Three Conflict Levels

DR. HARTMAN'S PAPER is an attempt to clarify the vicissitudes undergone by the dyadic psychotherapeutic process when a third element is added to its dynamics—whether that be an institution, a seminar, a case conference, or a supervisory situation. This is a most relevant and valuable work for psychoanalysis and psychotherapy since it makes evident the existence of collateral factors that influence the course of treatment. William Caudill (1954) did an exhaustive study that demonstrated that, for a hospitalized patient, the therapeutic process operates not only via the psychotherapeutic sessions but also through the interaction with institutional life, the latter interfering, as often as not, with the dynamic interaction of individual treatment.

The author focuses his study on a specific aspect of this phenomenon: the understanding of the conflict created by the addition of a third variable to the analytic situation, in the dynamics of transference, countertransference, their course, and resolution. With Dr. Hartman's patient, this third element emerges from the dynamics of the case conference.

It is important to point out that the references cited are superfluous save for the paper by Searles (1955). The works of Guiora and associates, Brody, and Whitman, are neither relevant to the author's purpose nor do they refer to the same phenomenon. One cannot regard a learning seminar and clinical case conference for residents and students as dealing with the same problems and dynamics of group process. The interests at stake, the attitudes, the degree of dependency, the quality of the rivalry—all the phenomenology and dynamics—have psychological nuances and intensities that make comparison impossible.

In this respect I believe that Dr. Hartman has based his report exclusively on the work of Dr. Searles. Using his theoretical framework, Dr. Hartman attempts to demonstrate that the emotional interaction between the members of the case conference and himself in his role