Anamnesis is the name given to the initial understanding of a patient's clinical picture, from information usually obtained by questions from the therapist to the patient.

Usually, anamnesis is confused with:

• an form that the patient fills out (and then the analyst completes) or
• an form or note sheet that the therapist fills out himself from questions asked of the patient.

The Anamnesis is widely used in the health and personal development field (nutritionist, doctor, dentist, psychologist, psychoanalyst, etc.).

Are Anamnesis and Preliminary Interviews the same thing?

No. Anamnesis and Preliminary Interviews are different things.

A anamnesis can be a means to conduct and record important aspects of preliminary interviews. But in psychoanalysis the preliminary interviews go far beyond the anamnesis .

We recommend that you read this other article on preliminary interviews and the beginning of treatment in psychoanalysis. The content of this article on anamnesis complements that of the article on the beginning of treatment in psychoanalysis.

There is no impediment for the psychoanalyst to do anamnesis and make notes of the sessions. In fact, anamnesis understood in a broad way is always being done by the analyst, even if he doesn't make any notes.

Almost always in psychoanalysis these initial notes to the patient or analisand (when the psychoanalyst chooses to make them) should not just be "demographic" questions .

We call demographic questions those such as: name, gender, age, profession, field of education, marital status, city of birth, etc.

The right questions to ask

We know that, in Psychoanalysis, more important than demographic questions are those reflections that bring aspects of the essence of the subject being analyzed. Questions such as: what are the psychic pains, what are the desires, what are the demands, what are the representations and repeated words, what is the image that the analisand makes of himself and of others, what other therapies has the analisand already done, what is his view on therapy, what kind of affective bonds does the analisand maintain with other people, who are these people, etc.

Much of this information do not come only from the analyst's questions Questions can be used all the time by the analyst as a mechanism to favor free association.

Be careful that your analyzer doesn't think that your questions are robotic. Don't let him think that he is answering an IGBE Census survey or a police interrogation.

Avoid administering a directive questionnaire at the beginning of treatment or at the beginning of a session because the ideal is that our analisand, from the beginning, makes free associations.

The limits that the answers bring

In fact, questions of any kind (demographic or essence) are answered by the conscious side of the analyzer's mind For example, if the psychoanalyst asks the analisand "what do you want most?

But while this may appear to be essential, this answer may only be on the surface of the iceberg. Many more analysis sessions will be needed to form a system that can reveal other issues and other desires of the analyzed which can go far beyond "changing professional area".

And this system will not emanate only from questions, much less only from an anamnetic questionnaire. It will require the comings and goings of floating attention and dialogue based on free association until analyst and analisand can minimally understand what would be the essence that appears as the one that brings more fulfillment and less dilemmas and conflicts to the psyche of the analisand.

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Can we use Anamnesis in Psychoanalysis?

We can, but be careful not to bombard your analyzer with questions in the initial sessions. Let your analyzer do the talking .

The analyst can use the anamnesis, but in a different way than other areas of health. At the moment of clinical care (that is, during the psychoanalytic session), it is recommended that the psychoanalyst maintain what is called fluctuating attention .

The analyst and the analisand must be free to hook ideas (and bring them into the therapeutic dialogue) that may have relevance, even though they may initially seem like superfluous or faulty ideas. Therefore, it is not recommended that the analyst write things down during the session.

We can, yes, fill out an anamnesis of our analisand, or whatever the analyst wants to call this record or annotation. But this is not exhausted in the initial session of attendance. notes can be made as information keeps appearing, session after session .

What to write down and when to write it down?

But, what to write down and when to write down in psychoanalysis sessions?

• When It is recommended that the analyst take at least five minutes at the end of the session (just after the analisand has left) to write down the most important points. Doing this at this moment is recommended, because the memories of what was free-associated will still be fresh.
• What If there is a relationship, link or opposition to ideas from previous sessions that the analyst has noticed in the most recent session, it is also important to note it down.
• Some more important points to note : desires, fears, possible resistances or defense mechanisms, transferences, perceptions of "improvement"/"worsening" of the analyzed, aspects of the self-image of the analyzed in relation to himself, to the therapy and to the relationship of the analyzed with other people from the family and/or work.

