• “How [do] you tell the risks to the patient has consequences. Even a mobile phone in the consultation room is not safe. This is easy to understand when it is question of a dictatorship but the hackers know no state borders. We have also to take into consideration that when something is once in the internet it may stay there for ever, and that using cloud services is said to be as open as a post-card.”; • “The other point I want to thank is the need to consult regularly IT-experts on the confidentiality issues in telecommunication. An ordinary analyst may find it difficult to imagine all the dangers there are involved and does not know what kind of security measures should be taken.” One respondent underlined the point that in the classical setting the analysand also carries some responsibility for the setting: “ What are the responsibilities of the analysand to maintain the specificity of the analytic work? Along [with] for example what we say to him/her regarding missed appointments and other frame issues. The presence of cell phones that are kept open or that could be pocket dialing accidentally. Should we stress the common responsibility (analyst-analysand) of the protection of the analytic process (harm done to analysis) so that the issue not be exclusively the protection of the analyst or harm done to the patient? ” 10.7 Third party requests One respondent wrote that “ the balanced advice to individuals and Societies about how to consider conforming with or arguing to resist demands made by a court for confidential material to be disclosed was excellent ” Two respondents pointed out that process notes may be requested by courts: “ Process notes would be deemed by courts to be part of formal record ”; and “ legally there is no difference between the process notes and the formal dossier. … if a judge or lawyer knows of this parallel dossier, it will be considered as the formal dossier and the judge may force access to it .” Another wrote: “ I would like to see in the final report something more about the possible intrusion by the health care system insurance companies to the analytic/psychotherapy process and its privacy.” 10.8 Child & adolescent analyses There were comments on the special circumstances of child and adolescent analysis: • “ The question of confidentiality is extremely complex in the case of adolescents who are living at home and where the main operative psychological unit is the family (in cases of severe conflicted dependence). Confidentiality may be instrumentalized to ban all communication with the parents as a defensive splitting rather that constructive interiority. This is even more important as the analytic work with them not only involves third party, health risk issues but also necessitates a special attention to boundaries and differentiation. ”
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