8 GENERAL CONCLUSIONS The principle that confidentiality is one of the foundations of psychoanalysis, which is stated by the IPA in its Ethics Code , has consequences both for the IPA as a professional organisation and for its individual members. Confidentiality is a matter both of ethics and of technique. It is essential for the well-being and future development of psychoanalysis, as well as for the well-being and benefit of patients, that confidentiality be rigorously maintained. Ensuring the maintenance of confidentiality can be a complex, difficult task and we need as a profession to keep it under constant review. In our current professional culture there are gaps between the theory and practice of confidentiality. We know, even if only anecdotally, that in actual psychoanalytic practice the thoroughness with which confidentiality is maintained is highly variable. This report aims to further the development of a culture of confidentiality in which failures in our practice can be recognised, thought about, understood, and acted upon. In this report we have identified major risks to confidentiality across three broad areas: ● Sharing of clinical material with colleagues, which is for the benefit of individual patients and of patients generally, but which can come into unavoidable and ultimately unresolvable conflict with the need to preserve confidentiality (see section 3); ● Telecommunications and use of technology, especially but not exclusively in ‘remote analysis’, which is creating new risks for which only partial protection is possible (see section 4); ● Requests from patients and from third parties (including legal authorities) for access to process notes, etc., where ethical and technical considerations are at risk of being subordinated to legal or political ones (see sections 5 & 7). Furthermore, across all three of these areas, problems arise concerning the possibility of obtaining ‘informed consent’, given the complications due to the transference in any psychoanalytic situation and the inherent unknowability of unconscious psychic content at all stages of psychoanalytic treatment. The IPA has a responsibility to provide guidelines for its members concerning all of these risks, but the guidelines can only be of a general nature. Individual psychoanalysts cannot escape the obligation of making difficult ethical and technical decisions on a case-by-case basis, often with inadequate information. For this they may need not only guidelines but also institutional support. Psychoanalysts generally need to become better informed about the risks to confidentiality. This implies a need for continuing professional development by individual analysts and a corresponding need for the IPA and its component organisations to develop ways of
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