Clinical Assessment and Psychoanalytic Theory: Finding the Meeting Point

The diagnosis of psychological disturbance in adult or child is based above all on clinical procedure. One human being faces another in a clinical interchange, and the diagnostician hopes to make enough sense of what takes place to get some idea of what (if anything) is amiss with his patient and what (if anything) may be needed to put it right. An adult patient who has sought the assessment of his own free will tries to help the diagnostician and hopes for some success. And although a child rarely seeks treatment of his own accord, the diagnostician will normally begin his clinical encounter supplied with a social history, obtained in a clinical setting, and with school reports based in part on academic performance but also on the personal impressions of teachers. Psychological testing (by a clinical psychologist) may play a significant part in the assessment. In most clinics and institutions, a case conference follows and, if possible, a clinical diagnosis, however tentative, is agreed.

If the diagnostician is a psychoanalyst, working with psychoanalytic colleagues, the diagnostic discussion will in all probability take place against a theoretical background that acknowledges the importance of unconscious mental processes, aggressive and sexual fantasies, oedipal and preoedipal organizations, and other concepts closely in tune with clinical practice and clinical findings.2 The theory