The International Journal of Int J Psychoanal (2013) 94:1163–1165

doi: 10.1111/1745-8315.12126

Psychoanalytic Controversy Rejoinder: What does the presentation of case material tell us about what actually happened in an analysis and how does it do this? Dale Boesky 614 Watkins, Birmingham, MI 48009, USA – [email protected]

There are, as to be expected, major differences in the discussions by Rocha Barros, Chabert and my own (Chabert, 2013, p. 1153–62; Rocha Barros, 2013, p. 1145–52). These differences in sensibility, language, cultural background and theoretical orientation are quite familiar to the readers of the International Journal of Psychoanalysis. And these differences are highly valuable for all of us as we struggle to find our way in the vibrant but confusing pluralistic psychoanalytic world of today. As we all know, our disagreements arise from numerous sources and inevitably when three colleagues from such diverse psychoanalytic cultures discuss our views about the daunting complexities of parsing the events of actual psychoanalytic treatment, we will benefit by a candid summary by each of us about difficulties we have had in understanding as well as being understood by our colleagues. We each agree in the abstract that theoretical discussions must be anchored in clinical ground. It will not come as news that it appears to be far easier for the three of us to agree about that lofty assumption than about the daunting and messy particulars about the obstacles to doing this. Ironically, there is more to fear from superficial agreements than from recognized disagreements. The cosmetic high level agreements too easily conceal the neglect of very important information about what was left out of these agreements. For the purposes of this exchange of views perhaps the best way for me to proceed will be to discuss the possibility of our not understanding each other because of these abridgements. It would be futile to attempt to describe even the fraction of our work that seems clear without omitting important obscurities, so the three of us have made selective choices. In fact it is the omission of a better understanding of the methodology of contextualizing the associations of the patient that I have chosen to make the principal topic of my own remarks precisely because it has been so much ignored in our literature. Depending on our theoretical priorities we each worry about different types of omission. Dr. Chabert worries that the analyst who contests the double path (including) the opposition of life drives and the death drives would lose the theoretical options of the two topologies that she has described which she finds essential to her own understanding of what actually happens during treatment (Chabert, 2013, p. 1154). I am more worried about omitting the contextualizing criteria deployed by the analyst in developing the key conjectures that are the usually omitted foundation for a clinical report. Thanks to her comments I can now Copyright © 2013 Institute of Psychoanalysis Published by John Wiley & Sons Ltd, 9600 Garsington Road, Oxford, OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA on behalf of the Institute of Psychoanalysis

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see that I did not make something about my view of the role of notes sufficiently clear. She quoted my intent incorrectly when she attributed to me the view that progress notes “provide a relatively reliable and efficient means of understanding everything that has happened…” (Chabert, 2013, p. 1156) (my italics). In fact I share her belief in the dubious value of progress notes in many circumstances. (Fenichel pointed out the defensive functions of the patients who dutifully write down their dreams and then lose interest in them.) Oscar Wilde spoke of the man who knew the price of everything and the value of nothing. So it is with the analyst who blithely hopes to circumvent the patient’s multiple ambiguities by using a tape recorder. My purpose in privileging writing notes after the session at certain times is to document and support the associative links traveled by the patients’ confusing narratives to follow the contextual red thread running through these associations. Certainly that could be achieved by some analysts in better ways without notes. But in no case would it be conceivable that notes could provide a reliable and efficient way to understand everything that has happened. What they can be is a valuable pedagogical and expositional device for demonstrating and supporting important contextual inferences. It is not the notes that allow the analyst to recognize patterns of contextualization. It is the hard-won knowledge of clinical experience that illuminates the manner in which the analyst listens and understands the defensively concealed patterns of hidden meaning that makes it possible to take the notes later that can be communicated to readers or listeners. Or indeed sometimes for better and later reflection by the analyst. Notes do not provide understanding to the analyst at work. It is the understanding that allows the analyst to prepare some form of record to share her presumed understandings so that productive and coherent comparisons of views can take place. Incoherent disagreements often underlie a number of our controversies. Incoherence arises when neither party realizes that they were unaware of the contextualizations inferred by the other. I agree with Chabert that the pursuit of a single truth in an interpretation is not useful. And in this sense I also agree with Rocha Barros’s approval of Ahumada’s aphorism: “The trouble with evidences [sic] is that they are not evident” (Rocha Barros, 2013, p. 1145). In my own view one very important reason for the elusive quality of evidence is that we have never developed a consensually accepted method to counter the epistemological problem of infinite over-determination of meaning. For over a century our history documents the fact that sooner or later just about anything can be said to mean anything. This is the basis for the tired old joke that sometimes a cigar is just a cigar. I have maintained elsewhere at length that it would be helpful to establish a yet unborn discipline of comparative psychoanalytic epistemology (Boesky, 2008). Just think of certain politicians or theologians when seeking examples of truth claims that are very poorly justified: “We have to distinguish justification from truth since either of these might apply to a belief in the absence of the other” (Audi, 1999, p. 457). Our literature about truth claims would benefit from a better understanding of a basic epistemological distinction between truth claims and justification. Justification is not a synonym for evidence nor is it a proof of truth. The danger of infinite over-determination could be at least exposed if we could refine our methods for contextualizing. Notes are merely one method to demonstrate Int J Psychoanal (2013) 94

