Without History: An Experiment in Case Presentaion

On January 10, 2015, UNBEHAGEN: A Free Association for Psychoanalysis organized an experimental event in New York City. Its general purpose was to examine new ways to present psychoanalytic case material in a group meeting. What follows are comments from the members of the planning committee on the results of the experiment.

Case presentations in group or individual supervision generally follow the same format: The presenter shares process notes from one or more sessions, important events of the patient's childhood, a history of family and romantic relationships, medication history, history of the current treatment (duration, frequency), information about prior treatments, features and characteristics of the current treatment (including transference and countertransference issues and the patient's personality and character traits), job and relationship status, and, of course, psychological symptoms, including the patient's “presenting problems,” and the vicissitudes of those symptoms throughout the treatment.

“Without History” grew out of a desire to question, investigate, critique, and play with this form. It also grew out of the planners' experience of case presentations in group or individual supervision as puzzles to be solved. Symptoms are fit like pieces into a case history, or vice versa, all via process notes and discussion (including parallel process) and-voila-the puzzle is solved through the trusty process of group or individual supervision. While most thoughtful supervisions and case presentations recognize history as both unstable and never entirely or completely knowable, a patient's history can become a technical crutch, leaned on by the analyst to maintain a state of knowing when, in fact, far less is known than the analyst thinks. It's not just that the facts of a patient's history are never concrete, but also that the analyst's need for history can occupy a piece of both the analytic dyad