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This report gives an account of four panels in the 47th IPA Congress in Mexico in 2011, which were proposed by the Project Committee on Clinical Observation. This Committee developed four panels to present the Three-Level Model for Observing Patient Transformations. The model is a tool for observing the same clinical material from the perspective of three different levels. The work with this model was then exemplified with two different cases. We will briefly review the work done in each panel.
In the panel on The Importance of Diagnosis in Clinical Work: Part 1, chaired by Marina Altmann, clinical material was presented by Virginia Ungar, and panelists Ricardo Bernardi and Pablo Cuevas discussed several aspects of the material. Specific initial moments of the analysis were observed, and transformations in the patient were described and examined.
Ricardo Bernardi briefly presented the Three Level Model for Observing Patient Transformations, and focused on the second level: the conceptualization of the main diagnostic dimensions, taking into account the dimensions of change proposed by the OPD—2, PDM and DSM—5 (draft).
He pointed out several dimensions: the awareness of his suffering, relational patterns and his structural limitations to perceive himself and others, and concluded that indicators of change in this process could be seen in mental functioning and the focus of therapeutic work on working through emotions, feelings and experience relating to himself and to others. He finished his presentation remarking that, in the case discussed, the model allows to focus on the problems that analysis should address to enable improvement in the patient.
Pablo Cuevas emphasized the importance of diagnosis and presented a psychodynamic perspective of the clinical material, pointing out the emotional deprivation of the patient, his protective armor and grandiosity.
Both presenters — Bernardi and Cuevas — agreed that these perspectives are complementary. Cuevas pointed out that t