality in guiding psychotherapy.

This workshop will include three sessions as well as time for discussion after each.


14.00 Introductions
14.05 Overview and Historical Context of Psychiatric Diagnosis

The language in which we talk about any phenomenon constrains how we can think about it. Ironically, as psychotherapy has evolved to be more essentially oriented toward the therapeutic relationship, and as vast evidence has accrued that the most powerful determinants of the success of psychotherapy are personality and relationship factors (e.g., the “therapeutic alliance,” “common factors,” “overall clinical skills”) rather than particular technical approaches, the mechanisms governing psychotherapy availability and evaluation have become increasingly objectifying, impersonal, and bureaucratic. Dr. McWilliams will describe the evolution of our contemporary classification systems, with emphasis on their impacts on treatment.

14.45 Q&A
15.00 Break
15.15 Personality Understood in Terms of Themes

Contemporary taxonomies of personality types and disorders, including the DSM’s alternative classification, tend to rely on research on traits, especially the “Big Five” traits of openness to experience, conscientiousness, extroversion, agreeableness, and neuroticism  or emotional instability. But traits are shared across personality types, and seemingly opposite traits may characterize particular personality styles for example, an obsessive-compulsive individual may be fastidious in some areas and messy in others; a person with a histrionic psychology may be both exhibitionistic and inhibited sexually. This session will cover the themes that define types and disorders of personality and explore the implications of this conceptualization for treatment.

16.00 Q&A
16.15 Break
16.30 Alternative Approaches to Personality Diagnosis

Dr. McWilliams will review alternative approaches to diagnosis, including the Research Domain Criteria initiative (RDoC), the Hierarchical Taxonomy of Psychopathology (HiTOP), the Power Threat Meaning movement, the DSM Alternative Classification System for Personality Disorders, and the Psychodynamic Diagnostic Manual (PDM). Recognizing their respective strengths and limitations, she will give particular attention to the PDM, emphasizing the clinical utility of its P-Axis (personality styles and disorders), M-Axis (profile of mental functioning), and S-Axis (symptoms) as they apply to the maturational phases of infancy, childhood, adolescence, adulthood, and later life. Clinical vignettes will illustrate this usefulness of this manual for psychotherapy.

12.15 Q&A

12.30 End