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In day-to-day work we draw partly on unconscious skills, knowledge and intuition. But the situation in which we need to be consciously in touch with a whole range of ideas and concepts is the diagnostic interview. Here I would stress diagnostic in conjunction with assessment for analytical psychotherapy; we have to be getting at some sort of diagnostic picture in order to think about the patient coherently and, if necessary, to be able to discuss him with colleagues to whom we may be referring.
My main qualification for giving this paper is the amount of consultation I do in private practice. The diagnostic interviews at the London Clinic of Psycho-Analysis of which I was Director for ten years were pretty specialised and it is in private practice, where for many years I have done an average of three consultations a week, that my experience of diagnosis and assessment for analysis and psychotherapy mainly lies. Of these consultations only about 10% turn out to be ‘therapeutic consultations’ in their own right, i.e. do not require referral for therapy, and only about 5% are subsequently placed in full five-times-a-week psychoanalysis. The therapeutic consultation is a special event which is not necessarily predictable at the point of referral. Winnicott wrote and taught about it. It is very rewarding for both patient and therapist and really does not fall within the scope of this paper. I will just say that it occurs when you can focus on a main, or presenting problem, and say or interpret something mutative; or when the very act of self-exploration by the patient, in this special atmosphere, enables him to reach a solution which satisfies him.
First, we must consider the ‘real’ role of the psycho-analytic diagnostician in contrast to the mythical role which often exists somewhere around the edge of many people's half-conscious phantasy. I am of the opinion that a good solid block of experience in general psychiatry early along the line of one's own development is a re