Diagnosis-of-the-Moment and What Kind of Good Object the Patient Needs the Analyst to be: Commentary on Paper by Neil Skolnick

I attempt to clarify Skolnick's idea that patients should be given the opportunity to identify with the analyst's self, especially struggles within the analyst engendered by the treatment process, as he or she analyzes—a process Skolnick calls “dynamic identification.” Specifically, I ask whether analysts should actively present their own struggles to patients or should allow patients to discover this aspect of the analyst's subjectivity in their own time. Skolnick is not explicit on this point. I understand the work of developmentally oriented theorists such as Balint and Kohut, as well as Skolnick's own ideas about the importance of the analyst's attunement to the patient's level of psychic organization, to indicate that certain patients need to be allowed to discover the analyst's struggle and limitations only as they are ready to do so.

This line of thinking leads to a consideration of the question of diagnosis, a theoretically uncomfortable concept for many relational analysts. I propose the concept of “diagnosis-of-the-moment,” which allows us to value diagnosis as a meaningful and clinically useful description of a person's functioning, without minimizing the contribution of context, reifying unsubstantiated assumptions about the patient, or constricting clinical possibilities.