confidentiality are outweighed by their commitment to meet the demand for professional services in circumstances where attendance at the analyst's office or consulting room is not possible, including in parts of the world where psychoanalysis has yet to establish a foothold. The questions that these analysts and their patients then face include: what kind of partial protection is adequate, how can it be obtained, and who decides? Among the many difficulties they must consider is how to think about endpoint security, as discussed above, and whether to involve the patient in thinking about this. Typically, the patient will be using his or her own device to communicate with, and the analyst will have no direct control over its security. Individual analysts evidently have widely differing views and beliefs about what constitutes an acceptable way of working psychoanalytically and of protecting confidentiality while doing so. The ethical obligation to protect patients’ confidentiality means that in each particular case where telecommunication is involved, the analyst will need to consider carefully the nature of the analytic contract that is entered into with the patient. The issues to be considered will include: ● whether the risks to confidentiality have been thoroughly explored; ● how the specific psychopathology of the patient can be expected to affect exploration of these risks; ● whether they should be left implicit or made explicit to the patient; ● if they are made explicit, whether this should be done orally or in writing; whether or not to seek the patient’s written consent; ● whether both the analyst and the patient have sufficient understanding of the technology to make informed decisions about its use; ● whether a viable psychoanalytic setting can be established, given that confidentiality cannot be guaranteed. telecommunications is not secure. A considerable number of psychoanalysts have already engaged in some form of remote working. Telecommunication is seen by many as a valuable tool for expanding psychoanalytic practice and culture globally, and institutional resources have already become committed to its use on a significant scale. It may therefore be difficult for the IPA to address this problem. Nevertheless, the long-term consequences for psychoanalysis of not addressing it may be more serious. It is uncertain how far the contemporary classical setting is similarly compromised by telecommunications surveillance. To the extent that it is, thought needs to be given to whether IPA members can be offered guidelines for minimising the associated risks. 4.9 Conclusion A serious problem is created for the IPA by the fact that confidentiality in
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