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Thoughts on Confidentiality In Journal Publication
Prepared by the IPA Confidentiality Committee
2025
Publishing Clinical Material is Essential
It is a widely shared conviction that analysts need to be able to present and to publish clinical material. Trainees learn from presenting their work in case seminars, and they benefit from hearing others’ responses. Members of institutes need to come together to reflect on clinical presentations that highlight emerging insights in the practice of psychoanalysis. Further, all analysts rely on clinical accounts in books and journal articles to widen their perspective on analytic work. Psychoanalytic writing allows authors to engage one another and a broader audience, in order to gain greater insight into analytic work. And of course, every individual analysis profits from the analyst’s ability, in a considered way, to gain perspective by sharing her experiences with a trusted colleague.
Publishing Clinical Material is Also a Complex Undertaking
Analysts are especially attuned to the presence of unconscious mental life and its intense mobilization during treatment in both analyst and patient in a mutually activating and intertwined spiral. No clinical presentation can be either exhaustive or exempt from unknown unconscious strivings on the part of the author. Further, clinical material selected as the subject of a presentation is always to some extent a construction created by the analyst. These observations highlight that while sharing clinical material with peers or supervisors may be a professional necessity, it is also a constant call to scientific modesty. We simply cannot know everything that we may be unconsciously communicating when we write about or orally present our analysands to others. We cannot rely on our scientific accuracy, and we cannot anticipate how our patients might respond to our writing. We are also not able to reliably predict the impact on patients, either immediately or long afterwards, of discovering that their analyst has written about them, whether their permission has been obtained or not. There are a variety of theoretical schools represented within the IPA, each with its own understanding of this complexity, with its own techniques and associated ethics. This means that there are many lenses through which to view the complexity of the unconscious transference and countertransference dynamics in any analytic treatment. Based on these complex, divergent models of unconscious processes, we conclude that there is no universal, fail-safe procedure in line with all of the theoretical models of psychoanalysis which can be recommended as the best way to protect the analysand when sharing clinical material with colleagues. Our ethical responsibility to protect our patients and their treatment goes beyond strict legal liabilities. Even when patients’ anonymity is respected so that they are not recognizable to others, their self- recognition may have distressful repercussions on their views of their analysts, of themselves, and of the treatments, whether ongoing or concluded.
We are forced to conclude that our ethical responsibility is a paradoxical one: we are responsible for the impact on our patients of our sharing their clinical material with others, despite the fact that we cannot
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