Multiple approaches to a single case: Conclusions Psychic change: What and how?1

This panel concluded the ‘Multiple approaches to a clinical case’ series, wherein clinical material from the audiotaped analysis of Amalia X, presented by Helmut Thomä and Horst Kächele, was studied from multiple perspectives. The task of this wrap-up session was to integrate the several panels that preceded it under the ambitious goal of determining the what and how of psychic change in psychoanalysis.

Robert Wallerstein's introduction noted that there are three main questions that run through the recurring considerations of the nature of therapeutic change in psychoanalysis: (1) the role of supportive vs. expressive-interpretive factors; (2) the roles of insight vs. the analytic relationship; (3) the relationship of psychoanalysis to the derivative psychoanalytic psychotherapies. Wallerstein proposed evaluating the three major presentations from the three major theoretical perspectives in worldwide psychoanalytic praxis, from the point-of-view of the stands each takes in relation to these three framing questions.

Juan Pablo Jiménez divided the initial presentation into two sections. In the first, he emphasized the value of a pluralistic psychoanalysis, one that must serve two masters, both plausibly integrating different theories as well as maintaining internal coherence. The second part of his presentation addressed the prior clinical track panels, and discussed the issues along four dimensions: (1) what made agreement difficult was that everyone defines clinical material from a very different point of view; (2) everyone struggled with how to discuss clinical material in a respectful way and avoid the temptation to ‘supervise’ the technique of the Ulm-based presenters; (3) an exuberance of theory and scarcity of empirical observations was noted as a key aspect of the observed relationship between theory and practice; (4) there was a wide consensus throughout the panels that, no matter what the differences in theoretical perspectives, the patient-analyst dyad was pr