jap a

Lynn Whisnant Reiser 48/2

“THE WRITE STUFF”

I n 1930, Freud received the Goethe Prize for literature. In the years
af ter Freud, the ability to write about clinical material has been
taken for granted. For most analysts, psychoanalytic writing has been
regarded as incidental to their professional activity, a skill acquired by
trial and error, put to use in process notes and summaries during train-
ing; later, by some, in case write-ups for certification; by even fewer,
in case studies prepared for presentation or publication; or, by a very
few, for research.
Many analysts actively avoid writing. Yet the time-consuming
nature of analytic work, and in consequence the small number of
patients any analyst can treat, has always mandated that analysts learn
from each other’s work. Effective writing about clinical process is cur-
rently being recognized as a matter of high importance for progress in
theory and research in psychoanalysis, as well as for technical advances
in psychoanalytic practice. Several papers in this issue of JAPA exam-
ine why clinical writing is important, what constitutes effective writing,
and why analysts often do not write. The papers address the complica-
tions and complexities that emerge as these issues are confronted.
Writing about the analytic process might sound straightforward—
but it is not a simple matter. To those who have never tried it, psycho-
analysis itself might seem a simple task, for both patient and analyst.
Although the patient has merely to say “whatever comes to mind,” it
quickly becomes evident that this is not possible. The patient is per-
ceptually informed by input from within and without the body. Mental
content is nonverbal as well as verbal, often vague and fleeting, not
organized in a coherent way even if it is verbal, and if coherent still
idiosyncratic and largely incomprehensible to a listener ignorant of
the referents.
The novice analysand discovers that even the “simple” task of
recounting a dream is not simple. The remembered dream is likely to
feel vague in comparison to the vividness of the experienced dream.
The task of putting the fragments of a recovered dream into words may

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make the account seem so incomplete as to lead the dreamer to decide

that it is so far from the original that it is not worth talking about.
As the patient has only to say “what comes to mind,” the analyst
has but to “listen with evenly hovering attention.” But the analyst too is
experiencing a multitude of sensory impressions, images, and personal
memories, and these are compounded by those recalled from earlier in
the work with this patient. While trying to observe both a personal inner
world and happenings in the consulting room, the analyst is attempting
to organize the data in order to understand what the patient is commu-
nicating. The analyst must take into account genetic and dynamic
aspects that relate all of this to technical and theoretical considerations,
while at the same time undertaking to formulate useful, timely, and
tactful interventions and interpretations.
Yet patient-analyst dyads do find ways to communicate with each
other and work together. Experienced patients and analysts find
that communication, like prof iciency in other processes, develops,
improves, and then goes on routinely in the consulting room as the
work continues.
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Writing about psychoanalytic process is very different from partici-
pating in it. Learning to do analytic work is not the same as learning to
write about it. Clinical writing aims to encompass what the patient does
and experiences, what the analyst does and experiences, and what goes
on between the two over a period of time. When the analyst becomes a
writer, what once was implicit becomes explicit, deliberate, and observ-
able. The analyst attempting to put the analytic process into writing will
first find the amount of data overwhelming. To present, coherently and
without oversimplifying, the analytic process and content (as it came
to the patient’s mind and was heard in connection with the analyst’s
associations) seems an impossible task. The analyst beginning to write
about analytic process, like the novice patient attempting to recount a
dream, may despair of ever being able to communicate a clear account
of the experience.
Analysts have felt compelled to devise individual methods for
selecting, organizing, and presenting their observations and experi-
ence—for example, into a life story or into networks organized by
affect. Each template demands attention to particular kinds of data, pro-
vokes different ways of making sense of it, and suggests unique ques-
tions for theory, research, and practice. The kind of data observed and
the way it is gathered, recorded, and reported influence the way the

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 “THE WRITE STUFF”

analyst understands the analytic process and in turn the way the
analyst works.
Why is there now greater interest in attempting to encompass the
complexities and intricacies of the analytic process in words and, con-
sequently, greater interest in the process of clinical writing itself ? The
convergence of several factors account for this attention. Increased
acknowledgment of the importance of the analyst’s role in treatment
has established as the unit of study the patient-analyst duet rather than
the patient’s solo performance. Concomitantly, the analyst’s stance has
become less authoritarian, increasingly open, and collaborative. This
has led to greater attention to countertransference phenomena and
enactments as elements to be sought out and understood rather than
pushed aside or denied. (This emphasis on accounts of analytic process
that include the analyst as well as the patient is evident in Lawrence
Friedman’s introduction to the Panel Reports in this issue and indeed in
the topics of the reports.) Because recording the details of the analyst’s
experience is a new task for many writers, this heightened awareness of
the analyst’s role has drawn attention to the process of writing as itself
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a subject for scrutiny.
Changes in the nature of analytic practice have also had an impact.
Greater interaction with “widening scope” patients has motivated
analysts to share experiences in order to generate new techniques. New
models of health care have challenged the field to provide accounts of
treatment relevant to the therapeutic action and outcome of psycho-
analysis. At the same time, advances in research stemming from the
convergence of neuroscience and psychoanalysis have created a demand
for detailed reports of clinical work that can be used to generate
hypotheses for collaborative research projects.
The papers on clinical writing in this issue assert the value of clear
and complete case histories, illuminate problems that have hindered
their being written, and propose ways of surmounting these difficulties.
As the authors attempt to sort out the issues involved in clinical writ-
ing, they repeatedly encounter certain dilemmas: (1) how to encourage
authors to be free and open in presenting both their intent in writing
and their clinical experience, while confronting the inhibitory factor
of knowing that some readers not only scrutinize the text but analyze
the author; (2) how to reconcile the needs of the profession for detailed
clinical information with the rights of patients for privacy and control
over disclosure of their case material (a situation exacerbated by the

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 Ly n n W h i s n a n t R e i s e r

increasing availability of information in this cyber age, and by the lack

of agreed-upon guidelines regarding permission, confidentiality, and
disguise; and (3) how to teach writing about clinical work in a way that
offers a model for organizing material and prepares students for eval-
uation of their clinical competence, yet does not constrict their learn-
ing or their ability to think creatively.
The authors of these papers assert that despite the diff iculties, good
clinical writing is essential if psychoanalysis is to develop as a method
of treatment and as a scientific discipline. All, each in a different way,
undertake the same deceptively simple task, that of identifying and
helping resolve the problems in writing case histories that have long
hindered readers from engaging fully with their colleagues’ clinical
material and so learning something new.
Like skill in being an analyst, proficiency in writing can be taught
didactically and by interaction with mentors, but it must also be
acquired alone through practice. Over time, every analyst develops a
unique manner of being an analyst and a particular way of being with
each patient. Over time, analysts also learn to write in ways appropri-
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ate for particular intents, purposes, and contexts.
Psychoanalytic practice depends on the notion that putting thoughts
into words and sharing them with another human being is helpful to the
patient. These papers suggest that writing about analytic process is
helpful to the analyst-writer, as well as to readers; that it benefits the
analyst to put thoughts into written words, just as it benefits the patient
to put thoughts into spoken words. Through these written and spoken
words we are able to confront what we understand and the limits of our
understanding, to know what is on another’s mind and on our own, to
enter into conversation with each other and with ourselves.

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E-mail: Lynn.reiser@yale.edu

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