Ive been thinking about this web page idea of presenting case (hi/her)stories for discussion and what that might mean and how this might or might not be done

Having participated in some solid years of private practice, my arms are elbow-deep in conversational soil. My intuitive response is to reject the idea of case presentations and to scoff at the notion of discussion, particularly discussion in the absence of the very people about whom the conversations are to be held, referred to as the cases.

While some may consider this a necessary and  legitimate professional practice, one sanctioned and required by law and modelled on the medical fraternitys practices of ward rounds and presentations, I politely call this  gossip -  professionally sanctioned and condoned gossip. A recent article by Wim Tengrove in the Sunday Times (Nov 10, 2002) referred to gossip as, the resource of the idle and of the vicious. He was quoting the countrys Appellate Division taking the media to task for a tendency to revel in salacious triviality…triviality that destroys at once robustness of thought and delicacy of feeling.  Psychologys case discussions should be taken to task for similar transgressions. The most obvious of these is a tendency to masquerade as truth   information that is desperately dressed up to look like, feel like and act like medicines  extensive wardrobe of  ECG graphs, x-rays, CAT scans, blood tests, and on and on. It takes a trained eye to spot a speck of bullshit on a cows tail and to accurately diagnose it as alltoohighness or, stated somewhat differently and perhaps more fashionably, Oh, where did the Emperor buy his clothes


I sit in a coffee shop in Cape Towns southern suburbs. There is a laminated poster headed,   Healing power of gossip.  The poster, I am told by the owners, serves to explain the rationale for naming the shop Kaffee Klatsch.  I ask about the articles origins and am told it is from a July or August 2002 edition of Readers Digest. I see the author is Peter Jaret.  The gist of the article is that a psychologist, a social anthropologist and a philosopher all contribute to an understanding of the phenomenon of gossip. They variously define gossip as being something that contributes to sound emotional health, establishes moral boundaries, helps  with the discovery, negotiation, transmission and reinforcement of unwritten social rules. Gossip is virtuous in that it allows an exchange of truths that might otherwise remain hidden.  I look a little to the right and see that a spider has spun its web across the corner of the artists easel holding the poster. Gossip, like a web, I think. Like Fritjof Capras The Web of Life

For years I have held the debate with myself and others about keeping case notes and participating in the psuedo medical farce of case conferences and presentations. Theres something about the experience of therapy and both the speaking about and/or the writing up of a case that makes the latter disingenuous. I am aware of sounding - and perhaps also feeling - like the Ernesto Spinelli , Jeffrey Masson-ites of  psychologys critical left.  That I view the world with one eye chanting its illusion while the other dis-es, I have long come to accept as my particular ocular prescription. Dis-illusionment is both my blindness and my 20-20 vision, no matter how many lenses I tint, crack or how many times I sit on my glasses. Viewing a rainbow and then trying to describe the experience is analogous to experiencing relationships with and through clients who come for psychotherapy and then writing and/or speaking about them. The relational arcs are colourful, extensive, diverse and clearly visible. From certain vantage points, that place called the rainbow, and seen and experienced as the rainbow, exists. Then there is that point spot at which it does not, but where everything in-between and beyond does. 

In the context of  cyberspace, where I am blind to the visual world of rainbows and can not see, it feels somehow tacky and ethically suspect, to add to this vaporous and finely spun web; to be writing up the stories of peoples lives and placing them in a public forum. It is like having an open-air confessional in the middle of the V&A Waterfront and providing ringside seats. Psycho-theatre by the Bay. Thats my  initial response. I regard therapy as sacred work and  the practice thereof as sacred ground.  And as I want to write that websites are just not the kind of  temple of healing I would choose to inhabit, Im aware of the sacred or is that holy cow, no make that cows, that have just moo-(v)ed across my path.

OK, so I have ideals and preferences about the way I like to participate in relationships and it is those ideas that create the kind of  truth and world I inhabit. One such ideal is to treat others  the way I mostly am and  like to be treated. Congruently, respectfully and with care and integrity.  The world of publishing, forums of conversation and connection abound.  Take your pick. There are as many realities and spaces and places as there are ideas and preferences out there. The Internet is as legitimate and potentially useful an instrument of healing as is the phone-in radio show, the Agony Aunt column in the popular magazine at the supermarket check-out counter, the 20-page pre-programmed astro-cum-numero-cum-colour-coded compatibility  report  I received whilst in the throes of my own partnership crisis.  What can I say or write? How can I set my spirit free?

