You are the therapist at The Willow Practice. Clients walk in with histories, relationships, defences and ways of organising self and reality. You choose what you do next. Their response changes what becomes visible.
The core loop is borrowed from character-led time-management games: open the day, work the room, earn insight, unlock clinic upgrades, then handle a harder caseload. The content underneath is psychodynamic structural assessment.
No diagnosis. No structural level yet. Describe the clinically useful phenomenon in your own language.
Representations of self and significant others need sufficient continuity and differentiation that the person can recognise complexity without having to reorganise the entire relational picture each time affect changes. The construct is especially useful when the clinician observes contradictory self-states or abrupt shifts in the representation of others.
Structural differences can become more visible when attachment, shame, rage, dependency or abandonment fears intensify. A person who looks highly coherent during calm discussion may show a much less integrated organisation when the therapeutic relationship becomes emotionally consequential.
Ask what remains continuous. Ask whether a loved person can remain the same person after disappointment. Ask whether conflicting self-descriptions can be linked into a coherent narrative. Track the response over time.
Can the person differentiate internal experience from external reality, evaluate perceptions against shared reality, consider alternatives and revise conclusions when evidence changes? Accuracy alone is insufficient as the definition. The capacity to reality-check matters.
Suspiciousness can occur under intense affect without representing a global loss of reality testing. Conversely, a person can sound articulate while becoming unable to consider alternative explanations during severe affective or psychotic processes.
After arousal decreases, can the person say, “I can see why it felt certain, but I do not know that it was true”? Does reflective distance return? How stable is the capacity across contexts?
A useful structural sequence is trigger → affect → defensive operation → interpersonal effect → short-term relief → longer-term cost. The label becomes meaningful when it explains the sequence.
Splitting, idealisation, devaluation, projection and projective identification are central to Kernberg's account of borderline-level functioning. Their use can keep contradictory representations segregated when ambivalence becomes difficult to tolerate.
In psychodynamic usage, projection becomes coupled with interpersonal pressure and enactment. The therapist may feel pulled into a role that fits the projected relational pattern. The therapist's experience can be useful data when the sequence repeats. It is never proof by itself.
Defensive maturity concerns flexibility and adaptiveness in managing internal conflict. It is not a moral ranking of the person and should not be reduced to a checklist of “good” versus “bad” defences.
More integrated object representations allow the person to experience another as a differentiated, continuous subject who has both positive and negative qualities. Love and anger can coexist without forcing the entire representation to switch from good to bad.
Look for differentiation of self and other, continuity across time, reciprocity, recognition of the other's subjectivity, tolerance of ambivalence and the capacity to repair after rupture without erasing one side of the relationship.
The therapist becomes an unusually rich object for observation because the relationship includes boundaries, frustration, care, dependence, difference and repair. The patient's representation of the therapist after a limit can reveal how relationships are organised under stress.
You now have to integrate the domains. Select a case and build the strongest structural formulation from the evidence wall.
You have four sessions of evidence. Click the cards you believe are structurally decisive. Then write your formulation in your own words.
Your result is generated from the decisions you made across the clinic and the final structural formulation.
Participants can download their personal result. The trainer report contains the same score, completion ID and decision record for submission to supervision or training administration.