each of them that can be taken by analysts of separate theoretical persuasions, it is not feasible for the IPA to devise a standard procedure for presenting and publishing clinical material that would be ethically sound and generalizable to all analysands. Our ethical responsibility to protect our patients and their treatment goes beyond strict legal liabilities. Even when patients’ anonymity is respected so that they are not recognizable to others, their self-recognition may have distressful repercussions on their views of their analysts, of themselves, and of the treatments, whether ongoing or concluded. Because of these limitations in our capacity to be confident about our particular ethical choices, in addition to our ethical responsibility as individual practitioners we are proposing a community-of-concern approach (Glaser, 2002) in which safeguards are introduced at several points in the development and presentation of clinical material, and responsibility for their effectiveness is held by all involved. The aim is to foster a culture of confidentiality in which protection of the patient´s privacy and dignity becomes a paramount concern at every point in the development, sharing, and presentation of clinical material. 3.2 Reducing potential and experienced harm to patients induced by the profession's scientific, technical, and ethical needs to share clinical experience The presence of unconscious mental life in every human being, and its intense mobilization during treatment in both analyst and patient in a mutually activating and intertwined spiral, makes it impossible to pretend that any clinical presentation is either exhaustive or exempt from unknown unconscious strivings on the part of the author. Moreover, the clinical material selected as the subject of a presentation is always to some extent a construction created by the analyst. This observation makes the sharing of clinical material with peers or supervisors both a professional necessity and a constant call to scientific modesty. We simply cannot know everything that we may be unconsciously communicating when we write about or orally present our analysands to others. And we cannot reliably predict what the impact on them will be, either immediately or long afterwards, of discovering that their analyst has written about them, whether their permission has been obtained or not. So we are forced to conclude that our ethical responsibility is a paradoxical one: we are responsible for the impact on our patients of our sharing their clinical material with others, despite the fact that we cannot fully predict or control this impact, or even know what aspects of it may have eluded our perception. The tension between confidentiality and the analyst's need to share is captured in legal advice commissioned by the IPA from the UK barrister, Anya Proops QC. On the one hand, she concludes that "In general, it is difficult to see how the disclosure of effectively anonymised data would amount to a misuse of private information at common law". On the other hand, this advice is subject to the following caveat: "if in practice, patients are given to understand that no aspect of what they say of their treatment will be divulged to any third
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