Erikson Scholar Dr. Nancy McWilliams: Mental Health Treatment Beyond Symptom Reduction
The Austen Riggs Center has been on the radar of psychologist, psychoanalyst, author, and recent (June - August, 2016) Erikson Scholar Nancy McWilliams, PhD, ABPP, since her years as a graduate student in the early 1970s. “I was interested in severe mental illness and loved the Berkshires,” she remarks. While she has traveled far and wide throughout her career, McWilliams has found ways to stay connected to Riggs, speaking and presenting here in the past. When the opportunity to spend time at Riggs as an Erikson Scholar presented itself, “I jumped at the opportunity,” she says.
The endowed scholar-in-residence program brings scholars to Riggs to carry out their work in conversation with the staff, creating a steady flow of ideas, bringing together diverse perspectives. During her time at Riggs, McWilliams focused on two projects: completing the editing of a revised edition of the Psychodynamic Diagnostic Manual (PDM), and working on a book of clinical experience and research that aims, as she explains, “to expand the public conversation about mental health treatment beyond simple symptom reduction.”
“It’s a challenge that I enjoy,” says McWilliams of the editing process for the PDM. “I love making language clearer and more concise.” She and her fellow editor, Italian psychiatrist and psychoanalyst Vittorio Lingiardi, are excited about the progress and expect the revised edition to be published in early 2017 by Guilford Press. “We think we’ve improved the document greatly; we’ve added some tools we think will be helpful to clinicians,” says McWilliams.
Regarding her new book, McWilliams notes, “I think we need a conversation about what mental health is and what it is we are trying to help patients to do.” She continues, “The popular definition of mental health problems -- as discrete categories, with symptom reduction being the criterion for improvement -- is at odds with the real-world experience of many therapists today.” What is needed, in her view, is a way to bridge the gap that exists between the therapeutic world and academic world to help achieve a greater understanding of how to work with the diagnostically complex individuals more and more clinicians are encountering. In her book, McWilliams plans to address “not just symptom relief, but basic security, constancy, affect tolerance and regulation, reflective function and mentalization, resilience, vitality, realistically based self-esteem, acceptance of what cannot be changed, love, work, play, and other core capacities.” In addition, she is collaborating with her daughter, a political theorist, who will add a dimension that examines the “sociocultural aspects of psychological wellness.”
McWilliams is encouraged by and an enthusiastic proponent of a movement among some researchers toward “practice-based research” and “practice-based evidence.” As she describes it, this approach “takes the best of psychodynamic, emotion-focused, behavioral, cognitive, and other approaches to psychotherapy and tries to figure out what works best for whom and when.”
“I’ve been thinking about it [the book] for a long time, presenting on topics related to it, and asking audiences of therapists to help me refine the categories and critique the way I have it organized. At this point, I’m really ready to go and the support of Riggs is wonderful.”
McWilliams spent her time as a scholar at Riggs with her husband, Michael Garrett, MD, who has worked with individuals in urban areas who are impoverished and experiencing psychosis for the past 35 years. Together, they offered a seminar to Riggs clinical staff on psychotic and non-psychotic paranoia.
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