Assessment for Psychotherapy

Assessment is a big subject. To arrive at something we might appropriately call diagnosis we need to do far more than what I wish to discuss in this paper. We would have to take into consideration the following areas of the spectrum:

1. the picture of the world the patient has in mind, i.e. the kind of internal world he has come to have as a result of his experiences. These experiences will be the result of the interaction between his impulses, the phantasies arising from them on the one hand, and, on the other, the external factors of his life, particularly the quality of the nurturing care he has received.

2. the home environment—external factors of the family as well as the organisation of his parents’ internal world, e.g. what was the position of the child in the family, was mother depressed in the child's infancy; was father violent; the relationship between the parents; the nature of their attitude to the patient.

3. external world—the society he lives in and the influence this exerts on him and his family, for instance, do they live in a delinquent sub-culture, is the adolescence exposed to drugs, and so on.

It will be seen that this is an interactional model, namely, development is seen as based on the interaction between internal and external factors*.

Internal factors are the child's endowment, especially the inborn relative strength of the capacity for love vis-a-vis his hate. If the infant has a low tolerance of frustration and is easily angered, this means that he will be more easily subject to intense and frequent persecutory anxieties. These in turn may make it difficult for him to accept help when it is forthcoming. A more favourably endowed infant will put up better with frustration and can be more easily consoled after an upsetting experience, thus reestablishing a loving contact more rapidly. External factors comprise the actual outer events in his life and also the amount and quality of the nurturing he has received, e.g. the understanding of the m