2 GENERAL PRINCIPLES 2.1
Psychoanalytic & non-psychoanalytic approaches to confidentiality As a profession, we have responsibilities to our patients, to each other, and to a wider public. We therefore have to engage with both psychoanalytic and non-psychoanalytic ways of understanding confidentiality. We need to assert and defend the requirements of a specifically psychoanalytic conception of confidentiality, while remaining aware of a wider, non-psychoanalytic discourse, and distinguishing between these where necessary. For psychoanalysts, confidentiality is not merely a requirement for the safe or ethical conduct of work that might otherwise be carried out unsafely or unethically. It is fundamental to the psychoanalytic method in a more radical sense: without the expectation of confidentiality, psychoanalysis would be impossible because both free association by the analysand and free listening by the analyst would be vitiated. Confidentiality acts as a container and as a boundary separating analytic space from a wider social space. The IPA states explicitly in the Ethics Code that confidentiality is “one of the foundations of psychoanalytic practice”. (IPA, 2015, Part III, paragraph 3a). 2.2 The analyst’s responsibility for the frame/setting The role of the psychoanalyst gives rise to profound responsibilities because of the ways in which the psychoanalytic framework both stimulates and frustrates regression, unfulfilled longings, and unconscious phantasy. The analyst’s responsibility encompasses an awareness of the seductive power inherent in the psychoanalytic setting. Although unconscious impulses and emotions are stirred up in both partners to the analytic encounter, there remains an important ethical asymmetry: the analyst has to respect the autonomy and separateness of the patient, whether or not this attitude is reciprocated by the patient. The full impact of the person of the analyst, and of the setting, on the treatment and on the patient’s reaction to it, may never be fully known to the analyst, and yet the analyst must try to assess it. For this reason, while a patient’s consent to a breach in confidentiality may render it permissible from a non-psychoanalytic viewpoint, such a breach may remain ethically compromising in the eyes of many analysts, who would feel that the patient cannot always know at the time how the transference has affected his giving consent. 2.3 The patient’s trust that the analyst will protect confidentiality For a psychoanalysis to be possible the analysand must be able to trust that the analyst will protect the confidentiality of their communication. It is not necessary that the analysand trust the analyst in every respect, and it may even be clinically undesirable, but without trust in the analyst’s willingness and ability to protect confidentiality it will not be possible for what they jointly undertake to be a psychoanalysis, because it will not be possible for the patient to attempt to associate freely, nor for the analyst to listen freely.
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