Current recommendations from the Ethics Committee make a case for what is called “discretionary privilege”, meaning that the who, how, and why of any demand for a breach in confidentiality is considered first and foremost a matter for clinical decision and ethical judgment by the individual analyst, a decision that can be based on what best protects the integrity of treatment and the patient. With regard to the treatment of minors, jurisdictions with mandatory reporting obligations must be honored. Additional factors may also have to be considered: when there is a concern of a credible threat of serious injury to self or others or of imminent suicide, a breach of confidentiality may be required.
PATIENTS’ ACCESS TO FILES, INCLUDING PROCESS NOTES
In relation to a patient’s right of access to any information held about them by a psychoanalyst, there appear to be noticeable variations internationally in the approach taken in different jurisdictions. The overall trend seems to be moving toward collapsing the distinction between formal, medical-type files (which must be accessible to the patient on request), and "process notes" taken by the analysts to aid their thinking about a case (which may remain private to the analyst).
Some useful suggestions for psychoanalysts to keep in mind include:
● Maintaining acceptable standards of record- and file-keeping; ● When requested, give the patient a summary of their information based on process notes; ● Ensuring that process notes do not contain any personal identifying information such as name, address, birthdate, and the like; ● Maintaining secure storage for the time that records must be kept and then ensuring the secure destruction of records once that time has passed. For a comprehensive discussion of confidentiality in psychoanalytic practice as a whole, please see the 2018 Report on Confidentiality. https://www.ipa.world/IPA_DOCS/Report%20of%20the%20IPA%20Confidentiality%20Committee%20(En glish).pdf
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