Should Patients be Presented In Person?

It has been generally held by psychiatrists actively engaged in the training of residents in psychotherapy that patients in therapy should not be presented in person. They have thought that it is directly threatening to the patient and indirectly damaging, through complicating the patient-doctor relationship. While these psychiatric educators usually encourage the presentation of psychotics in person to groups of residents, they refuse to use “live” neurotic patients in individual and group supervisory sessions, maintaining that the resident's case record and verbal report are adequate.

“The use of patients as teaching material has one further hazard: it almost invariably threatens the patient. At worst, such presentations may demonstrate callous or disrespectful tendencies in staff members, without an opportunity to discuss the import of such behavior upon the patient.” (1). Such statements as this can be found among the writings of excellent teachers of psychiatry.

There is a definite trend away from such a restricted viewpoint. In the second Cornell Conference (2), Levine writes, “In graduate teaching some centers use audio-visual aids, e.g., movies, recorded interviews, etc. Other centers find little use for such techniques and stress the fact that live material is so available and so much in keeping with on-going experience that it seems preferable.”

The GAP Report No. 31 (3) states, “The one-way vision room is an increasingly popular medium of demonstration”; but even this excellent report omits mention of direct presentation of patients.

The psychoanalytic institutes are the most conservative in this regard, despite the experimentations of Freud and Ferenczi with the supervisor sitting in on the student's session with his patient. At the 1955 annual meeting of the American Psychoanalytic Association, during a discussion of problems of curriculum, the only representative to speak in favor of the use of live material in conferences and supervision was t