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Whether we are in our consulting room engaged with our patients or cloistered trying to write by ourselves, we are often searching for words to say what really matters. But rarely do sentences spill out easily on the page or gather themselves gracefully into paragraphs of clinical prose. Even if they did, how could they do justice to the unconscious depths, intimacy, and emotional complexity of psychoanalytic experience? As Thomas Ogden (2004) writes, “Psychoanalysis is a lived emotional experience. As such, it cannot be translated, transcribed, recorded, explained, understood or told in words.” (p. 857). “One can no more say or write an analytic  experience than one can say or write the aroma of coffee or the taste of chocolate” (Ogden, 2005, p. 16).


Yet we need to write about our clinical work. We owe it to our patients, colleagues, and ourselves and to those who want to learn more about psychoanalysis and psychotherapy. Because you have opened this book, chances are you or the writers you mentor would like to write with more daring, confidence, clarity, and ease.


Structure and Spontaneity in Clinical Prose will teach you how to read gifted writers for inspiration and practical lessons in the craft of writing; apply the principles and techniques that characterize what I call the narrative, evocative, enactive, lyric narrative, and paradigmatic  modes of clinical prose; and put what you learn immediately into practice in eighty-four writing exercises.


You will learn how to tell a clinical story in different ways; “recreate an emotional experience” (Bion, 1992); evoke “in the experience of reading . . . ‘the music of what happen[ed]’ (Heaney, 1979, p. 173)” (Ogden, 2005, p. 16); and employ language that invites readers to participate in what the analyst experiences as the analysis unfolds.


Each of the modes uses different means to construct worlds out of language. The paradigmatic mode abstracts ideas from experience to build concepts and theories. The narrative mode organizes experience through time, creating meaningful relationships between events, between human motivation and action, interactions and internal states, causes and effects. A story’s plot is what separates a narrative from a list of events, the annals and chronicles of old from history (White, 1981). A plot creates coherence retroactively where little may be discernable as events unfold.


As you will see, I have reserved the term lyric narrative for a particular kind of clinical story that creates the illusion of events unfolding in an uncertain present before hindsight allots importance and anchors meaning. The evocative, enactive and lyric narrative modes create an illusion of opening up the present moment for reexperiencing. The evocative mode works by invitation and suggestion. Christopher Bollas (1999) calls evocative description “a conjuring of the nominated” (p. 195), a phrase that is itself evocative and thus performs or enacts its meaning. The enactive mode creates an experience to be lived as well as thought. All of these differences will be explored in the chapters ahead. . . .


Daring to write differently, you may make discoveries about your patients, your work, and yourself. Whether you are doing the exercises, drafting a paper, writing clinical notes, or preparing for supervision, experimenting with different modes of clinical prose will help you deepen your work and develop your voice.


If you are not a psychotherapist, you will also find much here. While Structure and Spontaneity is about clinical prose, it is fundamentally a book about reading, writing, and honoring different ways of organizing experience in words. Its lessons may be broadly applied and are relevant to writers in the humanities and social sciences. . . .


Consider this book an extended writing seminar that is always open for you to drop in. I have field tested my approach in more than fifty clinical writing workshops for both new and experienced writers, unpublished and published alike. What you hold in your hands is the culmination of more than twenty years of teaching, coaching, and editing experience combined with my passion for literature, my respect for what words can do, and my training as a literary critic and psychoanalyst.





Bion, W. (1992). Cogitations. London: Karnac.


Bollas, C. (1999). The mystery of things. London: Routledge.


Ogden, T. H. (2004). This art of psychoanalyisis. International Journal of Psychoanlaysis 85: 857-7.


Ogden, T. H. (2005). On psychoanalytic writing. International Journal of Psychoanalysis 66: 15-29.


White, H. (1981). The value of narrativity in the representation of reality. In. W. J. T. Mitchell (Ed.) On narrative (1-23). Chicago: University of Chicago Press.

From the Preface

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