An account of psychiatric casework in three clinical encounters using a psychoanalytic lens

Abstract

Transference and countertransference are key diagnostic concepts in psychoanalysis which are unacknowledged in categorical diagnostic systems in psychiatry. This may also highlight the fundamental differences in understanding clinical presentation in the context of the individual. In psychoanalysis, the clinician's response to each patient is carefully thought about. Three vignettes are used to illustrate how clinicians use their countertransference to ask key questions which address the sense of the uncanny that the patients' stories evoke. This is then linked, using the theoretical notion of projective identification, to unconscious communication between doctor and patient. I conclude by describing an ICD-10 category of patients who present a disturbance in articulating emotions, tending to evoke and manifest powerful bodily experiences. The examination of countertransference is suggested as adding depth to a diagnostic process that risks losing the value of data from individual patients.