Learning from Our Mistakes: Beyond Dogma in Psychoanalysis and Psychotherapy (review)

Patrick Casement has written a small gem, the condensed perspective of a master meditating about clinical psychoanalysis and psychotherapy. Learning from Our Mistakes joins his earlier books as a contribution toward teaching at all levels, from psychology interns to analytic candidates. Casement's humane and user-friendly set of compass points offers wholesome grounding to trainees and yet also declares a clinical ethos pertinent to the most experienced senior analysts—and, perhaps, an important corrective to decades-old autocratic forms of psychoanalytic "training." (As James McLaughlin has observed to me in a personal communication, his entire long career could be viewed as a recovery from his training.) True to his subtitle, Casement seeks to carry us "beyond dogma" to the heart of darkness in analytic work, where novel territory lies waiting to be discovered by analyst and patient. At this level, Casement is an eloquent and sure teacher.

This being said, I could not help but read Casement's book, in parallel, at a second level. At this second level, my imagination generates a picture of Casement organizing his thesis, with particular personal poignancy and high seriousness, around his now-famous account of his treatment of Mrs. B., published originally in 1982 and thoughtfully included at the end of this volume as an appendix. While, at the surface of Casement's argument, I find passages that strike me as elaborating, explaining, and even justifying his clinical choices with Mrs. B., the total message and spirit of this book seem to me to constitute a deep and subtle act of tacit reparation.

All of us who write and publish accounts of our own clinical work, along with our theoretical perspective or reflective musings on the analytic process, stand exposed as a "fixed figure for the time of scorn / To point its slow unmoving finger at" (Othello, 4.2.56-57). We must stand with what we have committed to print, while other voices (including, now, this review) emerge to idealize or denigrate, recognize or misrecognize, applaud or denounce what we have offered (both to our patient and to our peers). Writing is, of course, an act of courage—whatever the admixture of purpose, principle, ambition, ego, naïveté, or foolhardiness. Casement's report of his work with Mrs. B. has attracted much commentary, both admiring and challenging.

Recall "Lord Jim," whose entire life is organized as a reaction of accountability for one act, one moment in which he leapt overboard, abandoning ship, as it turns out, unnecessarily. Writers also take leaps, and may live out the consequences over decades of exchange in "the literature." I conjecture that, despite its being composed in large part of presentations and papers written by Casement over the course of the past decade, Learning from Our Mistakes is a book profoundly determined by a struggle with accountability and conflict in the wake of Casement's controversial choices with Mrs. B.

For those unfamiliar with Casement's article, "Some Pressures on the Analyst for Physical Contact during the Reliving of an Early Trauma" (1982), I offer this brief summary. Mrs. B., at eleven months of age, had suffered a severe scalding. At seventeen months, during a surgery under local anesthesia to relieve healthy skin from scar tissue, her mother fainted and let go of the child's hand, disappearing both from contact and from view, while the surgeon proceeded with the operation. I would highlight, in selectively summarizing the treatment crisis presented by Casement, three significant moments, or phases. First is the occasion when Casement overrides the patient's hand-raised signal for him to stop, and pursues a penetrating interpretation. Mrs. B.'s distress at Casement's proceeding, like the surgeon, to go on with his "operation"—out of contact with her state—leads her to arrive at a request that, should she require a special measure during analytic reliving of her childhood trauma...