When a psychoanalytic patient comes for the first time into the therapist's office there are a number of things that that therapist is going to do.

The first is to get an assessment of the symptom. What is the symptom? When does it happen? When did it begin?

You then wanna rule out biological problems. You wanna ask about this person's genetic history. You wanna find out about their biological relatives. Did they have similar problems? Is there depression, is there anxiety in the family? You wanna make sure that this person is amendable to primarily talking rather than to a medical therapy. Is this person someone who is experiencing some kind of delusions or hallucinations in which case you're going to be thinking in more of a biological direction. 

You wanna know about this person's history. How does this symptom fit into this person's life history? Where does this person come from? How do I understand what this person's mind is like now given what I know about this person's history, about the way this person experienced his/her history? 

A fourth thing you want to ask about after the symptoms, the biological history and the person's developmental history - you wanna essentially get some idea about this person's primary conflicts and defenses. You wanna know what's going on about the surface? What is it that's bothering this person as well as how does this person try to regulate that? And how does this person in general try to regulate their emotions?

Finally you try to get an assessment of their object relations. Is this a person that's capable of intimate relationships? Is this a person who has particular deficits in that respect? Who has particular conflicts which get in the way of relatedness. Is this a person who avoids relationships entirely because of fears that have developed a long time ago about relationships, that they're somehow threatening or that things aren't going to work out in them.

(There is, indeed, a great deal of evidence now suggesting that patterns of attachment that you see as early as 12 or 18 months in a laboratory are predictive of social behaviour in pre-school, in the elementary school years and we're starting to have some evidence suggesting that these patterns are passed on from generation to generation. Most of the studies have found particularly the primary caretaker which is usually the mother; that the way the mother appears to be attached to her own mother or her own parents as an adult is highly predictive of the way her child at 18 months or 6 years will be attached to her.) So that's the way a psychoanalytic assessment would proceed with the patient.

-- Drew Westen