3 PROTECTION OF PATIENTS IN THE USE OF CLINICAL MATERIAL FOR TEACHING, ORAL PRESENTATIONS, PUBLICATIONS, & RESEARCH 5 3.1 Preliminary remarks and the problem of ‘informed consent’ Given the complexity of the unconscious transference and countertransference dynamics in any analytic treatment and the variety of theoretical schools represented within the IPA, each with its own understanding of this complexity, with its own techniques and associated ethics, there is no universal, fail-safe procedure which can be recommended as the best way to protect the analysand when sharing clinical material with colleagues. The problem can be illustrated by considering some imaginary examples of statements that analysts might make if they were required to justify their positions when presenting clinical material in scientific presentations or publishing clinical material: ● Example 1: “I believe that what transpires in the psychoanalytic consulting room is a product of the conscious and unconscious activities of both patient and analyst. I consider it appropriate and proper to ask my patients’ permission whenever I use clinical material from our work together. The patients whose material is referred to in this paper have vetted it and given their written permission.” ● Example 2: “There is no doubt that any clinical event is properly speaking a unique product of the interaction between a given patient and a given analyst. Any description of it by the analyst is naturally therefore subject to that analyst’s point of view, in ways not necessarily fully comprehended, including his or her theoretical bias and unconscious personal equation, at a given moment of time. However, it is my conviction that asking a patient’s permission to use clinical material in a scientific presentation is a significant intrusion into his or her psychoanalysis or psychoanalytic therapy and thereby to be avoided if at all possible without harm to the patient. I have chosen to disguise the personal histories referred to in this article so that other persons would not recognize them. As for the patients who might recognize themselves, I hope that they will feel that I have tried to respectfully render our work together as a particular contribution to society.“ ● Example 3: “I do not believe it is right to involve patients in discussing publications of mine which make reference to their work with me. The inevitable and ethical asymmetry of the therapeutic relationship makes informed consent both problematic and unavoidably troubling to the patient. With a view to protecting the confidentiality of my patients and to correcting for my own unconscious blind spots,
5 As will be evident from the Further Reading listed at the end of this report, the Committee has been able to draw upon a substantial literature examining the conflict between the ideal of absolute confidentiality in relation to patients and the equally absolute need to consult with colleagues in order to maintain our capacity to work as psychoanalysts. For ease of reading, we have chosen to keep references in the text to this literature to a minimum, citing only when we think the point being made might otherwise be viewed as controversial.
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