[Objective diagnosis, relational diagnosis--science or art?].

This paper describes the dilemma the psychotherapist faces when dealing with the psychosomatic disorders that are referred to him by the primary care physician. Psychosocial and psychosomatic evaluation and treatment standards are based on relational and contextual dimensions, in order to assign comprehensive and meaningful perspectives to previously disconnected symptoms. On the other hand, quality management and cost-benefit criteria require the use of objective diagnosis, decisional trees and treatment guidelines. The author proposes an ethical compromise and a doctor-patient negotiated partnership as a solution to the dilemma.