Psychodynamic/psychoanalytic diagnosis has been controversial from its beginnings. And there is a paradox inherent to the process: it is difficult, if not impossible, to diagnose without having considered the case over time and in detail. At the same time, the choice of treatment approach depends on having made a prior commitment to a diagnosis. And the relevance of a diagnosis can only be established after treatment is well underway. Moreover, unlike in clinical medicine, direct empirical observation is impossible. There is simply no realistic way to establish the presence or absence of pathology or illness with a fixed system of meanings and nosology. In clinical medicine, unlike psychodiagnostics, the physician has at his or her disposal a complement to the patient’s recollections: direct examination with sophisticated, sensory enhancing technologies (Verhaeghe, 2004).
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