Psychoanalysis Assessment and Diagnosis 2 — Questions and Answers
Question 1: In psychoanalytic assessment, what does 'ego strength' primarily refer to?
- The patient's ability to tolerate frustration and regulate affect without excessive regression (Correct answer)
- The dominance of conscious over unconscious processes
- The strength of aggressive drives relative to libidinal drives
- The patient's intellectual capacity as measured by IQ tests
Correct answer: The patient's ability to tolerate frustration and regulate affect without excessive regression
Ego strength refers to the ego's capacity to manage anxiety, tolerate frustration, and maintain functioning without collapsing into primitive defenses or regression.
Question 2: Which of the following best characterizes a 'borderline' level of personality organization according to Kernberg?
- Intact reality testing with identity diffusion and primitive defenses (Correct answer)
- Impaired reality testing with intact object relations
- Neurotic-level defenses with stable identity
- Psychotic-level regression with strong ego boundaries
Correct answer: Intact reality testing with identity diffusion and primitive defenses
Kernberg's borderline personality organization is characterized by identity diffusion, use of primitive defenses (especially splitting), but preserved reality testing.
Question 3: What is the psychoanalytic significance of a patient's capacity for 'triangular' (oedipal) relating during assessment?
- It indicates the patient has achieved a level of development beyond purely dyadic object relations (Correct answer)
- It suggests the patient is fixated at the oral stage
- It indicates pathological jealousy requiring immediate intervention
- It means the patient can only relate to therapists of one gender
Correct answer: It indicates the patient has achieved a level of development beyond purely dyadic object relations
The capacity for triangular relating suggests the patient has progressed developmentally beyond pre-oedipal dyadic relating and can tolerate third-party relationships and rivalry.
Question 4: During a diagnostic interview, a patient describes her boss as 'completely evil' this week after describing him as 'perfect' last month. Which defense mechanism does this most likely reflect?
- Splitting (Correct answer)
- Reaction formation
- Undoing
- Rationalization
Correct answer: Splitting
Splitting involves maintaining polarized all-good or all-bad representations of self and others, inability to integrate ambivalent feelings about the same person.
Question 5: In psychoanalytic assessment, 'object constancy' refers to the ability to:
- Maintain a stable, positive internal representation of a significant other even when frustrated or angry with them (Correct answer)
- Remember the physical appearance of important people
- Keep the same therapist throughout treatment
- Maintain consistent behavioral patterns across situations
Correct answer: Maintain a stable, positive internal representation of a significant other even when frustrated or angry with them
Object constancy, associated with Mahler's rapprochement subphase resolution, is the ability to hold a stable, loving internal image of a person even during frustration or absence.
Question 6: A clinician using the Psychodynamic Diagnostic Manual (PDM) would primarily organize their diagnostic formulation around:
- Profile of mental functioning, personality syndromes, and symptom patterns together (Correct answer)
- DSM categorical diagnoses only
- Neurobiological markers and symptom checklists
- Behavioral frequency counts and functional impairment ratings
Correct answer: Profile of mental functioning, personality syndromes, and symptom patterns together
The PDM organizes assessment across three axes: personality patterns (P-Axis), profile of mental functioning (M-Axis), and symptom patterns (S-Axis).
Question 7: What is the primary purpose of assessing a patient's 'relationship history' in a psychoanalytic intake?
- To identify recurring relational patterns that reflect internalized object relations and likely transference configurations (Correct answer)
- To determine if the patient has adequate social support for treatment
- To assess for interpersonal skills deficits that need behavioral intervention
- To gather factual data about the patient's social network
Correct answer: To identify recurring relational patterns that reflect internalized object relations and likely transference configurations
Relationship history reveals repetitive relational templates — internalized object relations — that will manifest as transference patterns in the therapeutic relationship.
Psychoanalysis Assessment and Diagnosis 2
In psychoanalytic assessment, what does 'ego strength' primarily refer to?