dialectical relation whereby the creation of trust makes possible the emergence of unconscious aspects of a profound mistrust. A third wrote of the importance of allowing the patient to have a fantasy that the analyst might divulge his secrets and not to be convinced of the analyst’s perfect honesty. 10.4 The community-of-concern approach The idea of a community-of-concern approach was commented on approvingly by more than one respondent. One wrote: “ We wholeheartedly support a community- of-concern approach…. The responsibility is shared by all [and] though we as analysts very well know the importance of confidentiality, it should not be taken for granted that it is followed rigorously, and a constant remainder is needed .” 10.5 Informed consent and sharing of clinical material Although the question of informed consent arises potentially both in relation to consent to treatment and in relation to consent to sharing clinical material, much of the detailed discussion of it in the report concerns specifically the sharing of clinical material, and the comments we received were mainly about this aspect. A wide range of views about the principle of informed consent was apparent in the comments. Some respondents argued that patients have a right to know when material is being shared and some argued the need for formal written consent. Others stressed the complications due to transference and doubted whether informed consent is even possible in a psychoanalytic context. One respondent suggested that program committees should state that no one can present material without written permission from the patient, and continued: “ I am of course aware of, and agree strongly with, that which you have carefully laid out as the profound problems with this choice. But there is no way around the essential fact that we are lying by omission to our patients when doing otherwise. If the treatment cannot withstand this intrusion then the question never should be asked, the material not [be] presented .” This range of views was already represented in the draft report and the Committee remains of the opinion that 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. Some respondents approved of the suggestion that authors explain their ethical position with regard to informed consent and confidentiality in clinical presentations and publications, while others were concerned that such statements would compromise confidentiality by giving information which would allow a reader to undo the disguise. Some were worried that consulting with colleagues would either be too cumbersome or lead to further confusion.
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