I have asked three colleagues to carefully read over and approve the material with this in mind.“ ● Example 4: “In order to protect the confidentiality of my patients, I have relied on amalgams of several patients, mine and those of my supervisees, in the clinical illustrations used in this paper. To avoid introducing an extraneous factor into their analyses, I have not asked any of these patients for permission.“ ● Example 5: “I feel that the analyst’s transparency about his or her motives and possible conflicts of interest are essential in an authentic psychoanalytic relationship. Therefore, I always discuss with my patients the possibility of my writing about them and my wish to enrich the literature with what I have learned from our work together. Each patient referenced here has read and approved the material included herein.“ Although in the views imagined above there are differing attitudes towards the notion of ‘informed consent’, we may suppose that all psychoanalysts would acknowledge its complexity. Whereas in most other professions the ethical requirement of informed consent is relatively straightforward, in psychoanalysis it is anything but. Freud’s discovery of unconscious resistance, the fact that patients are unconsciously opposed to treatment and to getting better, and his realisation that resistance needed to be identified, understood, and worked through rather than admonished, entailed a paradigm shift in his therapeutic model. The object of analytic inquiry, the unconscious, complicates any notion of informed consent within the transferential field. Neither the analysand nor the analyst can be immediately aware of all the unconscious motives that impel permission for the sharing of clinical material and neither of them can predict the future après-coup impacts of such a decision. There is therefore an inherent ethical uncertainty about informed consent in psychoanalysis, given the always-only-partial knowability of transference and countertransference. We know that patients can give consent to share clinical material and still feel that the analyst has breached their trust, with potentially serious consequences for their treatment. As mentioned above (see 2.7), apart from the option of not sharing clinical material at all, every alternative at the analyst’s disposal has its limitations and risks. It is not reasonable to expect that an analyst will always detect or correctly predict a patient’s reactions when information is shared (Anonymous, 2013; Aron, 2000; Brendel, 2003; “Carter”, 2003; Kantrowitz, 2004, 2005a, 2005b, 2006; Halpern, 2003; Robertson, 2016; Roth, 1974; Stoller, 1988). Some analysts believe that the interactive engagement triggered around the request for consent is on the contrary the ethical action to take with therapeutic benefits and enhanced scientific accuracy accruing from adding the patient’s point of view. These analysts (Aron, 2000; Clulow, Wallwork & Sehon, 2015; Crastnopol, 1999, LaFarge, 2000; Pizer, 1992; Scharff, 2000; Stoller, 1988) are less reluctant to disturb the treatment with a request for permission. Given the multitude of complex clinical situations that occur in different phases of psychoanalytic therapy, and the differing ethical positions regarding
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