How to write a clinical paper in psychoanalysis?

Why it may be so difficult? To help thinking about this questions, an Interview with Dana Birksted-Breen Editor in chief of IJP (International Journal of psychoanalysis)

This interview has been made by the Società Psicoanalitica Italiana and has been published in the 17Th December of 2013 on YouTube.

Dana Birksted-Breen is Training Analyst and Supervising Analyst of the British Psychoanalytic Society, member of the IPA, and current Editor-in-Chief of The International Journal of Psychoanalysis.

(This is not a literal transcription of the interview, but the main ideas of it)

Interviewer: I want to ask you two questions about writing psychoanalysis. Ogden says that analytical writing is a match with languages with the intention to translate into words the emotional experience of the psychoanalytical encounter, besides the difficulty of linking the clinical experience with theory, can you tell us something about the tension between the theory and the experience?

Dana Birksted-Breen: writing the clinical material or writing the clinical experience is very interesting and complicated and it depends on the situation, if you are writing for a supervisor it would be very different from writing for a Journal, but even writing for a supervisor is a complex issue because different supervisors and different psychoanalytic traditions and societies have different requirements.
Here we are talking about writing a journal paper. It’s complicated because, first of all it’s difficult to remember what goes on in a session, the forces of repression start kicking in and it’s very much about the perspective of the analyst, it’s not an objective view of what happened in the session, of course it’s from what the analyst thinks happened and what he or she can remember happening;  and the ‘raw’ experience is never completely ‘raw’, it is not devoid of a theoretical frame and we write up clinical material in the ‘après coup’ which restructures and gives coherence, we might say ‘secondary revision’

  There is an interchange between theory and clinical practice and from this interchange a journal paper can emerge but the paper is also a dialogue with other authors, with oneself, supervisors, one’s colleagues…
I see a paper very much as a process of research, leading to  further research, and I think when someone starts writing a paper they may have an idea but other  ideas  seem to be born from the process of writing and also it can go in directions that were not planned. For me that’s very important; some people perhaps have a clear idea of what they want to write before they start but I view it much more as a process of development of an idea, dialogue with oneself,  and with other people. The French Philosopher Blanchot  says that “le malheur de la question c’est la réponse” and I think that’s very much the case with papers, I mean, the paper is not the answer, it’s a journey from which another paper will develop and will continue the dialogue, and so it keeps going on; a Journal like IJP is a record of this ongoing journey, this dialogue through the decades , showing the development of ideas and shifts in preoccupations.  How you write the clinical material is part of that journey. Writing a paper is like being an analyst, it is a journey, I think it’s very much the same thing, you start, you go on, you start again, you suddenly have a new perspective and you change the main focus, you restructure, and I think that’s the pleasure of it, because it’s unexpected as you said, if it would be what people expected, or what you had expected, it wouldn’t be a good paper.
And similarly when you write your clinical material, I suppose you rethink what you were going to say, what you thought about the patient; in very practical terms it is not writing a case report; when you write a paper you select in order to make a point; you are not proving, you can’t prove anything, you select to illustrate the point you are trying to make, I think that people usually make the mistake of giving too much clinical material which is not relevant.  There has to be enough so that a reader can see if it does validate the argument but not so much that it is just a case report.
Ogden- what he’s pointing out is how difficult it is to convey what happened, because it’s not  only the words, it’s the music that you heard, maybe the patient  could have listened to another music. It is not easy to convey an atmosphere, or non verbal elements and an author can feel disappointed by how much isn’t conveyed. Some authors can feel they lack the ability to write but there is also the danger that an author with literary talents can get carried away with the words so that it becomes more of a literary piece than a psychoanalytic paper.   

Interviewer: What’s a good psychoanalytic paper constituted of, can you give us some advice to stimulate our confidence and reduce the anxieties about the reviewing process?

Dana Birksted-Breen: It is a creative process and any creative process might bring a lot of anxieties, also our unconscious anxieties, persecutory anxieties, about being envied, punished, the depressive terror that the things will never come together or after it’s published, the post natal depression, that this is all that is inside and nothing else will ever come out, so I think that one is battling with all that; people battle with the ideas: Can I say anything new? Am I stealing ideas from my analyst? Pregenital issues come in:  how big and important is my production, is it a big ‘thing’ or just a ‘piddly’ little one ?  And also where do I fit in, do I have to quote so and so, because I want them to realize that I belong to the group and I’m looking up to them, so I’m not taking their place, they are not going to lose their place, and will I benefit from being amongst those admired elders, all of these things can be there. As we know there is no activity free of unconscious thinking and phantasy. For some people, writing a paper could be felt as a destructive process, that you are killing other people who said something before you or different from you, or that they will kill you if you say something different or better, all those anxieties are normal in a creative process and they are going to be there and I think this gets projected into the editors, the reviewers so that they are seen as persecutors.
In fact I’m very excited when I see, Oh a paper has been submitted, I’m curious to see what it is,  I would like that paper to be accepted, we very much try to help the authors, it’s a further process, another dialogue that continues, because you always need somebody from the outside, another external, anonymous reader, who might have another point of view, or can show you what is not clear.  I think that’s quite interesting about the IJP because it is international and we will choose some reviewers from the same cultural group and who are sympathetic with the approach but we may also chose one reviewer with a different perspective and this is also important, it will give ideas about what further work needs to be done, to make it for instance more comprehensible to someone outside the tradition.
We hardly ever accept a paper first go and most paper go back for modifications, either minor or extensive; we like to help the author, we always try to explain where we see the problems and what would need to be done for the paper to be suitable for publication in IJP; the same applies to further versions of the paper. If we still don’t feel the paper is suitable for the IJP, another Journal may accept it.  We consider the process as a journey, from submission to final acceptance, or if the paper is not accepted the author, we hope, will have been helped by the process and maybe the next paper could go a little bit further. A paper is allocated usually to 3 anonymous reviewers and an associate editor, and including myself this means that five people are all thinking about their paper, it’s a lot of help actually.