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Psychoanalytic Controversy: Presenting case material

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how meanings are inferred but their value in my view is only to compare and demonstrate contextualizing methods. Whenever the analyst wants to know: ‘Why now?’ she is in pursuit of an elusive context. That is much of the bread and butter hard work of doing clinical psychoanalysis and it is time that we confront the price we have been paying for omitting this gap in our understanding of our controversies.

Rocha Barros ‘Actual’ in my understanding does not mean verbatim reports. I am in strong agreement with Rocha Barros when he says: “…in an analytical process we might gain more from re-establishing the associative chains that have been broken by repression or splitting than from reconstruction of the conjecturable historical truth” (Rocha Barros, 2013, p.1149). That is precisely why I wish us to give contextualization by the analyst its due. I agree with him about an ‘actual’ that is dynamically resonant in the associations of the patient rather than an ‘actual’ that (merely) describes actual historical events. Rocha Barros also asks: “What then is the relation between presenting clinical material and validation” (Rocha Barros, 2013, p. 1151). Where my emphasis differs from his is in his omission of contextualization in the gap between clinical material and validation. He is properly concerned that no science can be constituted solely on direct observations. But I am unclear about what he means when he claims that our theoretical inferences can be reliably based on “generating structures that will be known by inference arising from their effects” (Rocha Barros, 2013, p. 1152). So I cannot agree (nor disagree) that I know how it is that we can say that: “This description best characterizes the manner of accumulation and validation of knowledge in psychoanalysis” (Rocha Barros, 2013, p. 1152). Each of these italicized terms needs clarifying. After all, the term ‘structure’ has had a stormy conceptual history in our literature. And what exactly is a generating structure? I cannot assume that I know what kind of inference Rocha Barros describes nor how we could recognize the ‘effects’ of these generating structures. Certainly, I agree that the repetition of certain forms of mental functioning can be the beginning of a useful evidential mapping, but I am reminded of the caption in ancient maps of unexplored seas: ‘Here there be demons’. So I cannot agree that the discovery of these repetitions are the best way to describe the relationship between presenting clinical material and validating theories without more information about the contexts inferred to generate inferences from clinical material. The value for me in this exchange of views is not in the answers we have provided but in the questions for further dialogue that we may generate. And for that I am grateful to Drs Chabert and Rocha Barros.

References Audi R (1999). Cambridge dictionary of philosophy. 2nd edition. Cambridge: Cambridge UP. Boesky D (2008). Psychoanalytic disagreements in context. Lanham, MD: Aronson. Chabert C (2013). Response: What does the presentation of case material tell us about what actually happened in an analysis and how does it do this? Int J Psychoanal 94:1153–62. Rocha Barros EM (2013). What does the presentation of case material tell us about what actually happened in an analysis and how does it do this? Int J Psychoanal 94:1145–52. Copyright © 2013 Institute of Psychoanalysis

Int J Psychoanal (2013) 94

Rejoinder: What does the presentation of case material tell us about what actually happened in an analysis and how does it do this?

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