The assessment and diagnosis of psychopathological conditions have traditionally been located within a positivistic paradigm which encourages the view that psychotherapists study their clients in a manner analogous to that employed by natural scientists. Linguistic studies of psychotherapeutic interaction have, however, suggested that the process in psychotherapeutic interviews is radically different since the object of study — the patient — is not passive, and that progress in the psychodiagnostic or psychotherapeutic interview depends upon the patient's co-operation, not merely as a purveyor of information, but as a full and active partner. This notion undermines the traditional view of assessment, and is the basis of this study. Pragmatic analyses of video recordings of first interviews reveal that patients and therapists structure their contributions according to an apparently implicit and ritualized framework of interaction, which leads to consensus regarding word use, communication strategies, and problem formulation. It is suggested that this process is an integral part of the psychotherapeutic routine and that, therefore, the notion of a therapist unilaterally deciding upon a diagnosis or formulation is rendered questionable. This has important procedural implications for psychodiagnosis and psychotherapy, especially when considered against the background of problems with current diagnostic practice.
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