The Ideal Patient and the Realities of Clinical Work

Abstract

As candidates, and later as practicing analysts, we filter the idea of what patients, analysts, and the analytic process should look like through our own ego ideal. Literature that is often stilted toward a theoretical ideal further muds the picture. Finally, we are often confused by the quest for the perfect patient who meets the criteria for analyzability outlined by our training institute, our supervisors, our teachers, and our own demanding superegos. This paper examines several cases of clinical work that falls far short of any ideal. However, these realistic snapshots of day-to-day clinical work are too important to be ignored as simply failed cases with unanalyzable patients. Often, even the briefest of clinical encounters enrich the analyst's understanding of human functioning and occasionally benefits the patient as well. If the analyst uses the analytic stance with all of his patients, a useful analytic discourse may take place with some of them. These cases are not “standard” or complete analytic treatments, but the results are often valuable to the practitioner and potentially helpful to the patient.