Towards A Meaningful Coordination of Etiology, Nosology and Therapy In Psychoanalysis

The recent publication of the third edition of the American Psychiatric Association's (1980) Diagnostic and Statistical Manual of Mental Disorders (DSM-III), with its multiaxial system of diagnosis, has furthered both the descriptive classification of mental syndromes, and the still rudimentary attempt to provide a profile of factors in the assessment of individual cases. However these contributions have been at a price that clinical psychoanalysis, together with the broad range of psychologically based psychotherapies, can ill afford to pay.

The psychoanalytic or psychotherapeutic clinician works directly with psychological phenomena, both in their present manifestation and in their relevance to past and future. The stock-in-trade of such a clinician includes work with the activation of memory, discharge of affect, cognitive and affective understanding of and integration of imagery and symbolism, the reality-testing of fantasy, working-through of transference and relational phenomena, the ascription of meanings, and an infinite number of other phenomena within the psychological field, both dyadic and personal. In the course of this subtle and complex work, the clinician relies on his or her ongoing and revisable assessment of the relationships among the various psychological factors of the patient's life, as a guide in the selection of appropriate therapeutic interventions. The patient's response to these interventions, the development and direction of the psychoanalytic or psychotherapeutic relationship, in turn constantly correct the search for connections between history and present attitude and behavior. In consequence, each analysis, each therapy, is among many other things an experiment in establishing meaningful connections among etiology, evaluation