The cunning of clinical reason in psychoanalysis: How a case makes use of reflective agents to conceptualize itself.

Abstract

The process of case conceptualization in psychoanalysis has at times been described by those involved as the progressive emergence of a “logic” that can be grasped only retrospectively. However, there has been little effort to frame this phenomenon in a theoretically grounded way. In this article, we suggest that Hegel’s doctrine of the cunning of reason may be used to better understand the process of psychoanalytic case conceptualization. According to Hegel, historical agents unwittingly realize the logic of history by pursuing their passion for self-aggrandizement. Analogously, we propose that reflective agents unwittingly realize the logic of the case by pursuing their passion for understanding. We illustrate this process by means of two case examples drawn from supervision sessions that were subjected to an interpersonal process recall procedure. The examples are used to document the progressive emergence of the logic of the case in a succession of reflective rounds, as evidenced by the unconscious repetition of certain words or clinical acts. However, it is only at the end of the process that the reflective agents can retrospectively become aware of the logic that was there from the beginning. In this sense, reflective agents may be thought of as the “means” through which a case attains the purpose of conceptualizing itself. We highlight five conditions for this purpose to be fulfilled: time, immersion, passion, opposition, and reflection.