Developmental Considerations and Diagnostic Assessments

When we attempt a diagnostic assessment of a child, ultimately we hope to offer a psychodynamically formulated understanding of the child and his1 particular difficulties. At one level we simply try to understand the child from the ‘inside’ by asking ourselves what the subjective world feels like for him. How has he made sense of his experiences? What are his wishes, pleasures and hopes, his fears and sadness? What sort of internal figures inhabit his world and what feelings have clustered around these figures? What too are his feelings about himself? The diagnostic sessions provide an opportunity to gain a sense of the actual child, how he relates and plays out or narrates his internal preoccupations. We then try to integrate this with what we know from external sources, i.e. the social history, psychological assessment and any additional reports such as that from the school. In the final assessment there is an attempt to offer a psychodynamic formulation on the child. The manner in which this is done necessitates a secondary order of understanding. This entails incorporating a view of the child from the ‘outside’ that is based on a wider overview of development. The term development itself tends to suggest a unitary, one-directional process of unfolding. What I hope to address in this article are the many different types of forces, endogenous and exogenous, that feed into and shape the way in which development unfolds. In this sense one might more appropriately think about the various developmental processes within a child, with perhaps a range of significant aetiologies of different statuses that lead to a disturbance. Some of the wider developmental considerations are, axiomatically, reflected in our psychodynamic formulations. As such they can rest on implicit and explicit assumptions about the nature of development. I hope to look at what some of these assumptions are and to suggest that ultimately a range of perspectives may be needed. In any given case the d