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Psychotherapy.co.za : Articles : Articles : Ethics & Professional Issues : Show Entry

 A case of discussion, storytelling or gossip
Submitted By administrator | Added on: 2004 March 14 | Total Visits: 15766 | Printable version

A case of discussion, storytelling or gossip

Jackeline Plank
Clinical psychologst Jackie Plank discusses the ethics of case discussions.

I’ve been thinking about this web page idea of presenting case (her/hi)stories for discussion and what that might mean and how this might or might not be done.Being private and having participated in some solid years of practice, which means my hands are elbow deep 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 - the “cases”.

While some may consider this a necessary and legitimate professional practice, one sanctioned and required by law and modelled on the medical fraternity’s practices of ward rounds and presentations, I politely call this gossip - professionally sanctioned and condoned gossip. Wim Trengrove, refers to gossip as “the recourse of the idle and of the vicious (Sunday Times, Nov 10, 2002),. He was quoting the country’s Appellate Division and its 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.” Psychology’s case discussions, I propose, can 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 medicine’s extensive wardrobe of ECG graphs, x-rays, CAT scans, blood tests and on and on. It takes a trained eye to spot a spec of bullshit on a cow’s tail and to accurately diagnose that as alltohighness or stated somewhat differently and perhaps more fashionably: “Oh where DID the Emperor buy his clothes?”

As I write this, I sit in a coffee shop in Cape Town’s 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 article’s origins and am told it’s from a July or August 2002 edition of Reader’s Digest. I see the author is Peter Jaret. The gist of the article is that a psychologist, a social anthropologist and a philosopher all variously understand 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 and is virtuous in that it allows an exchange of truths that might otherwise remain hidden. I look somewhat to the right and see that a spider has spun its web across the corner of the artist’s easel holding the poster. Gossip, like a web, I think. The Web of Life, by Fritjof Capra.

I’ve had this debate with myself and others for years, the one about keeping case notes and participating in the psuedo-medical farce of case conferences and presentations. There’s 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’m aware of sounding and perhaps also feeling like the Ernesto Spinelli , Jeffrey Masson-ites of psychology’s critical left. I have long come to accept as my particular ocular prescription that I view the world with one eye chanting its illusion while the other “disses”.. Dis-illusionment is my blindness and my 20-20 vision, no matter how many lenses I tint, crack or how many times I sit on my glasses. Here, I want to use the metaphor of viewing a rainbow and trying to describe the experience in writing as analogous to writing and/or speaking about relationships I experience with and through clients who come to see me for psychotherapy. The relational arcs are colourful, extensive, diverse and clearly visible. From certain vantage points, that place called and seen and experienced as the rainbow, exists. Then there’s that spot at which it doesn’t. And everything in-between and beyond.

In the context of cyberspace, where I am blind to the visual world of rainbows, it feels somehow tacky and ethically suspect, add to this vaporous and finely spun, to be writing up the stories of people’s lives and placing them in a public forum. It’s like having an open-air confessional in the middle of the V&A Waterfront and providing ringside seats. Psycho-theatre by the Bay. That’s 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’d choose as a place to inhabit, I’m 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 its those ideas that create the kind of truth and world I inhabit. One such ideal idea 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 Ask Agony Aunt column in a popular magazine at the supermarket check-out counter, the 20-page pre-programmed astro-cum-numero-cum-colour-coded compatibility report sent to me in the throes of a 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 - like a novice actress reading the big-screen scripts of those professional stars who’d “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, the therapist got and how obscure and almost incidental the patient, client, child…where is Little Albert now and had he known how famous he’d be, would he have insisted on copyright or negotiated royalty payouts. Did his parents sign a consent form and what’s it like to be psychology’s 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 I’m 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 psychology’s lullaby-mantra. The tune that puts psychology to sleep and sees the profession slide into facts-and-fiction land – here’s the plodding melody, “publish or perish, publish or perish, publish or perish” .

Psychology was written and chanted, alternatively gossiped and spun into existence by Freud, he pioneered, in line with his medical background, the art of case discussions. He formed a sacred circle of fellow practitioners and they played show me yours and I’ll show you mine. His were letters, long, indulgent, intimate letters, to others, to Ferenczi, Jung, Letters describing, outlining, inventing, ignoring, highlighting, formulating, obscuring . The Kaffee Klatsch letters of the Vienna circle. Letters that others responded to and so the Fairytale grew and grew and so did the participants and players. That’s what we’re doing here, what I’m doing here, years and years later, in cyberspace, we’re still writing and recreating the original fairytale. The coffee’s cold and instant but I’m one of them, a bona fide cast member, interchangeably therapist, client, patient, supervisor, supervisee and on and on.

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’ve experimented with numerous ways of recording information. Recordings both auditory and visual, shorthand notes, mind maps, drawings and key ideas and phrases. At times I’ve written nothing at all. I see that I’ve 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. Allow the image and memory to bring to mind what is there about this person, this family, this group experience. I resolve to shred and destroy those files that are older than five years. I make another resolution, that I am not 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. I resolve that I will endeavour to find ways to represent as congruently and authentically as I can my experiences of relationship with others.

I toy with the idea of journal keeping as a legitimate way to write about therapeutic experiences. A journal 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 would and 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 reflection of a slice of the client’s life. These are the thoughts and ideas that present themselves to me like flickering flame lights 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 a capacity 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 isn’t a single question that I’ve asked that hasn’t 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 this spirit free .

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’s the price for admission, how many points secure a lead role? Who else is playing , who is in the audience? What goes on backstage and how transparent are the curtains that signal the end of the piece?

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