Nancy McWilliams -OCTOBER 5, 2019,


Clinical Implications of the Continuum of Personality Structure

with Special Attention to Narcissism

Clinical Implications of the Continuum of Personality Structure with Special Attention to NarcissismNancy McWilliams, Ph.D.


This workshop is informed by Wittgenstein’s observation that how we talk about things structures how we think about them. How we name and subdivide mental suffering has profound effects on how we understand and treat it. Psychoanalysts find the “neo-Kraepelinian” premise of the current DSM (categorical concepts, with present-versus absent criteria) inconsistent with clinical experience and not very helpful to their work with patients. For example, the DSM has only four psychotic disorders. Analysts, in contrast, tend to view psychopathology dimensionally rather than categorically, using the term “psychotic” in the broader sense of loss of contact with consensual reality. Dr. McWilliams will posit that there is a psychotic level of many psychological “disorders” and a psychotic version of all personality types. She will construe narcissistic dynamics as on a spectrum, exploring their complexity and nuance. Throughout the day, emphasis will be on clinical implications of thinking dimensionally about psychological problems.


  1. Discriminate descriptive and categorical psychiatric diagnoses from more inferential and dimensional diagnostic formulations.
  2. Describe the evidence from both clinical experience and empirical research supporting the conceptualization of psychopathology and personality organization along a continuum from relative health to extreme disturbance.
  3. Construe narcissistic and psychopathic psychologies in terms of underlying themes rather than observable, present-versus-absent traits.
  4. Account for some of the difficulties the DSM-5 work group on Personality Disorders encountered in conceptualizing Narcissistic Personality Disorder.
  5. Describe the continuum from normal narcissistic preoccupations, through malignant narcissism, to frank psychopathy and the DSM’s Antisocial Personality Disorder.
  6. Describe how issues of socioeconomic and political trends, gender, sexual orientation, culture, ethnicity, and religious background may affect the diagnosis and treatment of putatively narcissistic disorders.


Nancy McWilliams teaches at Rutgers University’s Graduate School of Applied & Professional Psychology and practices in Lambertville, New Jersey. She is author of Psychoanalytic Diagnosis (1994, rev. ed. 2011), Psychoanalytic Case Formulation (1999), and Psychoanalytic Psychotherapy (2004). She is associate editor of the Psychodynamic Diagnostic Manual, 2nd ed. (2017) and a former president of Division 39 (Psychoanalysis) of the APA. She has been featured in three APA videos of master clinicians, the most recent being “Three Approaches to Psychotherapy.” Her books are available in 20 languages; she lectures widely both nationally and internationally.

CLASS DATE & TIME:  October 5, 2019  9:00 am to 4:00 pm



8:30 to 9:00 Registration

9:00 to 10:30 am: Rethinking the continuum between sanity and madness. Clinical implications

of a more dimensional view of mental suffering.

10:30 am to noon: Borderline and psychotic-level psychopathology. Implications for treatment

from research conducted across a range of theoretical orientations.

Noon to 1:00 pm: Lunch

1:00 to 2:30 pm: Narcissistic dynamics and personality organization along the spectrum of

pathology: Clinical implications.

2:30 to 4:00 pm: Case presentation(s) or vignettes and discussion in light of material covered.


LOCATION: Orange County Location to be determined

NUMBER OF CE/CEUs : 6 Continuing education credits

COST: $180/ $165 Early Bird Prior to August 30th, 2019

NPI Members: $165/ $150 Early Bird Prior to August 30th, 2019

Students: $110/ $95 Early Bird Prior to August 30th, 2019

For more information contact:

NPI Administrator:  Socorro Klingman, 714.505-9080 or [email protected] or