PROTECTION OF PATIENTS IN THE USE OF CLINICAL MATERIAL FOR TEACHING, ORAL PRESENTATIONS, PUBLICATIONS AND RESEARCH 2
Reducing potential and experienced harm to patients induced by the profession's scientific, technical, and ethical needs to share clinical experience
Candidates routinely present their analytic patients in classes, in supervision, and in written write-ups for graduation. Analysts often feel drawn to present clinical material when teaching or in talks at conferences, in consultation groups or in papers for publication. Research frequently draws on specific clinical material from analytic work. But in all of these cases, and many more, there is an inevitable compromise of the patient’s confidentiality. Analysts need to be aware that clinical material, whether written or oral, once presented has a potentially unlimited audience, especially when it can be accessed over the web. Although the risks of recognition may be judged to be low, any such risk raises the crucial issue that it is not only the reality of a consequent breach that is of concern, but also any perception that there has been or could be a breach.
The problem of “informed consent”
Neither the analysand nor the analyst can be immediately aware of all the unconscious motives that underlie the request and granting of permission for the sharing of clinical material and neither of them can predict the future après-coup impacts of such a decision. There is therefore an inherent ethical uncertainty about informed consent in psychoanalysis, given the always-only-partial knowability of transference and countertransference. We know that patients can give consent to share clinical material and still feel that the analyst has breached their trust, with potentially serious consequences for their treatment.
The disguise of clinical material
A classic alternative to informed consent is the disguise of clinical material. Problems also arise here, however, because it is not easy to find the right balance between disguise and respect for clinical reality.
Moreover, even when patients’ anonymity is respected so that they are not recognizable to others, their self-recognition may have distressing repercussions on their views of their analysts, of themselves, and of the treatments, whether ongoing or concluded.
THIRD-PARTY REQUESTS FOR A BREACH OF CONFIDENTIALITY
Requests from outside the profession for breaches in confidentiality by psychoanalysts usually take one of three forms: requests that material from a treatment be shared with another party who has a stake in the treatment (insurance companies, government agencies, parents); orders from a legal body (a court or the equivalent) that an analyst testify or produce clinical notes; and, where there is no specific legislation to that effect, requirements to report to authorities suspicions about crimes or harm or risk of harm to self or third parties, such as minors.
2 See also “Thoughts on Confidentiality in Journal Publication” , as well as “Thoughts on Confidentiality in Conference Presentations” and “Thoughts on Confidentiality for Directors of Psychoanalytic Institutes”
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