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One of the functions of the preliminary interviews with a new patient is to arrive at a prognostic evaluation. All that is learned, observed, and felt during these contacts is at the same time utilized for diagnostic, prognostic, and therapeutic purposes. Prognostic work, in fact, only somewhat artificially can be dissociated from the diagnostic and the therapeutic. These are only different aspects of one process, the interaction between the personality of the patient and that of the physician. The prognostic function, however, must especially be kept in mind from the beginning, because each new factor from then on will add its weight to the prognostic evaluation, and because prognostic considerations will sometimes have to guide us toward eliciting relevant material and provoking revealing reactions in the patient.
Prognosis, according to one medical dictionary (Dorland) is “A forecast as to the probable result of an attack of disease…” In our work, however, it must be taken in its most comprehensive connotation. It must also include an evaluation of the patient's ability to undertake, participate in, persist through, and benefit from psychoanalytic treatment, and should also consider the therapist's chances of helping him, in relation to his skill, degree of interest, and possible emotional reactions to the patient.
In order to better understand certain features of prognosis in psychoanalysis, it may be advantageous to compare it with prognosis in another medical specialty, such as internal medicine. I think that there is a very close parallelism between the two, which should surprise no one, if one remembers that internal medicine and psychiatry deal with two aspects of the same individual.
In both cases the person facing us for the first time is always a variant from the average of the species, and as such is always a “quid novum.” Both in internal medicine and in psychoanalysis prognosis is a forecast ideally based on all of the individual contingencies accessible