Without History: An Experimental Case Presentation

Without History: An Experimental Case Presentation

“For today’s event, we have asked our three analysts to present the same case, which is an ongoing psychoanalysis, being conducted by yet another clinician who’ll remain anonymous. Our three analysts will present this case based on a set of process notes only, without access to case history or other information about the case. Also, no one in today’s audience will have access either to the process notes or to any case history. This includes the event’s planners: neither I nor any member of the planning group has looked at the process notes, nor do we know details of the case. We’ve designed this event so that, aside from the three presenters, everyone else in the room will listen from a radical position of—“not knowing.” We’ve designed this event flexibly, with a number of possible directions in mind for exploration. But a central aim of the radical kind of listening that I’ve described is to amplify the experience of clinical listening itself, and to highlight everyone’s awareness of the movement from a stance of more fluid listening to a stance of listening with the sense that one is coming to “know” something about the case. So a theme of this event is listening vs. knowing, and the dialectic between the two.

You might ask: Why remove case history in particular? Well, case history is typically central to clinical thinking. Often, though not always, we’re trained to hear case history through the filter of a preferred theory. And once a link is made between a case history and theory, you have a heuristic tool for identifying and interpreting clinical phenomena. So in short, a case history is a medium for importing theory into a case, and together, case history and theory create a basis for a sense of “knowing” about a case. Many and perhaps most of us, have been trained to do this as a matter of course.

We have no intention of suggesting that case history has no clinical value. Of course it does, or at least it can. But today, by removing case history, we’re putting a speed bump into this process of knowing. The hope is that by slowing down the movement from listening to knowing, each of us will be able to observe that process more closely. The presenters were given completely free rein, in terms of what and how they present today. However, we’ve asked them to not only give us an account of the case, but also to tell us about their individual processes of making sense of the clinical material, starting with first contact.

As for the audience, we’re asking that you too attend to your process of making sense of what you hear. How do you waver between listening and knowing? How are you listening to not one but three presentations in counterpoint? When do you reach for theory? And finally who is the patient you’re tuning into. We assume that today’s experience will be, at times, disorienting, and maybe unsettling. What role do these states have in the play between listening and knowing?

Of course, for a case presentation, we needed a case to work with. But it’s probably clear at this point, that our aim is to explore not the case itself, or at least not only the case, but rather the process of listening to a case.

What do you hear, and what do you do with what you hear?

The planning group talked in great detail about this structure of this event. You’ll observe, for example, that there are three presenters, rather than one. The case being presented belongs to none of the three. Of course, history has been removed for the reasons I’ve discussed. Each of these choices among others had an intention in line with aims of the experiment, and, if there’s interest, we’d be happy to talk about how and why we structured the event in the way we did during the discussion.

I do, however, want to mention one of these choices that we felt might be controversial. That is: there won’t be any moment of revelation at the end of the event: the history of the patient, and of the treatment, will not be revealed. This may be unsettling to all of us, in different ways. We chose this route first to protect the clinical material from over-exposure. This is an ongoing treatment after all, and the analyst rightly asked that we protect that treatment with various levels of confidentiality. However, we also felt that the spirit of this experiment is about un-settling things; it’s also about listening, and continuing to listen, in the face of not knowing. We felt that refraining from revelation, and leaving behind a not-knowing might be the best way to leave all of us on a note of wondering and reflecting on what happens today. And I want to repeat: this is an experiment. We really don’t know how it will turn out.” – Introductory Remarks from the Planning Committee delivered by Jason Royal

Planning Committee: Ezra Feinberg, Evan Malater, Jason Royal, Jamieson Webster, Hannah Wallerstein

Participants: Muriel Dimen Patricia Gherovici, David Lichtenstein

Click here to read the Guidelines for Participants

Click here to read Jason Royal’s “The case presentation series of Unbehagen: What is there to question in the case presentation as a form?” (posted with permission from Jason Royal)

Click here to read full text published in DIVISION/Review – Fall 2015 (posted with permission from DIVISION/Review)

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