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Personality, formulation and specialized treatment · Chapter 32
From formulation to PDM-3: McWilliams, Lingiardi, Blatt, Westen and Shedler
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Chapter contents
- The historical problem: symptoms are not the whole patient
- Blatt: relatedness and self-definition
- Westen and Shedler: clinical description meets measurement
- The PDM project and its development
- Capacity is not the same as knowledge
- An original review meeting
- What the present adds—and what it does not prove
- Source and reading notes
The historical problem: symptoms are not the whole patient
As descriptive psychiatric diagnosis became increasingly influential, psychodynamic clinicians needed ways to communicate personality and subjective experience without abandoning clinical complexity. McWilliams’s formulation work, Blatt’s research on personality development, Westen and Shedler’s assessment program, and the Psychodynamic Diagnostic Manual represent related but distinct responses. None makes symptom diagnosis unnecessary. They ask what a description of symptoms alone leaves unexplained. [98] [126] [225] [7]
In plain English: two people can meet the same symptom criteria yet experience the problem differently, need different kinds of help, and form very different relationships with a therapist.
Blatt: relatedness and self-definition
Sidney Blatt described a developmental interplay between interpersonal relatedness and self-definition. Anaclitic vulnerabilities center more on dependency, loss and abandonment; introjective vulnerabilities center more on self-criticism, achievement and failure. His importance is not just naming two styles of depression. He connected personality development with treatment process and research questions about change. These dimensions should be investigated rather than used to predict treatment success from a label. [126]
A fictional patient says improved mood feels unimportant because she still cannot tolerate making a mistake. Another says work success feels empty because no one is there to share it. The distinction directs questions toward what improved and what remains, not toward replacing one DSM diagnosis with two new stereotypes.
Westen and Shedler: clinical description meets measurement
The Shedler–Westen Assessment Procedure, or SWAP, uses structured descriptions and a Q-sort method to assess personality. A clinician sorts statements according to how characteristic they are, subject to a specified distribution. The aim is to retain clinically meaningful description while making assessment more systematic. It is neither a quick self-test nor permission to score an absent person from anecdotes. [225]
In plain English: instead of only asking whether a symptom is present, describe how this person tends to feel, protect themselves and relate—and use a method that permits comparison rather than relying solely on an impression.
This approach raises testable questions about reliability and validity. It does not mean every psychoanalytic formulation has been validated because some aspects can be measured. Training, evidence base, population and purpose matter for any instrument.
The PDM project and its development
The PDM project, associated with multiple psychoanalytic organizations and contributors including Stanley Greenspan in its early development, made personality, mental capacities and subjective symptom experience explicit parts of diagnostic description. Later editions edited by Vittorio Lingiardi and Nancy McWilliams expanded and reorganized the project. The third edition was published in 2026. Its contents proceed through developmental periods and include sections on psychological experiences that may require attention without being captured by a diagnosis. [7] [7]
For adults, the P, M and S axes concern personality, a profile of mental functioning, and symptom patterns as subjectively experienced. Developmental sections should not be assumed to use adult priorities in the same order. The contents name contributors across childhood, adolescence and later life, including Norka Malberg, Anna Maria Speranza, Carla Sharp, Franco Del Corno and Daniel Plotkin. Their presence matters because an adult personality template is not enough for a lifespan framework. [7]
Capacity is not the same as knowledge
A person may know what mentalizing means yet lose the ability to consider minds during a conflict. Another may describe self-compassion fluently but remain unable to use a compassionate stance after an error. A functioning profile asks about capacities as lived, their stability, their context and available supports. It should include strengths, not just a finer-grained deficit list.
In plain English: understanding the instruction is different from being able to do it when it matters. Formulation needs to explain that gap before choosing more instruction as the treatment.
An original review meeting
Mara’s symptom ratings have improved, but she still leaves relationships by becoming silent. The therapist does not declare success solely from the scores or failure solely from a persistent pattern.
Therapist: “There is less distress, and the silence after disappointment still costs you. Which changes matter most to you now?”
Mara: “I no longer think I am awful for wanting things. I still cannot say them soon enough.”
They examine emotion recognition, self-esteem, reflective capacity under stress and actual opportunities to communicate. The review may support further relational work, a more focused practice task, a change of treatment or an ending. The framework organizes questions but does not require an indefinite course until every capacity is ideal.
