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Dewald, P.A. Nuetzel, E.J. (1993). Learning from our Unsuccessful Cases. J. Amer. Psychoanal. Assn., 41:743-754.

(1993). Journal of the American Psychoanalytic Association, 41:743-754

Learning from our Unsuccessful Cases

Paul A. Dewald, M.D. and Eric J. Nuetzel, M.D.

DEWALD OPENED THE PANEL BY CITING Kuhn's (1962) paradigm of scientific advance: it occurs in situations where observable data do not fit predictions offered by existing theory. Such observations in the clinical situation led Freud to his major revisions of theory. Yet most case reports in the psychoanalytic literature involve vignettes demonstrating success, thereby supporting rather than modifying a preset theoretical position.

The definition of success is a relative concept and thus refers to degrees of success or failure. There are various sources of data to evaluate psychoanalytic work. Second analyses and followup studies, as well as supervision and consultation, can help in assessing the outcome of a given case. Psychoanalysts in practice learn by trial and error, modifying technique and/or theoretical perspective in their subsequent work.

Dewald explained that the following presentations relate to cases in which, although the treating analyst's clinical and theoretical judgment led to the anticipation of success, success was not realized. The focus is on elements in the psychoanalytic process that interfered with the conduct of the case in question and led to the unsuccessful outcome. Dewald found it fortunate for the panel to have three experienced analysts willing candidly to expose personal difficulties in their work.

Jacobs' presentation involved two cases: the first, a failure; and the second, a case headed for failure. The problems posed by the two cases had much in common. Jacobs had presented the material on the first case, Mr. L., at an advanced-level clinical seminar. A renowned colleague heard the presentation and declared that the case was a model analysis. Three months later the patient quit treatment. Jacobs wondered what had happened, and identified two issues.

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