Intersubjectivity and psychiatric diagnosis

INTRODUCTION: Classical psychopathology underlined the significance of the clinician's feelings, empathy, and intuition in the diagnostic reasoning process. Recently, there has been a resurgence of attention to this topic and a renewed research interest in the investigation of the intersubjective dimension in clinical psychiatric settings. This review, informed by PRISMA guidelines for systematic reviews, aimed at critically evaluating these studies and discussing the clinical relevance of their findings.EVIDENCE ACQUISITION: We searched the PubMed database for scientific papers written in English that were performed on mental health clinicians seeing a patient for the first time and included a standardized assessment of the clinician's subjective experience during patient evaluation.EVIDENCE SYNTHESIS: Nine studies were identified. Two pioneer studies focused on the diagnostic value of the putative schizophrenia-specific ineffable intuition named "praecox feeling" and reported mixed results. The other identified studies used a recently developed and validated measure named Assessment of Clinician's Subjective Experience (ACSE). These studies reported significant and theoretically consistent relationships between the clinician's subjective experience during the first visit and both categorial diagnosis and the main psychopathological dimensions. Also, they found several associations between the clinician's subjective experience and clinician and patient gender. No association was found between cultural diversity and the clinician's subjective experience. In a study on patients treated with short-term psychodynamic psychotherapy, the clinician's subjective experience of the first interaction displayed many significant correlations with the early therapeutic alliance.CONCLUSIONS: The findings suggest that the clinician's subjective experience during the interaction with the patient can be reliably measured and has clinical value. The time seems ripe for reintroducing the concept of intersubjectivity at the core of the diagnostic process.