7 PATIENTS’ ACCESS TO FILES, INCLUDING PROCESS NOTES The issue of patients’ control/ownership of clinical material about them arises in connection with every use of such material, including in presentations, supervisions, publications, etc. Although this topic is not centrally one of confidentiality, and although such requests are still rare, any request for access to files or notes by someone who does not yet have access to them, including a request by a patient, potentially raises questions about whose confidentiality is being protected, and why. In relation to a patient’s right of access to any information held about them by a psychoanalyst, there appear to be noticeable variations internationally in the approach taken in different jurisdictions. The overall trend seems to be moving toward collapsing the distinction between formal, medical-type files (which must be accessible to the patient on request), and "process notes" taken by the analyst to aid their thinking about a case (which may remain private to the analyst). For example, in the UK all records, even those on which the name of the patient is not recorded, must be made available to the patient on request: a requirement to release the records is enforceable whenever the record has any sort of identifying information, or information which would enable a reasonably competent third party to identify the patient. The variability of this situation across regions and the paucity of test cases makes it difficult for the IPA to give specific guidance on this issue. Nevertheless, since requests by patients for a copy of all the information related to them can be expected to occur sooner or later in the practice of many analysts, any analysts who have reservations about sharing personal or process notes in this way will need to think about how to prepare for such an eventuality. This means making themselves aware of the requirements of the jurisdictions in which they operate and – where possible – beginning a joint reflection with colleagues about how to prepare for, and handle, such a request. More generally, the psychoanalytic community needs to give consideration to these issues. In many jurisdictions, the law recognizes the risk of harm to the client or to third parties as a legitimate reason for refusing to allow access to the personal notes of a professional service provider. On the other hand, the analyst’s interest in maintaining his or her own privacy, and what that might mean within a psychoanalytic relationship, is more or less unexplored legal territory as far as we are aware. The wish by an individual patient to take advantage of a right of access may be rich in intersubjective meaning that is explorable in the analysis. 24 Some useful suggestions for psychoanalysts to keep in mind include: ● Maintaining acceptable standards of record- and file-keeping; ● Keeping the official file on each patient required for insurance or regulatory purposes separate from process notes on the patient;
24 Although one hears of occasional requests by patients to see their files we are not aware of much reference to this possibility in the analytic literature. See Furlong (1998-1999).
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