The Initial Interview: Part I

Compiled and edited from lectures on Psychoanalytic Technique given by the late Karen Horney at the American Institute for Psychoanalysis during the years 1946, 1950, 1951 and 1952. Further lectures in this series will appear in subsequent issues of the Journal.

The initial contact between patient and analyst is much more than an introduction to analysis, much more than the moment for making practical arrangements or obtaining clinical data and past history. The initial interview can be analysis as much as any other analytical hour.

When we talk about diagnostic values, we are not just concerned with the severity and extent of illness, but what kind of human being the patient is. We must determine what he's out for, what he wants from the analyst and what is the status and availability of his constructive resources. It would be too ambitious to expect that we can get the whole diagnostic picture right away; however, it is necessary and possible to get some feeling of the patient and of the distribution of forces within him.

Intuition: Our first impressions are most important because in sizing up the patient we usually can start out without prejudice. Therefore, these unbiased impressions may be more valid than we know during the initial interview. We are dealing here largely with the role of intuition, the perception and evaluation of objective reality operating unconsciously and representing a sum total of all the analyst's past experiences—physical, emotional and mental. The preliminary interview, perhaps even more so than the rest of analysis, requires a lot of cooperation, and the closer the analyst is to his totality of experiencing, the more available will he be for cooperation and understanding the patient. Even with our first impressions, diagnosing and prognosing do not occur in the emotional vacuum of complete scientific objectivity, so the analyst's relatedness to the patient must constantly be taken i