I Clinical thinking in psychoanalysis

A common ground in clinical discussion groups Intersubjective resonance and implicit operational theories

Ricardo Bernardi

Introduction

In this chapter I discuss the nature of the dialogue among analysts who employ different theoretical frameworks. I focus on the conditions that facilitate fruitful exchanges. The fact that this dialogue can actually take place is relevant to elucidating the epistemological status of our discipline and to laying the foundations for the development of true scientific controversies. Such controversies generate more favourable conditions for the progress of clinical practice and psychoanalytic education and research.

The features and effects of pluralism continue to interest our discipline. First, the word pluralism denotes a fact: there is a plurality of theoretical and technical ideas in psychoanalysis. Second, it suggests the existence of a collective agreement that enables the coexistence of these diverse ideas within the same institutional framework. This was, for instance, the result of the well-known controversies between Freud and Klein (King & Steiner, 1991), which took place in the British Society between 1941 and 1945. These controversies ended with a "gentlemen's agreement" that made it possible for different schools of thought to coincide in one society.

Yet the idea of pluralism involves a more ambitious aspiration, namely the existence of a space for sharing ideas and experiences among the various schools. The aim is not just to achieve consensus but, more essentially, to develop an interaction that will favour the growth of the discipline. Such interaction includes both agreement and the clarification and explanation of dissent. Nonetheless, the conditions that render this exchange fruitful are rarely found. The Freud-Klein controversies did not lead to the development of such a space. Neither did pluralism help meet this goal in the Rio de la Plata (Bernardi, 2001). Widlocher (2008) has wondered, with good reason, if psychoanalysts know how to debate. Without debate, pluralism may easily cease to be a shared argumentative field where alternative hypotheses can compete and interact and become a "plurality of orthodoxies" (A. Cooper, 2008), resulting in the fragmentation of the field.

A common ground is needed for an enriching interaction to occur. In the philosophy of language, the expression common ground or grounding refers to the "mutual knowledge, mutual beliefs, and mutual assumptions that are essential for communication between two people" (Clark & Brennan, 1991, p. 127). Communication includes productive agreements and disagreements and brings into play not only content-related issues but also questions tied to the exchange itself. In this chapter I pay particular attention to communication that brings to light a clinical common ground and ways in which this common ground may favour a fertile pluralism.

First, I examine the nature of the difficulties posed by theoretical and clinical communication in psychoanalysis. Wallerstein and Green engaged in a key debate on the existence of a clinical common ground in 2005. Both concluded that an exercise or procedure should be developed to determine whether or not this common ground exists. My analysis is based on the experience of IPA clinical discussion groups that applied the Three-Level Model for Observing Patient Transformations (3-LM). Second, starting from these group experiences, I look at the features of the clinical common ground in each of the three levels making up the model: phenomenological observation, clinical conceptualization, and theoretical explanation. Finally, I present conclusions about the relevance of the clinical common ground for psychoanalytic training and scientific dialogue among analysts.