A Fourth Pillar: Unlocking the Power of Case Writing in Analytic Training with Stephen B. Bernstein, MD (Brookline, Mass.)

“I've had the experience of having some wonderful supervisees, many of whom have done quite fine work and where it has not been an issue of any kind of great concerns. And allowing the candidate to see what's written and also discussing it with them, obviously makes it quite easy for them to get both positive input, but also at times, input that will help them evolve and deepen their work even more.” 

Episode Description: We begin by exploring the critical role of case writing in psychoanalytic training, discussing Stephen’s concept of "a fourth pillar of analytic training." Stephen introduces the dynamic interplay between writing and self-reflection, arguing that the act of writing illuminates resistances, countertransference, and areas of growth that might elude the analyst in supervision or personal analysis. He shares his innovative "three-minute chess match" technique for identifying the heart of a case narrative and reflects on his journey—from his mother’s poetry to his current work mentoring candidates in the art of case writing.

We explore Stephen’s insights on the 're-immersion anxiety' that can inhibit case writing, and how addressing these resistances transforms the writing process and deepens clinical work. We conclude with a discussion of how the process of writing fosters an enduring capacity for self-supervision and analytic insight.

 

Our Guest: Dr. Stephen Bernstein, MD is a Training and Supervising Analyst at the Boston Psychoanalytic Society and Institute and has chaired a discussion group on writing about analytic cases for over 30 years. He is a prolific author, including his recent paper, The Process of Case Writing: A Fourth Pillar of Analytic Training, published in the Journal of the American Psychoanalytic Association. Dr. Bernstein’s work highlights the centrality of case writing as an essential tool for self-reflection and professional development. Beyond his focus on writing, he has contributed to the field with early research demonstrating the compatibility of preparatory psychotherapy with psychoanalysis and continues to mentor candidates, fostering their growth as analysts and writers.

 

Recommended Readings:

• Bernstein, S. (2023). The Process of Case Writing: A Fourth Pillar of Analytic Training. Journal of the American Psychoanalytic Association.

• Gabbard, G. O. (2000). Disguise or Consent? Problems and Recommendations Concerning the Publication and Presentation of Clinical Material. International Journal of Psychoanalysis, 81, 1071-1086.

• Kantrowitz, J. L. (2004). Writing About Patients: I. Ways of Protecting Confidentiality and Analysts' Conflicts Over Choice of Method. Journal of the American Psychoanalytic Association, 52, 69-99.

• Stimmel, B. (2013). The Conundrum of Confidentiality. Canadian Journal of Psychoanalysis, 21(1), 84-106.

• Stein, M. H. (1988). Writing About Psychoanalysis: II. Analysts Who Write, Patients Who Read. Journal of the American Psychoanalytic Association, 36, 393-408.