different perspectives on a candidate’s work, but that utility needs to be balanced with maintaining the privacy of both the patient and the candidate. It is incumbent upon the institute to remind supervisors to be mindful of confidentiality concerns in their reports. Supervisors writing about their supervisees and candidates writing about their patients should use password protection when sending documents by email.
B: Protecting the confidentiality of candidates’ analysands:
Candidates may also struggle to maintain the confidentiality of their patients in the process of presenting clinical material in class. It can be difficult to discern, especially early in training, which of the multitude of details in a session are relevant and what should be disguised or omitted. New analysts may be overwhelmed by the clinical material they are engaged with and unconsciously seek relief by telling more than is warranted. Candidates hearing their classmates’ clinical material may also struggle to contain their affective responses and need to find a confidential place in which to discuss these. Certain strategies for maintaining confidentiality can be taught, but there are the also “unconscious strivings in ourselves,” 2 which are harder to manage procedurally, and which may lead to breaches of confidentiality unless those strivings can be satisfied in other ways. Supervisors should be encouraged to play a role here in helping their supervisees think about how to present their cases in a way that reveals the truth of the clinical situation without exposing identifying details of the patient.
C: Teaching on Confidentiality :
The importance of confidentiality in psychoanalytic treatment requires that candidates be made aware of this issue early in their training, by identifying it as a key point in our practice.
1. Include a seminar about confidentiality as part of the training which would have the following goals: (a) to make candidates aware of this issue early in their training; (b) to keep the issue alive in our minds whenever we talk about analysands; (c) to facilitate discussion of the advantages and disadvantages of different ways in which confidentiality might be protected in the sharing of clinical material (disguise, informed consent from a psychoanalytic point of view, amalgamated case material, multiple or anonymous authorship, etc.); (d) to facilitate discussion of the local legal and professional regulatory environment with scenarios about how to proceed when there is or could be a conflict with psychoanalytic confidentiality. 3
2. Sample articles from institute syllabi include:
Furlong, A. (1998). Should we or shouldn’t we? Some aspects of confidentiality of clinical reporting and dossier access. International Journal of Psychoanalysis, (79): 727-739.
2 2018 IPA Report on Confidentiality 2018 p. 7. 3 2018 IPA Report on Confidentiality p. 13
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