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Strupp elaborate that the patient needs to possess "sufficient capacity to emotionally distance from these feelings so that the patient and therapist can jointly examine them."

This structure is an attempt to provide a coherent, comprehensive, plausible, and we hope accurate account of the individual's personality development and current functioning that is based on the life history of a particular patient as that history is told, lived, and retold by the patient in the course of the psychoanalytic encounter.

One also strives to follow patients' associations (i.e., to note the squence in which the themes are presented).

In this chapter we present an account of psychoanalytic case formulation as it is used clinically in conjunction with psychoanalytic treatment. Because it was developed in a clinical context, it is less formal and systematic than other approaches in this volume which are research based.

a working definition

It strikes me as strange that the case histories I write read like short stories and that,as one might say,they lack the serious stamp of science.I must console myself with the reflection that the nature of the subject is evidently responsible for this, rather than any preference of my own.. detailed description of mental processes such as we are accustomed to find in the works of imaginative writers enables me to obtain at least some kind of insight into the course of that affliction.

Rapaport and Gill,two important later figures who contributed to the structure of psychoanalytic case formulation,argued that a comprehensive case formulation would have to include the following multiple perspectives:dynamic, structural,genetic,adaptive,topographic,and economic.That is,corresponding to the order of the preceding terms,the formulation would have to address the patient's major con-flicts (dynamic: e.g.wishes,and defenses against those wishes), those as-pects of the patient's personality involved in the conflicts(structural: e.g.,id vs. superego),the historical and developmental etiology of the conflicts(genetic),the adaptive and maladaptive compromise formations involved in the patient's defensive and coping strategies (adaptive),the conscious versus unconscious status of the conflicts(topographic),and the "eco-nomic" consequences of the preceding factors, not in the original sense of the distribution of "mobile" and "bound" cathexes but in the more de-scriptive sense of how constricted and brittle the patient's adjustment is by virtue of the excessive "energy" invested in his or her defensive ma-neuvers.Although contemporary case formulations generally contain less metapsychological language than in the past,with the exception of the economic viewpoint,they do attempt to cover the perspectives just outlined.

They reported findings in Japan that differed from those found in the American samples, which pointed to the conclusion that the Western emphasis on autonomy and individuation did not apply in the same way in the Japanese children

multicultural considerations / general considerations