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This paper is an attempt to describe a diagnostic schema that is meaningfully connected to psychotherapeutic technique. It is an attempt to bridge the gap between diagnostic formulations and the specific stance taken by the psychotherapist. The issues contained herein grew out of a dissatisfaction with the lack of functional guidance provided for the therapist by traditional diagnostic thinking. So often, in my opinion, after hearing a case presented, well worked up, intelligently discussed by the staff, the listener is left with the question of how all these labels or formulations are related to technique.
The diagnostic thinking presented is based on the notion of ego needs. It is almost a truism that therapeutic technique should be tailored to a patient's needs. Balint was stimulated to write his book The Basic Fault to deal with the lack of fit between the analyst's “otherwise correct technique and a particular patient's needs.”1 The wide variety of patients who are treated psychotherapeutically presents us with a wide variety of needs that to a significant degree must be met before these people are willing to commit themselves to therapy and an open dialogue with the therapist. This paper is an attempt to describe ego needs and to relate particular needs to the need fulfilling responses the therapist can offer. It is an attempt to answer the question, “What do you do when. …?”
In order for technique to be talked about meaningfully, the goals that the techniques are designed to accomplish must be specified. I will discuss two goals sought after in psychotherapy: (1) establishing the therapeutic relationship, and (2) promoting ego