The IPA is thus faced with two ambitious goals. On the one hand it seeks to expand the profession, including into new geographic areas, whilst maintaining high professional standards. In this process, increasing numbers of individual IPA members are finding themselves drawn towards engaging in some form of remote working. On the other hand, IPA members are committed by the IPA Ethics Code to protecting patient confidentiality, without which some would argue that the free association that is central to psychoanalysis is impossible. It is desirable that IPA members who wish to make informed decisions about remote working improve their knowledge about the nature of technology they are using or plan to use. However, this, as we said above, does not mean that the possibility of total protection exists. As we have seen, even the classical setting now entails risks and it has never been able to guarantee absolute confidentiality. We are in any case witnessing, from the classical setting of the past to the contemporary classical setting to remote analysis, a progressive increase in risks that can be best addressed with corresponding increase in protective measures.
Informed consent and its limitations
One measure that is sometimes suggested as a way of addressing this problem is obtaining “informed consent” about risks from technology from patients at the beginning of treatment. However, the difficulties concerning this notion, which exist for psychoanalysis generally due to the transference, increase in the case of telecommunicative settings because neither party is generally well-informed about the technology.
Ethical implications and some possible partial protections
Analysts who practice telematic treatment will need to ensure that they are able to protect confidentiality sufficiently. It is realistic to suppose that by taking adequate precautions, confidentiality can be given enough protection against some possible intrusions upon privacy. Examples of such precautions would include:
● use of dedicated devices for clinical work (that is, devices that are not shared with family members or colleagues, who may inadvertently download compromising software); ●storage of clinical material on user’s computers, and not in the cloud; ● use of strong passwords wherever possible; ● avoidance of public WiFi hotspots; ●avoidance of apps that record conversations; ● use of Virtual Private Networks (VPN) for all communications which are not otherwise encrypted; ● end-to-end encryption for audio and video communication; ● use of encrypted email; ● regular security auditing, with active testing of potential vulnerabilities; ● seeking expert advice about establishing and maintaining an adequate system.
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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