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Shapiro, S.H. (1984). The Initial Assessment of the Patient: A Psychoanalytic Approach. Int. R. Psycho-Anal., 11:11-25.

(1984). International Review of Psycho-Analysis, 11:11-25

The Initial Assessment of the Patient: A Psychoanalytic Approach

Stanley H. Shapiro


A method of assessing prospective patients is described in which reliance is placed largely on

the use of the associative procedure from the outset rather than a formal anamnesis. The similarity to Freud's recommendation to undertake a 'trial analysis' to assess the patient is noted, but an open-ended format of weekly face-to-face meetings is considered more practical today. The diagnostic and prognostic value of attempting to have the patient free associate is illustrated and discussed. The difficulties encountered are viewed as resistances, and interventions in the form of clarifications are utilized to explore these obstacles as one would in analysis proper. Particular attention is paid to the manner in which the patient reacts to the analyst and to the consultation. These responses, reflecting the doctor-patient relationship that is being established, provide useful information about the patient's capacity to form object relationships in general. While not transferential per se, they reflect 'transference readiness'. It is argued that this method of evaluation is preferable because it generates analytic data on which to base a treatment recommendation. It has the added advantage of not requiring a shift in technique from the usual analytic posture. For the patient, this approach provides an experience with how treatment works enabling him to make a more informed decision. The method also facilitates a smooth transition to analysis or psychotherapy, to be carried out directly by the consultant or through referral.

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