It is also important that the analyst perceives questions about himself, That is, about the analyst himself, such as his limitations, "gaze addictions" and countertransferences. This may give insights to the analyst about:

• new approaches or "themes that the analyst can adopt with the analyzing one,
• further theoretical studies that the analyst needs to do (since it is part of the psychoanalytic tripod to continue studying),
• new points to discuss in your own therapy session I mean, in therapy in which the analyst is analyzed by another professional (since it is part of the psychoanalytic tripod that the analyst is also analyzed);
• new points for your supervision This is where the analyst discusses his or her cases with a more experienced psychoanalyst (since it is part of the psychoanalytic tripod to have his or her cases supervised).

Freud teaches us that the process of free association must be present from the preliminary interviews.

Our analyzer must already free-associate. From the beginning, the test treatment ("testing") is already in progress, both for the analyst to understand how to continue in his approaches, and for the analisand to understand the dynamics of psychoanalytic clinics.

The analyst's eagerness to take notes during the session may lose something significant in the quality of the listening that is offered. It may generate a noise in the interaction with the analyzed, instead of an aggregating factor of the interaction.

The correct way to use anamnesis in Psychoanalysis

You are a psychoanalyst and want a anamnesis sheet model What we have to tell you is:

• You can find these sheets on the Internet, you can adapt models used in psychology, psychoanalysis, etc.
• You can create your own anamnesis form, just put down on paper the information you hope to get.

However, what seems to work best is one blank sheet of sulfite paper On this sheet you only fill in the date of the session and a summary with a few words about what it is about:

• relevant knowledge achieved in the session and/or
• serve as insight for approaches in subsequent sessions.

Nothing pre-formatted. Everything free-floating as is the method that governs the sessions themselves. And, when you finish the session's notes on the sheet, you just make a dash (or "scratch") to, below the dash, note insights from the next session.

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Sigmund Freud, in the text On the Beginning of Treatment (1913), says about the importance of preliminary interviews, also called by Freud test treatment :

We don't have it available other than this test But this preliminary rehearsal is already the beginning of Psychoanalysis and should follow its rules.

In general, the material with which we begin the treatment is indifferent, whether it is the patient's life story, history of illness, or childhood memories. But in any case, we leave it up to the patient to choose the starting point. We tell him, therefore: " before I can tell you anything, I need to have a lot of information about you; please tell me what you know about yourself ".

We make an exception only for the fundamental rule of psychoanalytic technique to be observed by the patient. We introduce him to this rule from the very beginning: "One more detail, before you start. Your narrative must differ at one point from an ordinary conversation . behave, for example, like a traveler sitting at the window of a train who describes to those who are farther away, on the inside, how the landscape is changing before his eyes. And finally, never forget that you promised full sincerity, and never pass over some fact just because for some reason this information is unpleasant to you (Sigmund Freud - On the Beginning of Treatment 1913)

In summary :

• We can maintain a anamnesis of our examinees .
• But not in the form of an interrogation that is exhausted in the initial sessions nor in the form of written records during the session that break the focus on free association.
• The psychoanalyst must know that pre-formatted questions dumped at once in the form of anamnesis sheet tend to achieve semi-ready and conscious responses from the analyzed.
• The psychoanalyst must be suspicious of the answers of the analisand and ask/elaborate from different angles to avoid ready-made answers from the conscious, in which the analyzing person may be establishing a self-image (or an image before the image that the analyst makes of him) that becomes a dome to the deep work of self-knowledge that psychoanalysis proposes.
• It is best, during the sessions, to focus on floating attention, while our analyzer free-associates, without taking notes while the analyzer speaks .
• E fill in insights little by little at the end of each session (marking the date and the main ideas, on a blank sheet of paper), without hindering free association during the sessions.

This article about Anamnesis in Psychoanalysis was written by Paulo Vieira the content manager of the Clinical Psychoanalysis Course, from the notes of professor and psychoanalyst Pedro Sá .