Academic journal article International Journal of Psychoanalysis

Learning from Experience in Case Conference: A Bionian Approach to Teaching and Consulting

Academic journal article International Journal of Psychoanalysis

Learning from Experience in Case Conference: A Bionian Approach to Teaching and Consulting

Article excerpt

In case conferences as well as didactic seminars, the power of the group can bring psychoanalytic education to life. However, primitive anxieties activated by group dynamics may also interfere with teaching and learning. The authors offer the example of a stalemated private practice case conference that had unconsciously organized against learning as the members began to read Bion's work. The case conference leader, an analyst, presented her case conference, which was mired in basic assumption dependency dynamics, to our peer consultation group. Drawing upon Bion's early contributions on groups, as well as his later ideas about thinking and mental growth, the peer group facilitated the case conference's return to work-group functioning and learning from experience. Activated in the peer group, commensal container[Lef-right arrow]contained processes gradually spread throughout the entire relational system of peer group, case-conference leader, case-conference members, and patients. This example underscores the importance of promoting within our institutes a culture in which faculty view themselves as part of an evolving intersubjective matrix that works to foster the containing capacities of candidates, patients, and faculty alike.

Keywords: case conference, group dynamics, container?contained, basic assumption groups, work group, parallel process, supervision, peer consultation, psychoanalytic education, learning from experience

Case conference is considered a cornerstone of psychoanalytic education. When it goes well, members generate associations and make connections that go beyond what is possible for any individual or any supervisory dyad, entering into a state of collective 'waking dreaming' (Ogden, 2006). Participants have a chance to develop insight into the unique ways their individual minds operate, as they reflect upon their own associations in the context of other minds. In addition, the clinical and didactic material presented within the crucible of the group situation often evokes psychic turbulence, and this emotional combustion can fuel powerful psychoanalytic learning.

At times, however, turbulence overwhelms the group. Primitive states of uncertainty and fear sometimes arise in the relatively unstructured environment of case conference, and the group can become dominated by anxiety or by collective defenses against anxiety. A case-conference leader may be a skilled clinical teacher, but members cannot benefit from the leader's efforts-or from the associative freedom, the intensity, and vividness of emotional experience that case conference offers-if anxiety or defense reach unmanageable levels. Learning will be subordinated to members' needs to protect themselves from unbearable affects and the threat of mental disorganization. Unless the case conference and its leader are together able to create adequate space for mental processing and sufficient containment for anxiety, the unique potential of case conference will remain unactualized.

Understanding and applying the principles of unconscious group dynamics can be crucial for case-conference leaders. Kernberg comments that 'the use of group analytic methods as part of the teaching method for continuous case seminars is [an] important contemporary tool, derived from the developments of psychoanalytic understanding of small group processes' (2005, p. 2). Yet he notes, 'It is impressive how little attention has been paid to innovating teaching methodology and systematic presentation of an integrated theory of [pedagogical] technique' (p. 3) for continuous case seminars and classroom teaching. This paper is a contribution to the development of pedagogical technique in case conference. It also has relevance for classroom teaching, not only in psychoanalytic institutes but also in the broader community.

We describe how one case conference, which had devolved into a state of nongenerative dependency and veiled hostility, subsequently regained its capacity to function creatively and developed into a lively working group. …

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