Thinking About “Thinking About Our Work: Case Presentations” Edward Elder1 issn 0362-4021 © 2014 Eastern Group Psychotherapy Society group, Vol. 38, No. 2, Summer 2014 157 1 Codirector, Group Training Program, Postgraduate Psychoanalytic Institute; Secretary, Eastern Group Psychotherapy Society; and private practice, New York. Correspondence should be addressed to Edward Elder, MDiv, LMHC, 19 West 34th Street, Suite 1200, New York, NY 10001. E-mail: edwardelder@msn.com. When I think about case presentations, I first think not about those in an article but about those that got many of us our certifications. To graduate from my training program, we had to present to the faculty a case on which we had been working. With this case, we had to demonstrate that we understood and could apply relevant theories. We were to tie the client’s history into whatever theory happened to fit best or, rather, show that this theory was supported by the facts of the case. We were very clear as to the purpose of this presentation: to graduate. We were also very clear that we were exposing ourselves to the potential criticism of our peers and supervisors (having gone over the case with at least one supervisor for most of the year, we could expect at least one positive response). Though almost secondarily helpful in understanding our client, the presentation was first and foremost a way of showing that we had some grasp of psychoanalytic theory as we headed off into the world. Stone’s article has left me thinking more about how using case material is a kind of enactment. We cannot claim to elaborate a new theory of the mind without using the facts we find in ourselves or our clients, though we are also well aware that the “facts we find” are subjectively experienced and thus not quite the hard facts of other fields. When we use case material to demonstrate the value of an existing theory, we could be said to be trying to demonstrate the replication of a previous experiment, though we are not likely to look for case material that does not support the theory we prefer. We look for ways to help our clients achieve their goals and tend to suit our theories to fit what seems to be working toward that goal. 158 elder I can easily imagine finding examples in works of literature or theater to explicate some theory (the Oedipus trilogy comes to mind) and thus would not have to bring in examples from my clinical work. At the same time, if I want to show how a theory explains change, I might be more hard-pressed to find examples outside fiction. And because those examples would be manufactured for the purposes of the author, there would be no reason to believe the same would happen outside of fiction. To the extent that I’m conducting an experiment with my clients (and all theories are tested by experiment), the outcome of the experiment is the outcome at which we arrive in the room. The case report, then, becomes the only thing that can meaningfully be used to support or refute a theory. I wonder, though, if case reporting is not also a way of giving ourselves a space to talk about our work openly. We are professionally and legally bound to keep our sessions confidential, yet this means that we cannot talk about what is often the most fascinating part of our daily lives. If my work life revolves around seeing clients and supervisees, and those interactions are off-limits for outside conversations, I will feel somewhat deprived of conversational topics. However, by having professional sanction to discuss my work (properly disguised) in an open forum, I have a way of releasing some of the energy that comes from containing what I find interesting (or frustrating) in any session. Our work is both extremely intimate and isolating. The work of preparing a case presentation will definitely get me to think more deeply about a client or a therapeutic dilemma. Were I to share that with the client, the client would have a clearer sense that I am thinking about him or her (which will be potentially gratifying...