Thinking about judgement in psychoanalytic assessment and consultation

Abstract

The role and nature of clinical judgement in psychoanalytic consultation are discussed and illustrated with clinical material from psychoanalytic consultations. The considerable and inevitable pressures that act on ‘judgement’ and ‘judgementalism’ are considered. A model for psychoanalytic consultation that takes these pressures into account is described, showing how the subjectivity of clinical judgement is an essential element in understanding and decision-making. Internal as well as external pressures on the formation and proper valuation of psychoanalytic clinical judgement are noted.

Keywords:

• subjective judgement
• judgementalism
• clinical judgement
• psychoanalytic consultation and assessment
• doubt
• negative capability

Notes

†A version of this paper was first given in November 2012 at the TCCR (Tavistock Centre for Couple Relationships) Annual Conference ‘Making Judgments or Being Judgmental? A Problem in Clinical Assessment and Beyond’.

1. This image of ‘blind judgement’, which was used on the publicity flyer for the conference at which this paper was given (Making Judgments or Being Judgmental? A Problem in Clinical Assessment and Beyond, TCCR November 2012), is found on ‘Google’ images under ‘Blind Justice’ and what distinguishes it is the blood that runs down the woman's face from behind the blindfold; ‘Justice’ is usually seen holding a balance scale in her hand, and is sometimes also blindfolded in the service of avoiding any bias in the balance of judgement, but is not in any other representation shown in this particular way.

2. European Psychoanalytic Federation: Working Party on Initiating Psychoanalysis. See Reith et al. (2012).