A Decolonial Approach to Case Formulation: Pragmatic Applications for Therapeutic and Political Action

Speaker: Daniel José Gaztambide, PsyD

This presentation will use a decolonial lens to review current thinking in psychoanalytic case formulation that addresses a) intrapsychic functioning (Davanloo’s feeling-anxiety-defense model), b) interpersonal dynamics (Luborsky’s wish-response of other-response of self), c) personality structure (Kernberg’s level of personality organization), and d) structural forces (Raque and Meisels’ structurally informed case formulation). Drawing on an integration of Freudian, relational, and decolonial perspectives, the presentation will explore evidence-informed and theory grounded principles for attending to the intrapsychic, interpersonal, and sociocultural dimensions of clinical experience. Specifically, a decolonial approach to case formulation informs how the clinician draws upon specific tools and interventions to attend to a) intrapsychic functioning (defense work), b) the patient’s contribution to relationships (transference work), c) the therapist’s contribution to the therapeutic relationship (rupture-repair work), and d) how each of these are grounded in wider relational and sociocultural realities (“social” work). Put differently, such an approach to case formulation not only clarifies to what extent clinical phenomena is “due to personal/interpersonal” factors versus “sociocultural” factors (to the extent these can be separated), but also helps clinicians distinguish between experiences of trauma and sociocultural marginalization that require accompaniment, and the defensive, avoidant uses of such experiences which require confrontation. In sum, such an approach supports clinicians in being socioculturally responsive to patients’ needs without losing sight of intrapsychic and interpersonal contributions to their struggles.