Case Presentations: A Response to Walter Stone

Abstract

Case Presentations: A Response to Walter Stone Howard Kahn1 issn 0362-4021 © 2014 Eastern Group Psychotherapy Society group, Vol. 38, No. 2, Summer 2014 163 1 Assistant Clinical Professor, Child Study Center, Yale University. Correspondence should be addressed to Howard Kahn, PhD, 436 Orange Street, New Haven, CT 06405. E-mail: howard. kahn@yale.edu. In response to Dr. Stone’s piece on case presentations, I first want to enthusiastically support his thoughtful endorsement of the usefulness of writing and publishing case material. Stone offers us his agreement with Aron’s perspective that case material “may be offered in the spirit of learning, sharing experience and thought, and encouraging reflection and contrasting perspectives” (Aron, 2013, p. 582). Aron went on to cite the “brilliant and groundbreaking work of Freud as reporter of case material,” and he says, “Certainly, as a clinician, case presentations stimulate my thinking about particular situations I am facing or clarify aspects of a theory” (p. 582). He sensibly offered us the caution of respecting the privacy of our patients and their right to maintain control over confidentiality and exposure of their personal lives. Finally, I agree, as Stone says, that case studies are not proof of a theory. They are open to discussion and controversy. Indeed, clinical examples invariably invite discussion, which, although at times acrimonious, is also the path to thinking more deeply about how we care for our patients and what we expect to share and/or teach about our work and theories. Stone addresses the fear of criticism or embarrassment attached to presenting one’s work to colleagues, for making “subtle mistakes . . . expose[s] his or her misunderstandings or lack of clinical skill.” He implies that there exists some objective standard by which critical assessments may rightly be made. In my opinion, such assessment by colleagues is out of place, inappropriate for the proper use of case study material. Let us consider adopting another paradigm or approach to case material that 164 kahn would lend itself less to polemic and argument; one that could enhance our own perspectives, invite dialogue, and improve training by promoting wisdom and sharing of information. I propose that the traditional perspectives of literature and folklore, with their emphasis on relationships within and between people, be background for understanding and evaluating case study material. I include literature that existed before writing, in songs and folktales (this includes therapy supervision) and, of course, theater, where dialogue, in the present, is of central importance. The literary perspective provides a suitable setting for developing a deeper understanding of others and ourselves. The case study in psychotherapy fits right in, because each vignette illustrates the nuance and variation of relationship encounters, which can unfold and be observed. Adopting a literary or aesthetic perspective would eliminate the constraint placed on the writer to be theoretically sound, to be a good scientist, or to be “correct” by some external theoretical standard of clinical skill. The case study is literature. It is a record of the therapist at work. The usefulness or power of case study material comes from the depiction of the relationship between therapist and patient in the actual therapy session. As such, it provides the material for the study of the ongoing relationship between these two people (or the group) that takes place in the particular situation we call therapy. I agree with British psychoanalyst Peter Lomas (as cited in Fierman, 2002), who, in his book The Case for a Personal Psychotherapy, wrote that “psychotherapy refers to a situation in which one person is aiming to help another to grow by offering him a relationship that has much in common with those in ordinary living but takes place in an unusual context” (p. 44). The case study, which is closest to ordinary human interaction, does not call for or benefit from higher levels of theoretical analysis to be useful for teaching and learning. Alan Kasdin (2008) has written, in his assessment of evidence-based research and practice, that “much of psychotherapy is not about reaching a destination (eliminating symptoms) as it is about the ride (the process of coping with life)” (p. 147). Louis Fierman (2002), in the preface to his book of...