Thoughts on Clinical Case Conferences

Abstract

INTRODUCTION One of the central clinical activities of experienced psychoanalytic therapists and novice clinicians alike is the discussion of clinical cases. Case conferences are important yet complex, and are likely to form a turning point in the development of the clinician and/or treatment presented. Some clinicians view clinical case conferences as a kind of court room in which their work may be judged; others view it as an opportunity to escape the loneliness of the clinical work, experienced by many; while others still hope it will fulfill their wish for acknowledgement by the analytic community. Nonetheless, such narcissistic fantasies about case conferences may often lead to disappointment on the part of the therapist presenting the case. Case conferences involve an extremely complex interaction that often turns out to be frustrating and intimidating both for the presenters and for the participants. The presenter may even feel traumatized, as he or she discloses intimate feelings, thoughts, and attitudes experienced during the course of analytic work. In such an event, participation can even delay development and professional growth as an analytic therapist. Indeed, at times, presenting at a case conference can be experienced as a low point in the therapist's professional life. Similarly, group discussion in a case conference can also be a damaging experience for the other participants, who may feel embarrassed or guilty of being misunderstanding or aggressive towards the presenter. These dangers make it highly important to examine the structure of case conferences, to understand their complexity and to evaluate how both the presenter and the participants can make the most out of it. There are many ways in which the social-professional encounter of case conferences can be studied, such as the influence of regressive, unconscious, personal and collective desires upon group processes, how individ- uals and groups can provide containment for the presenting therapist, and so forth. Yet, despite this variety of possible perspectives, case conferences have hardly been evaluated by psychoanalytic therapists and the literature rarely touches upon its issues. One of the few papers on the topic, by Tuckett (1993), emphasizes the need to evaluate three aspects of clinical case studies: 1) the theoretical differences that characterize the discussion and the common attempts to ignore them; 2) the individual ways in which therapists present the narratives of their treatments and the influence this has on the discussion; and 3) the personal and interpersonal context in which the treatment being presented developed, while the therapist is perceived as a participant-observer. Herein, I intend to examine the construction and attribution of meaning by participants in case conferences and to assess to what extent these reflect current epistemological understanding and perception. Specifically, this article will evaluate ways of attributing meaning and constructing interpretation to transferential-counter- transferential events that seem both transformative and constitutive and that reflect vicissitudes in the analytic clinical process. In most case conferences, therapists present their clinical work to colleagues in their professional community, be it as part of a discussion group within an institute, a meeting amongst colleagues set up for this purpose, or a working group within a public clinic. In many cases, a clinician's motivation to present clinical work stems from a desire to receive recognition from peers for development as a professional and to share responsibility of therapeutic work. The presentation and discussion of a clinical case, wherever it takes place, is performed with the aims of assisting in the development both of the psychoanalytic therapist as a professional and the treatment he/she has chosen to present through better understanding of the analytic process, its components, and its development. …