How to fail your psychodynamic case report

In my current and previous course team roles, I’ve been responsible for courses that attempt to teach psychoanalytic theory to trainee counselling psychologists. The usual means of assessing this is the case report, where the trainee writes up a piece of work where they have attempted to intervene psychoanalytically, or sometimes, a piece of work that they have carried out in another therapeutic orientation, reformulated psychoanalytically.

I’m often asked how to pass these case reports, and am always stuck, because to my mind, there is really no recipe for passing a case report.  I was required to give a lecture recently with the implicit demand of ‘how to pass’, and in thinking about how to do that, I came across similar presentations on different topics with, tongue firmly in cheek, lots of advice on how to fail.  ‘I can write about that’, I thought to myself.  Because there may not be a sure-fire way to pass, but there certainly are predictable ways to fail, which, if you avoid them, will certainly increase your chances of passing.  So I present to you my Top 10 Tips on how to fail your psychodynamic case study.

1: Context
To fail: Note many important factors in the context, such as similarities/differences between you and the patient, challenges to the frame, etc. and never mention them again

To pass:

  • Formulate how the patient’s relation to frame and difference relate to their problem
  • Analyse these as potential transference dynamics to be considered and possibly worked with
  • Consider the patient’s suitability for psychodynamic work, and time-limited work (where appropriate) – and yours

2: Assessment
To fail: Fill up half the report with intricate details about the patient’s family and early life, without mentioning these in the formulation or working with them in the treatment

To pass:

  • Ensure that hypotheses in the formulation are backed up with relevant assessment information
  • Ensure that early dynamics are well formulated, repetitions considered, and attended to in the intervention, ideally evidenced in one of the extracts

3: Formulation
To fail: Include a number of different psychoanalytic theories, some of which directly contradict, with no logical order or structure

To pass:

  • Ensure theories are complementary (integrative vs. eclectic)
  • Ensure the formulation can theorise the unconscious dynamics you encountered and worked with

4: Treatment plan

To fail: Describe a psychodynamic treatment in very general terms, with no rationale, no link to the formulation, and no plan for what you were intending

To pass:

  • Ensure strong links between theory, formulation, plan and intervention
  • Why a psychodynamic treatment? Why a Kleinian one? Why not an established brief model like DIT (etc)?

5: Extracts
To fail: Choose extracts which have nothing to do with psychoanalysis

To pass:

  • Extracts should ideally show your ability to translate theory/formulation into practice/intervention
  • Where not possible, use the commentary to discuss an alternative intervention, think about what went wrong, etc.

6: Countertransference
To fail: Identify several ways in which you fail to be helpful, such as not being brave enough to interpret, fearing failure, being new to the model, etc, blaming yourself entirely

To pass:

  • Consider how these might reflect transference pulls from the patient – how do they recruit people to this position? Are you getting a sense of what it’s like to be them or someone in their world?
  • What in you receives and believes such projective and identificatory processes? How does this aid or hinder the treatment?

7: Problems with the patient
To fail: Blame the patient for being insufficiently psychologically minded, resistant, etc.

To pass:

  • “Resistance is on the side of the analyst” – what are you resisting of theirs?
  • Consider your own impositions in expecting patients/analysis to be a certain way – what does this re-enact for the patient?

8: Problems with the formulation
To fail: Blame the model, and suggest that you should have done CBT or person-centred work after all

To pass:

  • What about the patient’s un/pleasure (or yours) got in the way of what they (said they) wanted to achieve?
  • Formulate this within model before considering alternatives
  • What does your wished-for alternative say about what the patient was ‘really’ hoping for from therapy?

9: Problems with the supervisor
To fail: Blame the supervisor for being too absent, too critical, too kind, and generally neglectful, abusive and sadistic

To pass:

  • Consider your part in this. What would you have needed to do to understand the patient better in supervision? Why didn’t you?
  • What parallel processes did you and your supervisor engage in, similar to you and the patient, and their system?

10: Perfection
To fail: Bluff over-coherence, over-integration, and complete characterological change in yourself and the patient or punish yourself for not achieving them

To pass:

  • Be honest about what did and didn’t ‘work’ and what you did and didn’t know
  • Formulate problems without blame, being realistic about the limits of the patient, the context, and your own training
  • Help the markers assess your awareness of dynamic theory and practice, rather than wishing for perfect analysis
  • How might you begin or formulate the work differently now?

And my best advice from my own training supervisor, to you:

Tell the truth …

  • what you did – who said what to whom
  • why you did it – what theory/ies underlined these interventions?
  • how you think differently now – about the patient, about yourself, about the theory, about psychoanalysis!

Good luck with failing to fail … and remember that at London Counselling Psychologists, we can offer psychoanalytic supervision and consultation on your client work and academic reports.

Dr Russel Ayling
www.russelayling.co.uk

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