Discussion of “The Use of Dreams in the Evaluation of Severely Disturbed Patients”

Diagnosis, for the psychotherapist, is made up chiefly of two elements: observing and evoking. Its purpose is to help establish a relatively interpersonal and emotional patterned concept of a patient's disturbances and to better formulate a process for overcoming the patient's role in his or her recurring painful life events. Diagnosing can assist in organizing and giving direction to psychotherapy.

Diagnosis has, however, inherent dangers. It may oversimplify and thus limit both observation and evocation. Limiting observations can occur by unjustifiably assuming parts of a diagnostic pattern or misinterpreting observed activity as an expression of some expected elements. Evocation can be restricted by failure to further explore elements in the patient, which by further pursuit might reveal more than is readily implied by an item in a diagnostic pattern. Evocation, for example, is often restricted by failure to explore affect. For example, a cautious, timid manner may be diagnosed as a paranoid response. It may, however, be the expression of humiliation over exposing some embarrassing behavior to an intimately questioning stranger, a psychotherapist. Or a clenched fist may be observed and interpreted as a sign of anger. It may, however, be a sign of conscientiously summoned courage necessary for the patient to tell something the patient is ashamed of.

Misinterpretation of a fist or failure to pursue far enough with the patient an observed element such as the fist may fit into a different diagnostic pattern involving hostility and may result in misdiagnosis. This could lead