2.4 The possibility of unresolvable conflict between competing needs or views
We can conceptualise confidentiality as pertaining to our professional relationships in at least two different ways. If we think of confidentiality exclusively in terms of the relationship between analyst and analysand, the need for the analysand to be able to trust the analyst to protect confidentiality is liable to come into conflict with the analyst’s ethical and scientific need to share anonymised material with colleagues in supervision, teaching, and publication. On the other hand, if we think of confidentiality in terms of a relationship whose quality and integrity requires from the beginning the inclusion of psychoanalytic colleagues as third parties with whom the analyst communicates clinical material ‘in confidence’, the analysand may not share this view, in which case there may be a conflict between the analyst’s and the analysand’s conceptions of confidentiality. Either way, a conflict between the analyst’s and the analysand’s views may be unresolvable. 2.5 Confidentiality as an ethical & technical foundation of psychoanalysis The principle that confidentiality is one of the foundations of psychoanalysis is a matter not only of ethics but also of psychoanalytic technique, and the ethical and technical aspects are inseparable. Protecting patients’ confidentiality thus involves the IPA in an ethical regulation of psychoanalytic practice. The challenge for analysts is that the object of our study, the unconscious, is as much a part of our being as it is in our patients, and as likely to emerge in unexpected ways. Our wish to protect our patients may be undermined by unconscious strivings in ourselves. It is for this reason that in this report regular recourse to non- judgmental listening by colleagues before the presentation or publication of clinical material is viewed as indispensable to detecting unconscious excitement stirred up by the process. Yet even this is not without its own pitfalls and limitations. 2.6 Confidentiality & privacy The words confidentiality and privacy are used in a variety of complex ways in everyday contexts, which often overlap and are sometimes confused. For the purpose of this discussion it will be helpful to distinguish them by thinking of confidentiality as arising always in the context of a relationship, within which private information, experiences, and feelings, are shared within strict limits. From a legal point of view, confidentiality is an ethical obligation, whereas privacy is an individual right. 1 Maintaining the privacy of what is communicated between analyst and patient is clearly a necessary condition of confidentiality in an analysis . This is the case regardless of whether confidentiality as an ethical requirement is understood to be unconditional or as subject to certain limitations or exceptions on clinical and/or legal grounds. Unless the privacy of their conversation can be assured, a psychoanalyst is not in a position to give or imply a 1 See e.g. http://criminal.findlaw.com/criminal-rights/is-there-a-difference-between-confidentiality-and- privacy.html
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