Commentary

It is both an honor and a challenge to respond to Robert Michels's comprehensive and interesting paper. “Psychoanalysis,” he begins, “is based on theories and on clinical data, the events that transpire between patients and analysts in the consultation room.” He then points to the scarcity of extensive case reports, noting that “the clinical data in our literature are more and more likely to consist of vignettes or snapshots, rather than full-length accounts.” Michels emphasizes the importance of comprehending “the psychoanalytic process as a whole, the story of the unfolding of the patient-analyst relationship and its influence on everything that transpires in the analysis.” He organizes his discussion around five perspectives: (1) the nature and (2) the purpose of case reports, (3) oral vs. written reports, (4) the relation between case reports and analyses, and (5) how the case report offers a special vista on the analysis itself, “revealing the analyst's awareness and comfort vis-à-vis his or her intentions” and conveying “more than the analyst knows,” as it is “at least in part a countertransference theme or enactment.” It is easy to follow his text, as he makes his point clearly. His conclusion is: “I find it far more enlightening to have analysts tell as best they can why they want to tell us anything at all, and then to weave an account of those intentions into their account of an analysis. The most meticulous reproductions of the most detailed data, dissociated from the context of why it was selected, for what audience, and for what purpose, is like an isolated electron microscope image separated from identification of the tissue, the organ, the species, or the stain—a demonstration of method isolated from scientific relevance.” This is what I wish to focus on, the aspect of the purpose of case reports. I will emphasize the necessity of opening windows on the analytic process.

Understanding, sharing of experience, introspection, and empathy are prerequisites