Writing About Patients: I. Ways of Protecting Confidentiality and Analysts' Conflicts Over Choice of Method

Abstract

Thirty American psychoanalysts who have published articles using clinical material from their patients were interviewed about their method for ensuring confidentiality. Almost twice as many analysts chose to disguise material as regularly requested permission for the use of patients' material. The other analysts in the sample varied their approach, depending on circumstances, between using disguise alone and using disguise but also requesting consent. Methods of disguise, the timing of request for permission in relation to the phase of analysis, and changes in analysts' ideas about the benefits and detrimental effects of these choices are discussed and illustrated. Each decision is reconsidered in light of its potential effect on patients and their analysis. The dilemma posed by the importance of writing about patients for the health and growth of psychoanalysis as a field and the potential negative consequences for patients and their analyses is considered.

A Feminist Phenomenological Description of Depression in Low-income South African Women

“…Today, patients' rights are accentuated more than ever before, and this is as it should be. Unfortunately, however, this tends to diminish psychologists' inclination to communicate clinical material (Kantrowitz, 2004). …”

“…However, as pointed out by Kantrowitz (2004), two major problems exist with regard to informed consent. First, truly informed consent can't ever be obtained, because it is always given under the influence of the transference between participant and researcher.…”

Case Studies and the Therapeutic Relationship

“…Among the many ethical considerations in publishing clinical cases are the following: (1) preserving confidentiality-that is, protecting the patient's right to privacy; (2) fulfilling the physician's pedagogical responsibilities; (3) adhering to the principle of nonmaleficence, which entails avoiding any action that may harm the patient; and (4) respecting the potential ownership rights of the patient to written material that pertains to his or her care [2].…”

“…publish what they learn from treating patients [1]. In publishing his case history of "Dora" in 1905, Freud took several steps to conceal the patient's identity; nevertheless, Dora's identity was eventually discovered.…”

Clinical Writing About Clients: Seeking Consent and Negotiating the Impact on Clients and Their Treatments

“…How the therapist-author ensures clients' confidentiality and considers the potential effect on clients and their treatment is currently under discussion (Aron, 2000;Gabbard, 2000;Kantrowitz, 2004aKantrowitz, , 2004bSmith, 1998). Currently, the debate in the field centers on whether to disguise clinical material or to obtain client consent (Aron, 2000;Gabbard, 2000;Smith, 1995;Stoller, 1988).…”