4 CONFIDENTIALITY WHEN USING TELECOMMUNICATIONS, INCLUDING FOR REMOTE ANALYSIS & SUPERVISION 4.1 Introduction Modern telecommunications, including voice telephony, video telephony or videoconferencing ( e.g. Skype) 7 , and email, are being increasingly used by psychoanalysts for communication with patients and with colleagues. Communications with patients include both occasional and regular consultations by telephone or Skype (or similar), and communications with colleagues include telephone consultations about patients, clinical supervision and seminars conducted by telephone, and the exchange by email of process notes and other clinical material. Psychoanalysts are currently exposed to increasing economic and cultural pressures to normalise these new forms of communication and to use them ever more widely in their clinical work. Conducting psychoanalysis by means of telecommunications (referred to variously as ‘remote analysis’, 'teleanalysis', 'distance analysis', and ‘Skype analysis’) is currently a subject of much debate among psychoanalysts. Many colleagues hold strong views either for and against this practice, with ethical and technical arguments being put forward on both sides. The depth of polarisation in the debate is evident in some of the feedback received by the Committee concerning the draft version of this report (see section 10, below). It is important to note that the scope of the debate about remote analysis is much wider than confidentiality, whereas this report is concerned with remote analysis only insofar as it relates to confidentiality. The inherent insecurity of telecommunications means that remote analysis, like all of the practices mentioned above, involves risks to patient confidentiality. The IPA has already issued guidance which emphasises that psychoanalysis is conducted “in the room - in person” and that other forms of analysis should be pursued only in exceptional circumstances (IPA, 2017). It points out that there are “issues regarding security, privacy protection and confidentiality over all form of telecommunications”, and it states that “Analysts must satisfy themselves that the technology they are using is secure and protects the patient's confidentiality” (IPA, 2014-17, paragraph 7). We explore below the risks to confidentiality inherent in the use of telecommunications for psychoanalytic consultation, and the implications for the IPA and its members. 4.2 Privacy in the classical setting In the classical setting of the psychoanalytic consulting room or office, when social and political conditions have been favourable, our relative physical control of the offices or 7 Also e.g .: FaceTime, WhatsApp, GoToMeeting, VSee, WebEx, Zoom, etc. The following independent website provides detailed comparisons between about 60 alternative platforms: https://www.telementalhealthcomparisons.com/private-practice
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