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Klumpner, G.H. Galatzer-Levy, R.M. (1991). Presentation of Clinical Experience. J. Amer. Psychoanal. Assn., 39:727-740.

(1991). Journal of the American Psychoanalytic Association, 39:727-740

Presentation of Clinical Experience

George H. Klumpner, M.D. and Robert M. Galatzer-Levy, M.D.

KLUMPNER reviewed the work of the Committee on Scientific Activities that led to recommendations for reporting psychoanalytic cases. The impression of paucity of clinical data in our literature was confirmed in a review of the 15 most cited psychoanalytic articles from 1969 to 1982. They contain no significant primary clinical data. Most were general statements of clinical observations, experience, or reflections. The most frequent descriptions of the papers included "no clinical data," "no evidence," "overgeneralized," or "untestable assumptions." It was as if the facts were known—the issue, interpretation, not documentation.

Case reports communicate clinical findings most compellingly. Details help readers understand the psychic reality of the clinical event. Retrospective analysis of events requires detailed information about patient-analyst communication which helps us resonate with the reporting analysts' experience.

In coming to its recommendations the Committee discussed many problems. Most analytic data are gathered retrospectively. Process notes seem to present primary data, but rarely do. Even when material appears verbatim it is often unclear how much is selected or revised. The reader has little chance to make direct contact with the clinical data to reach his own conclusions. Observation is conflated with inference. Undue reliance on narrative and brief vignettes obscures analytic experience and supports received theory.

Lack of detailed clinical descriptions makes alternative understanding difficult. Analysts are trained to tolerate ambiguity and generate various accounts of clinical events. Narratives sparse in detail interfere with the reader's use of this training to compare his thinking with the author's.

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