Diagnosis in Clinical Practice: Its Relationship to Psychoanalytic Theory

The rapidly growing diversity of psychoanalytic clinical practice calls for a reexamination of its relationship to psychoanalytic theory. This is as strikingly evident in the field of diagnosis as it is elsewhere. Many analysts bring together their clinical observations in a clinical theory that may appear to fit their clinical findings well. But a clinical theory is not to be identified with a theory of the way the mind works (metapsychology), and an attempt is made, in what follows, to clarify the relationship between the two. It is argued that an uncritical attachment to clinical theories unsupported by metapsychological understanding has been furthered by two main longstanding developments: “object relations” theory and the extension of the clinical concept of transference. A misapplication of Freud's structural model may, in part, have contributed to these developments. This argument, and matters related to it, is pursued in some detail in respect to problems of psychoanalytic diagnosis, with special reference to some of Anna Freud's contributions to the field that seem to be somewhat neglected. Finally, in pointing to metapsychology as a check to clinical speculation, some of the illustrations are drawn from psychoanalytic treatment material, on the grounds that psychoanalytic work with the patient can be viewed in terms of continuing diagnosis.