I do not remember anyone teaching me during my analytic training how to write about what was occurring in the analyses I was conducting. Thus I felt a mixture of injury and slight betrayal by my institute when the supervisor of my first case mentioned after reading my first year's progress report that he thought it might be useful for me to think about the difference between analytic process and process notes in my future clinical writing. Of such small slights are abiding interests born.
Years later I attended my first meeting of the Committee on Certification of the American. I sensed in the discussion an implication that the analyst could not or should not be guided or taught to write about his or her work. It was as if a case report should spring fully formed from one's bosom, perhaps as the litmus test of one's training.
During the same meeting, some other new committee members began to question whether applicants for certification should be given some guidelines about case report writing. I said that I thought analysts could in fact be helped to clearly demonstrate their work with patients and that such a guide ought to be written. The committee chair, Arthur Rosenbaum, agreed: “Why not try to write one?”
That guide to treatment report writing was eventually published and is now a part of the “Standards, Procedures, and Guidelines” (1992–98) of the Committee on Certification.
Don Rosenblitt, chair of the Board on Professional Standards, knew of my interest in clinical writing and invited me to organize some workshops to see if the problems with teaching and learning about clinical writing could be rectified. I asked several of my former colleagues from the Committee on Certification (Melvin Bornstein, Alex Burland, and Arthur Rosenbaum) and some other interested analysts (Ellen Blumenthal and Jonathan Palmer) to join me in organizing two BOPS-sponsored workshops at the meetings of the American. These are the workshop “Teaching About Analytic Case Writing,” which will be offered Thursday, May 11, from noon to 2:00 p.m., and the discussion group “Writing About Your Analytic Work in a Case Report,” also to be held on Thursday, 4:45–7:15 p.m. Both groups are independent of the Committee on Certification.
The workshop on teaching about analytic case writing is for faculty, graduates, and candidates interested in teaching writing about analytic process, including curriculum and seminar planning and faculty development.
At the first meeting of the teaching workshop, in May 1999, Blumenthal discussed an eight-session seminar for fourth-year candidates at the Boston Psychoanalytic Society and Institute. This seminar calls for weekly writing assignments of short analytic segments that eventually give the candidates the experience of having written much of a case report during the seminar. At the December 1999 meeting of the teaching workshop, Katherine Burton and Derek Hawver described a ten-session writing seminar for third-year candidates at the Washington Psychoanalytic Institute.
In addition, workshop leaders have been developing such topics for ongoing group discussion as “Reading an Analytic Case Report” (Burland), “Mentoring and Supervising About the Case Report” (Bornstein), “Specific Issues in Teaching About Clinical Writing” (Blumenthal and Rosenbaum), “The Writer's Experience” (Palmer), and “Creating a Writing Environment For Analytic Training” (Bernstein). At the most recent meeting (December 1999), whose twenty-five attendees represented eighteen analytic institutes, it became clear that a growing number of institutes are teaching or developing seminars about clinical writing.
At the May 2000 meeting of the teaching workshop in Chicago, Susan Furman will present some significant effects both on her clinical writing and on her analytic work as a result of having presented two versions of a writing specimen at one of these discussion groups, one written before and the other after a brief telephone consultation about her initial version. Elisabeth Young-Bruehl, an analyst and professional writer, who has written a number of analytic works, including Anna Freud — A Biography, will discuss teaching methods to help analysts enliven the analytic narrative in case reports and other clinical descriptions.
“Writing About Your Analytic Work in a Case Report” is mainly for candidates and graduates involved in the process of clinical writing for progression, graduation, or certification. However, this meeting also has been attended by institute faculty who want to learn about writing techniques, to study ways of teaching about analytic process writing, and to discuss the writing experience.
At the initial May 1999 meeting of the writing group, Peggy Warren discussed several sections of a case report. Attendees could observe her ability to reveal her work and to draw the reader into the experience of the analysis in identification with both patient and analyst. They also could see her oscillate between the experience-near process and more observant reflections on her experience.
At the December 1999 meeting of the writing group, five candidates and recent graduates from various institutes (Susan Furman, Lincoln Hess, Cynthia Lee, Scott Twentyman, and M. R. Vallabhaneni) presented two-page writing specimens which were discussed by the group of forty attendees.
At the May 2000 meeting of the writing discussion group, several analysts will present two-page writing specimens to be discussed by the group. Young-Bruehl will present some revisions of these writing specimens sent to her in advance of the meeting. She will try to demonstrate strategies for showing greater engagement, aliveness, and a better description of the analytic process.
Of interest to many participants is a format distributed in both the teaching and the writing workshops. The format, part of an unpublished paper, “Writing about the Analytic Process,” will be included in a commentary on Robert Michels' plenary address “The Case History” in JAPA 48:2. It was developed as a starting point for writing about the clinical
Stephen B. Bernstein, M.D., is a training and supervising analyst at the Boston Psychoanalytic Society and Institute, where he chairs the Education Committee. He is a clinical professor of psychiatry at Tufts University School of Medicine and a lecturer in psychiatry at Harvard Medical School.
interaction and can later be extended, reshaped, or discarded as the analyst's own creativity and comfort with the writing experience evolves.
The format's three-part structure encourages writing about the analyst's and patient's experience both in the immediate interaction and longitudinally, over time. In an initial “experiencing section,” the reader is drawn in and involved for several paragraphs through experience-near descriptions of microprocess. These depict limited periods of time and use short quotes and paraphrases to enliven the material. A “reflecting section” allows the writer to step back from the interaction and reflect on the longitudinal scope and meaning of the process description. In this one-paragraph section, the analyst may begin an ongoing formulation of the analytic process. Here, information about the analyst's experience and the patient's responses to the analyst's interventions enriches the more typical formulation of the patient's dynamics. Finally, a short “transitional narrative section” describes internal and life situation shifts and changes that may have occurred and provides a connection to the next segment of the analytic process that is described. Thus, the reader is transported from an awareness of the patient's and analyst's experience to the analyst's reflection and understanding, and on to the next segment of analysis to be described.
I hope these writing groups will help us find better ways to translate from the oral mode of clinical interaction to the written mode of professional discourse. Many of us have felt uncomfortable with clinical writing tasks during and after analytic training. Our literature may be weighted toward the theoretical over the clinical because of this discomfort, and in my experience, many case reports or clinical vignettes written by fine analysts seem to hide the analyst or the process.
Most disciplines in the arts and sciences have an accepted methodology or format for the presentation of their results or data. This methodology is studied and taught to students entering the field, and it is open to scholarly examination and critique when clinical data are presented in the research and clinical literature. However, a generally accepted method of written discourse has not been developed in our field, and the case reports, illustrations, or vignettes published in our journals sometimes do not convey in sufficient detail the analytic process necessary to support the theoretical positions their authors espouse.
Our two workshops will have served a significant purpose if they can bring increased attention to the study and teaching of clinical writing by our training institutes, by our local and national program committees, and by our analytic journals, and if they can encourage an atmosphere for the open discussion of our methods of analytic description.