Failed Cases

When Arnold Goldberg decided to study treatment failure, he offered a seminar entitled “Failed Cases” at the Chicago Institute for Psychoanalysis. A large number of candidates, graduate analysts, and faculty quickly reworked their schedules so that they might participate. Goldberg’s reputation as a provocative, stimulating and brilliant teacher, combined with the unusual subject, encouraged a large membership. Goldberg asked Brenda Solomon and Caryle Perlman, two author participant members of the long running study group, resulting in the book Errant Selves, to help line up presenters and take notes on the seminar. Lining up presenters was not always an easy task. Most people had mixed feelings about presenting work clearly labeled a “failed case” to a group of their peers. The candidates were perhaps more willing to expose what might be a failure on the grounds of being “just a candidate so it is not surprising I have failed doing this treatment.” The participants of the seminar did not hold back in their myriad responses to the “failed cases.” Such responses ranged from blaming the analyst to blaming the patient, to thinking this was not a failure so no one was to blame, and finally to concluding that this analysis was so inappropriate that failure was inevitable from the start. Some presenters felt traumatized after presenting, even if they said it was useful, while others said it helped them look at the treatment in a completely different way. One said that the whole purpose of the group was a sado-masochistic enactment but she was still glad she had presented. Goldberg never asked for Perlman’s or Solomon’s notes. Instead, he wrote the book on his own. Perhaps he did not want to deal with the enormously time-consuming process of the study group and the multiple case presentations he had lived through. Perhaps he knew this was going to be his last major work and so wanted the liberty to write it in his own eloquent style, on his own timetable, and with his own examples. His examples are, in fact, usually not clear failures but rather demonstrate the struggle of a very experienced analyst engaged in the murky work of psychoanalysis. The book, The Analysis of Failure certainly reflects and comes from the Seminar but the content moves back and forth from the most practical to the most philosophical questions around failure and, as in his other writing, gives us a true sense of the depth of Goldberg’s mind. He utilizes material from many sources that are both close and distant from psychoanalytic thinking. He even uses a Darwin scholar as a reference. He read voraciously and deeply and plays with ideas that, while distant from psychoanalytic theory or practice, shine some light on his ideas about treatment success and failure, and all the grey in between. How are we to understand failure? Failure is the other side of the coin of greatness, the greatness that is a remnant of childhood grandiosity. We hate failure for many reasons but the most powerful one is what it does to our self-esteem. We feel ashamed that we are not great and, in addition, have let our patients down. Although the participants and Goldberg were mostly supportive of one another, the presenters were often flooded by their own loud choruses of blame, “oughts,” and “shoulds.” The group and later, the book, try to understand the nature of blame and responsibility as well as discovering the causes of unsuccessful treatments.