Diagnostic Thinking about a Boyhood Disturbance

It is not always recognized that Anna Freud had reservations about the use of her diagnostic profile schema (1962). In particular, she was afraid that the schema would be used as a questionnaire and filled in accordingly. She would sometimes become ominously silent when a diagnostician attempted to make lengthy statements about such matters as a child's narcissism in the absence of any information on which to base an opinion. In her view, the profile was simply a guide to psychoanalytic diagnosis and to diagnostic thinking about a case. She often pointed out that, in many child referrals, the diagnosticians were faced with a mixture of parental prejudice, childhood reluctance, and psychological-test material which, certainly in the young, was not always very reliable. Even under the best conditions, a psychoanalytic diagnosis was tentative and provisional; and she disliked the fact that the profile sometimes prompted people to move from legitimate speculation to unjustified guesswork.

Anna Freud thought deeply about every case coming to the Centre for diagnosis; she had often reached some kind of formulation before she listened to a profile; and she did not think in headings. The profile is a useful way of ordering initial data and subsequent inferences about a case, but the bulk of the psychoanalytic thinking needs to be done before a profile is made. The schema headings may certainly stimulate further thoughts and often draw attention to aspects of the child's development and personality of which nothing, or very little, may be known at that stage.

The psychoanalytic assessment which follows was presented at a diagnostic meeting in the narrative form it takes here. It sprang from a policy which strove to discourage the automatic use of headings as organizers of thought. Certainly a profile format can be discerned, especially in the section on metapsychology. But it was hoped that the lack of explicit