background This article considers whether failure to include a patient's subjective experiences in a psychiatric assessment can result in an inadequate diagnosis of psychotic symptoms. A psychodynamic approach gives specific attention to a patient's subjective experiences.
aim To investigate whether a psychodynamic assessment of psychotic symptoms based on the structural interview devised by Kernberg can be useful in clinical practice.
method First of all, the psychodynamic assessment of reality testing is described. This is followed by an investigation of the extent to which this method is compatible with the findings of the cognitive model for psychoses. Then some interrater-reliability studies are discussed.
results Within the psychodynamic interview the focus on inducing anxiety and on withholding contextual information from the patient is compatible with the cognitive model for psychoses. Reliability studies should be confined to delusions and hallucinations.
conclusion Psychodynamic assessment can be a useful addition to the standard psychiatric assessment of psychotic symptoms. However, further studies of the reliability of the psychodynamic assessment are required.