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IN DAY-TO-DAY WORK, one draws on principal conscious skills, knowledge and intuition. But the situation in which you 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 analytic 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. This picture has to include, of course, what the patient is not.
My main qualification for writing this paper is the amount of consultation I do in private practice. The diagnostic interviews at the London Clinic of Psycho-Analysis are 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.
First, we must consider the "real" role of the psychoanalytic diagnostician in contrast to a mythical role which often exists somewhere around the edge of many people's half-conscious fantasy. 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 real help; this is principally linked to the fact that I myself had that and, therefore, my view immediately underlines another factor, which is that we cannot expect or even desire that subjectivity