In fairness, or feignedness I go to the bookshelf and scan the textbooks and novels there. Case studies. I flip through the pages, notice how diligently I marked and commented on the case studies that formed the content of my undergraduate studies.  I was intrigued, fascinated, awed and somehow, a novice actress reading the big-screen scripts of those professional stars who had made it. Freudian, Jungian, Adlerian studies, some cases written after hours and hours of session time, recorded and condensed into predictable stories of  suffering and aide. What struck me though, was how much airtime the school, the approach, the orientation, the founder, the guru, or the therapist got and how obscure and almost incidental the patient, client, child… Where is Little Albert now? Had he known how famous he would be, would he have insisted on copyright or negotiated royalty payouts? Did his parents sign a consent form.  More to the point, what is it like to be psychologys Spiderman? Then there are the fictionalised novels: Dibs in Search of Self, I never promised you a Rose Garden, The story of a Schizophrenic Girl and the movies, The Three Faces of Eve, Birdy, One flew over the Cuckoos Nest…Time-honoured, time-framed, and dated. Suddenly Im in the world of words, pictures, images, further and further into the rainbow, I fall into the lap of illusion and find myself chanting an old familiar tune,  one that I have dubbed psychologys lullaby-mantra. The tune that puts psychology to sleep and sees the profession  slide into facts-and-fiction land.   The mantra is, publish or perish, publish or perish, publish or perish .

Psychology was written and chanted, alternatively gossiped and spun into existence by Freud. In line with his medical background, he pioneered the art of case discussions. He formed a sacred circle of fellow practioners and they played show me yours and Ill show you mine. His were letters, long, indulgent, intimate letters to others, Ferenzi and Jung in particular.  These , letters described, outlined, invented, ignored, highlighted, formulated, and obscured. The Kaffee Klatsch letters of the Vienna circle. Letters that others responded to and so the Fairytale grew and grew and so did the circle of participants and players. Thats what were doing here in cyberspace, what Im doing here, all these years later. We are still rewriting and recreating the original fairytale. The coffee is cold and instant, but I am one of them; a bona fide cast member, interchangeably therapist, client, patient, supervisor, and supervisee.


I walk to the filing cabinet that houses and holds my own collection of client information. I flip through files, yellow manila folders, with neatly written dates and codes. Over the years I have experimented with numerous ways of recording information: recordings both auditory and visual; shorthand notes; mind maps; drawings; key ideas and phrases. At times I have written nothing at all. I see that I have developed highly personal and at times obscure ways of recording information. There are letters, drawings, cards and pictures that clients have left with me. I read through some notes. I allow the image and memory to bring to mind what is there about the person, the family, the group experience. I resolve to shred and destroy those files that are older than five years. I make another resolution, that I will not be an information gatherer of arbitrary bits of bio-psycho-social information, an  x-ray machine taking pictures of an x-rated life. Or worse, a bad photocopier trying to reproduce the professionally sanctioned rewrite of a Freudian Fairytale circa eighteen hundred and whatever. I resolve that I will endeavour to find ways to represent as congruently and authentically as I can my experiences of relationships with others.

I explore the idea of journal keeping as a legitimate way to write about therapeutic experiences. Journals  written not about the other but about experiences of myself in relationship with others and the world. I would want to write and record in such a way that at any point I could hand over this journal to a client and that the writing therein would be like a verbal photo album, - good quality pictures, not necessarily flattering or brochure perfect, but accurate, clear and discernibly the best possible rendition in time of a slice of the clients life  - a slice paid for and participated in. These are the thoughts and ideas that present themselves to me like flickering flames of light in the oft darkened passages of interpersonal meanderings: in a world where what is paid for and what is received and rendered as service is increasingly obscure and vague. The very least a client can expect money to buy is privacy and the therapists capacity to hold this relationship in a mature, revered and honoured manner. The least the client pays for is the therapists capacity for silence, for stillness, for the ability to hold the tongue and engage the head and heart. Short of proposing the taking of a vow of something or an oath of something else, I offer, as a daily journal writer of almost 5 years now, the practice of asking questions, of living in wonder-ment. I have found to my utter amazement that there is not a single question that I have asked that has not found an answer and that when struggling or pondering or needing assistance and clarity  in relationships with clients and myself, it is this practice that has set the spirit free .

Another guiding idea I like is that if everything I thought and said and did in relation to myself and my client were observable, open and known to all, could I stand or sit and watch myself and others and give account for that in and through which  I participate ? In  other words, could I act, direct and be the best possible audience to this part of a greater play or script? Could I, when invited to participate in conversations with colleagues about others in a manner that makes me cringe and curl up inside, speak the truth of my convictions, my experience of this gossip, without blame or judgement, or would I choose to walk away?

So, what is this web page case discussion forum? Is it useful? Will it heal others, will it heal me? Is this the way to go? Are there other ways to remain within the story, other plotlines to be developed and explored? Is this a legitimate way to secure a place in the cast? What is the price for admission? How many points secure a lead role? What is the membership fee? Who else is playing? Who is the audience? What goes on backstage, and how transparent are the curtains that signal the end of the piece?

Jackie Plank 2002


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