Supervisory Session

Dr. Arlow: Before Dr. Smith begins I'd like to make some introductory comments on how I will approach this kind of experience—listening to the material second-hand as distinct from the clinical experience in general. I am a strong believer in the principle of psychic determinism. Dr. Smith has an enormous amount of material available to him. From this material, he has made a selection to present to us. By agreement, he will present some introductory material and a brief anamnesis. The core of the presentation will consist of process notes. I find listening to process notes more congenial to any effort to understand the patient. It is only the dynamic record of the patient's associations, the material that emerges in context, in which the contiguity of elements and the figures of speech appear—this is the material which forms the basis for substantive interpretations. Material obtained in this manner gives us a genuine sampling of how the patient's thinking is influenced by the dynamic pressure of unconscious fantasies.

While it is true that process notes are far more revealing of the patient's inner conflicts and unconscious thinking than an anamnesis, if we remain true to the principles of determinism, we can see that, in a limited way, examination of the anamnesis may furnish certain important insights into the patient's problem. Let us bear in mind, for example, that when Dr. Smith sat down to write for us an introductory overview of this case, he had available to him thousands, perhaps millions of details. He chose consciously what he felt we should know in order to understand the patient and the material that he was going to present. But while this conscious process of editing was going on, we can also see the influence of a parallel unconscious process. This can be determined from the precise material selected, the order and the sequence in which they are placed. All of these suggest certain interpretations that one can entertain, interpretations derived from t