ABSTRACT
Very often, one may embark on an assessment without any clear idea of what one is supposed to come up with by the end of the consultation. Should it be a psychiatric diagnosis, a psychoanalytic categorization, a developmental history? Certainly, together with the patient, we need to reach some mutual understanding of his current predicament, reflecting internal conflicts and early life experience and whether he would benefit from psychoanalytic psychotherapy. Bearing in mind Winnicott’s view that psychoanalytic work is for those who need it, who want it, and who can make use of it, the aim of an assessment consultation is to reach a psychoanalytic formulation in order to make an appropriate referral. People frequently come to an assessment deeply troubled, but one must remember that desperation can be a poor indication for psychoanalysis. We are not offering a crisis service. Our objective in a psychotherapeutic consultation is to identify the unconscious phantasies and object relations that characterize the patient’s inner life and, consequently, his relationships with other people. It is not simply modelled on a medical or psychiatric diagnosis. A diagnosis is the identification of disease through the patient’s symptoms, while a psychotherapeutic assessment is 10based on a patient telling us his life story and current difficulties and our observation of how he uses the consultation. Diagnosis usually plays a part in arriving at a formulation, but is absolutely essential when faced with acute disturbance, such as florid psychosis, paranoia, suicidal tendencies, perversion, addiction, or the likelihood of violent acting out. This does not necessarily preclude psychoanalytic work, but a referral needs to be carefully considered with an awareness of what the therapist will be dealing with and the possibility of the necessity for medical or psychiatric cover. Diagnosis is primarily based on the objective evaluation of symptoms; we are equally concerned with the healthy part of the patient and whether he has the ego strength to withstand the pain and frustration of psychoanalysis.
