CPPNJ - The Center for Psychoanalysis and Psychotherapy of New Jersey

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Opening Up Psychoanalytic Writing

Contributed by: Nina Williams, PsyD

I first read Freud in college in a class that was required for English majors but not for psychology students. I liked Freud for the same reason I liked Sherlock Holmes – he provided the pleasure of discovering a world visible only to those who paid careful attention. Freud’s confidence in his interpretation of reality was reassuringly absolute, and so I imagined I would be when I became an analyst.

By the time I had finished training, psychoanalysis and I had jointly grieved our imagined authority and come to respect the boundless possibilities of mutuality. One development of particular interest to me is how case writing is changing. No longer the presentation of ‘perfectly’ perceived reality, the best writing now is the beginning to a conversation. The writer describes a co-created process from which the reader can not only learn but also contribute another subjectivity. The journal Psychoanalytic Dialogues works from this premise when it publishes an original article alongside commentaries by invited readers and response by the author.

Although you may never aspire to contribute to the literature, this new writing style offers real benefits not only to those who practice it but to those of us who teach and learn from case reports. It’s tempting to write only about the moments where your tactful, well-timed interpretation pointed the client toward freedom. It’s a lot scarier to present yourself as struggling with your countertransference or learning from your client. As a profession, though, we’re grateful to the writers who take the risk; we learn more when case reports includes this kind of material, and a community that respects this level of examination is likely to encourage more openness. Individually, there is no better way to learn about your case than to write about it for someone else to read. Freud said, “I write to know what I think.” As an analyst-writer, it was only in writing about a case of mine ten years ago that I discovered the unacknowledged countertransference that had stood in the way of understanding.

When I taught the Final Case Seminar in 2009, I decided to try a teaching method based on the ideas of Stephen Bernstein and taught at the psychoanalytic institute at Columbia University. The course was structured like a writers’ workshop: candidates completed four 3-page writing assignments to articulate and communicate their experiences of the following clinical phenomena within their control case:

  1. An incident that elicited a countertransference reaction
  2. A verbatim clinical interaction in which the writer described what the patient said, what the analyst thought, what the analyst said, and how the patient responded.
  3. A narrative of the clinical trajectory of the case over time, in which major themes and changes in transference, countertransference, resistance, object relations, and other key areas were identified.
  4. A description of the major theoretical influences on their clinical work

Each candidate’s assignment was circulated in advance of the class at which it was discussed. The students and I focused on only one question in our reading: did the assignment express what the writer intended? Invariably, there were differences between what was meant and what was written and here was where the discovery of open writing began. For example, one student experienced her client as lovable but wrote a description the class experienced of a hostile, devaluing opponent. When we asked the student to explain more of what made the client lovable, she described interactions that illustrated this. As we asked the student to reflect on our shared experience of the devaluation, she began to wonder about what she might not be hearing. When this candidate revised the exercise after consultation and reflection, the sample vividly presented the subtle, poignant wishes for connection the analyst has sensed but not described in the draft. This made the candidate’s clinical choices clearer to all of us, and we discovered together how unrecognized countertransferences always influence how we narrate our cases.

The feedback from the first class was uniformly positive; candidates found the assignments useful in clarifying their thinking about their cases, felt supported and informed by the class’s feedback, and felt less anxious and better prepared to tackle future writing. Students’ supervisors also confirmed that the writing enriched the supervision.

Based on students’ reactions that they wished they had taken a writing course earlier in training and that the workload was too heavy, I redesigned the course into four, month-long summer courses. Each course is devoted to one of the writing assignments listed above (last summer’s group wrote about countertransference) and students were at various points in their training including post-graduation.

What makes the course so fascinating to a relational analyst is power of the collaboration. Common themes emerge in feedback, but individual readers also pick up details that resonate with them in some particular way. The class members’ openness and the writer’s curiosity about these connections invariably led us to an even deeper understanding of the case. I feel excited at this process for a familiar reason: like Freud and Holmes, the class provides the pleasure of discovering a world visible only to those who paid careful attention. But it’s not the writer’s discovery of the hidden world of the patient that convinces us of her conclusions; it’s the writer’s discovery of her own hidden countertransferential world. Freud made have written to know what he thought; contemporary analysts are writing to discover what they have not thought.