You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
From his experience with psychiatric examinations of survivors from Nazi persecutions in Germany, Dr. Hoppe has delineated two important topics:
The influence of the psychiatrist's emotional reaction on his diagnostic skill, and
the survivor's corresponding reactions.
As so often occurs, extreme situations bring certain problems into focus and the detrimental consequences of countertransference difficulties in diagnostic examinations was very convincingly demonstrated.
We know a great deal about countertransference in long- or short-term treatment. There is considerably less information available on the impact of countertransference reactions on diagnostic examinations. Because of the short contact with the patient, it takes a rather experienced clinician to spot quickly his own countertransference reactions and to pick up subtle cues which indicate the patient's reactions to them.
The difference in the structure of a diagnostic examination for the purpose of reaching the best treatment recommendation, versus a diagnostic assessment in which a third party (e.g., court, compensation agency, etc.) is involved, presents various pitfalls for countertransference difficulties. For instance, as Dr. Hoppe demonstrated, countertransference may be acted out against the patient, as well as against the third party. On the basis of my own experience in doing and supervising diagnostic examinations for many years in the Outpatient Service of the Menninger Clinic, I agree with his emphasis on the importance of countertransference in diagnostic assessments.
An extreme case comes to mind from my experience, the case of a battered child syndrome, in which the husband probably had killed his first-born, and had severely injured his second child, whereupon the latter was removed from the parental home by court order. The father stated rather coldly that he could not control his anger when the child would not stop fussing or crying. But he had made no attempt to obtain psychiatric help for th