The Case Conference as a Reflection of Unconscious Patient-Therapist Interaction

THERE HAVE BEEN surprisingly few studies of case conferences in clinical settings. Each week members of hospital, institute, and clinic staffs "present" patients and treatment plans to colleagues and superiors in almost ritualized group events. These conferences represent a vast untapped source of information about the group processes operating among staff personnel and also may reveal previously unconscious interaction between the therapist-presenter and the patient. This paper describes an experience with a case conference in which a previously unrecognized dilemma in the psychotherapy of a young schizophrenic woman was played out in the course of the presentation and discussion.

Several authors have discussed the case conference in terms of group dynamics. Whitman (1956) used both ratings and observation techniques in his analysis of a psychiatric staff conference. He suggested that conferences were a source of emotional satisfaction for staff personnel and therefore a rich and complex source of group interaction. He used Bion's (1961) scheme for understanding group process—that despite the group's stated learning purpose, members find themselves seeking to fulfill fight-flight, pairing, or dependency needs. Whitman also pointed to the "hidden agendas" of presenters. Brody (1961) viewed the case conference purely as a learning experience and emphasized the role of the discussion