What the present adds—and what it does not prove
PDM-3 demonstrates an ongoing effort to update psychodynamic assessment, including lifespan transitions and distress beyond diagnosis. Its publication is not proof that every construct or rating has equal empirical support. A textbook’s claim to be evidence-informed must still be examined at the level of particular measures and clinical uses. [7]
Study task: build three short accounts of the same fictional case: symptom description, personality/mental-functioning description, and individualized formulation. Explain what each contributes, what it cannot establish, and how to discuss the conclusions with the patient in ordinary language.
Source and reading notes
Independent educational synthesis. Fictional conversations illustrate reasoning. Review scopes describe the material consulted; they do not certify all clinical claims.
Psychoanalytic Case Formulation (opens in a new tab)
Selected sections checked
Selected accessible chapters or article sections reviewed for the cited concepts. This does not indicate a full-book review.
Selected primary text inspected for the current teaching revision: https://www.guilford.com/excerpts/mcwilli2.pdf?t=1 . Introduction selected passages on subjective/empathic understanding and communicating a person's particular psychology and therapeutic requirements in ordinary language; selected discussion of self-correcting clinical work. This is the8-page introductory excerpt, not a reading of the book's full case-formulation chapters. Do not mark every detailed dimensional personality assertion as verified from this introduction. Earlier source record: Publisher listing reviewed (title, date, ISBN). Not read.
Recorded check: 2026-10-13. Source used for this record (opens in a new tab)
Pathway source review: carried forward
excerpt: Selected primary text inspected for the current teaching revision: https://www.guilford.com/excerpts/mcwilli2.pdf?t=1 . Introduction selected passages on subjective/empathic understanding and communicating a person's particular psychology and therapeutic requirements in ordinary language; selected discussion of self-correcting clinical work. This is the8-page introductory excerpt, not a reading of the book's full case-formulation chapters. Do not mark every detailed dimensional personality assertion as verified from this introduction. Earlier source record: Publisher listing reviewed (title, date, ISBN). Not read.
carried-forward from earlier Learn library; not a new full-text review
Scope concerns what was consulted; it is not approval of every claim or author endorsement.
A practical companion to Psychoanalytic Diagnosis focused on building an individualized understanding of a person rather than a category.
formulation, assessment, temperament, identity, relationships
Purchase or library access.
Interpersonal relatedness and self-definition in normal and disrupted personality development: retrospect and prospect (opens in a new tab)
Abstract checked
Abstract or official summary reviewed. Full paper not appraised.
Author synthesis of relatedness and self-definition; abstract reviewed, not every cited empirical study.
Recorded check: 2026-10-15. Source used for this record (opens in a new tab)
Pathway source review: carried forward
abstract: Author synthesis of relatedness and self-definition; abstract reviewed, not every cited empirical study.
carried-forward; not independently rechecked in finishing pass · Recorded date: 2026-10-15
Scope concerns what was consulted; it is not approval of every claim or author endorsement.
Further reading for psychodynamic history, theory and practice.
Access depends on the destination; saving a link does not unlock paid material.
Refining the measurement of axis II: a Q-sort procedure for assessing personality pathology (opens in a new tab)
Abstract checked
Abstract or official summary reviewed. Full paper not appraised.
Checked identity and accessible abstract. Full work not read; this does not independently establish every adjacent clinical or historical assertion. Edition/translation date may differ from original publication.
Recorded check: 2026-10-16. Source used for this record (opens in a new tab)
Pathway source review: checked at stated scope
abstract: Checked identity and accessible abstract. Full work not read; this does not independently establish every adjacent clinical or historical assertion. Edition/translation date may differ from original publication.
checked at stated scope · Recorded date: 2026-10-16
Scope concerns what was consulted; it is not approval of every claim or author endorsement.
Further reading for psychodynamic history, theory and practice.
Access depends on the destination; saving a link does not unlock paid material.
Psychodynamic Diagnostic Manual, Third Edition: PDM-3 (opens in a new tab)
Publisher contents checked
Publisher description and table of contents reviewed. Chapters were not read.
Publisher identity, 2026 publication and lifespan organization checked; not a full-manual reading.
Recorded check: 2026-10-15. Source used for this record (opens in a new tab)
Pathway source review: carried forward
contents: Publisher identity, 2026 publication and lifespan organization checked; not a full-manual reading.
carried-forward; not independently rechecked in finishing pass · Recorded date: 2026-10-15
Scope concerns what was consulted; it is not approval of every claim or author endorsement.
Further reading for psychodynamic history, theory and practice.
Access depends on the destination; saving a link does not unlock paid material.