Thoughts on Confidentiality for Telematic Frames
Created by the IPA Confidentiality Committee
2025
INTRODUCTION
The topic of confidentiality is of the utmost importance in psychoanalysis and especially in relation to the increasing use of telecommunication and tele-treatment in analytic work. Telematic psychoanalytic practice (working by phone or over video) allows access to therapy for people who would otherwise be excluded from it, but it also requires an awareness of the threats to confidentiality that this modality of treatment poses. The classical setting allows for considerable safeguards to confidentiality, but because telematic relationships between patient and analyst involve a third party, the confidentiality of the encounter is exposed to the vulnerability of the platform used. For this reason we aim to elicit a “community-of-concern” approach 1 extended to all IPA members, in which safeguards are instituted to protect our patients’ privacy. While we will offer suggestions to reduce the risk of breaching patients’ (and analysts’) confidentiality and to ensure acceptable protection of telematic treatment, there are no absolute guarantees. We will come to see that in the age of digital technology, the best protection is to maintain awareness of the problem and to seek the best possible solution on a case-by-case basis.
GENERAL CONSIDERATIONS
Psychoanalysts are currently exposed to increasing economic and cultural pressures to normalize these new forms of communication and to use them even more widely in their clinical work. Modern telecommunications, including voice telephony, video telephony or videoconferencing, email, SMS and WhatsApp messages, are increasingly used by psychoanalysts for communication with patients and with colleagues. Communications with patients include both occasional and regular consultations by telephone or video platform, and communications with colleagues include telephone or video consultations about patients, clinical supervision and seminars, and the exchange by email of process notes and other clinical material. There are specific third party vulnerabilities to telecommunications that require special precautions to protect patients’ confidentiality. Technologies are evolving at a rapid pace, with an increasing role of AI “supports” that offer to record, transcribe, or summarize conversations that occur over video. There is no assurance of what happens to the record of such conversations, raising concerns about breaches to confidentiality. Analysts will need to actively consider emerging threats to confidentiality with each new app or platform that they use.
LOSS OF PRIVACY IN TELEMATICS
While modern telecommunications greatly expand the possibilities for working with patients and for exchange among colleagues, they are also to some extent vulnerable to electronic interception and eavesdropping without the need for separate local access to premises, access being provided by the telecommunications device itself (i.e. the telephone or computer). We know that telecommunications may
1 Glaser J.W. (2002). The community of concern: an ethical discernment process should include and empower all people relevant to the decision. Health Prog. Mar-Apr 83 (2) 17-20, cited in IPA Report on Confidentiality, 2018, p. 12.
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