Rain Forest or Mud Field?

Burland recently analysed a sample of 450 case summaries prepared by candidates in search of certification and found a common core of agreement in their accounts. He notes that

almost without exception what the analysand experienced was similar: a step-by-step regression into a revisitation of their past, in memory, in the transference, and in current reality … The patients struck me as sharing a more or less common repertoire of affects and struggling with them in similar ways … [T]here was a striking cumulative effect from seeing this described so similarly, over and over, in some 450 instances, even though with different patients and different psychoanalysts (1997, p. 469).

It seems more than a little unlikely that this large a sample of case reports would show the kind of agreement witnessed by Burland. We are led to wonder whether the concordance may stem from each candidate's need to appear normative and unexceptional and to generate an account that would maximise his or her chances of being certified. This kind of clinical summary would seem to be the likely outcome of conscious and preconscious narrative smoothing and unless accompanied by audio recording, it is a less than perfect indicator of clinical skill. Burland's discovery might better be described as a possible example of the way in which received theory can influence memory.

Fictional reports can also be created by the need to protect the patient through unmarked disguise, by assembling a published (but actually imaginary) case from bits and pieces of actual cases (see Goldberg, 1997, for discussion of each of these paths) and by the need to ‘reassure the [psychoanalytic community] and each individual member about their psychoanalytic identity’ (Widlöcher, 1994, p. 1234). The general rule is clear: whenever we are less than completely faithful to the record, we run the risk of composing a fictional rendition. But even when faithfully captured, the record rarely speaks for itself and we are left e