Confidentiality

by Charles Levin, Allannah Furlong, May Kay O'Neil

Linking general issues of privacy to the intimate details of psychotherapeutic encounter, this text should serve as a basic guide to a wide range of professionals, including lawyers, social scientists, philosophers and of course, psychotherapists, therapy patients, policy makers and the wider public will find it instructive to know more about the special protected conditions under which one can better come to know thyself.

Hardcover

First published July 1, 2003

Reviews

[Hanan AL-Raddadi · Rating 5 out of 5]

Confidentiality: Ethical Perspective and Clinical Dilemmas brings together a group of psychoanalysts and lawyers discuss ethical, clinical, and legal implications regarding confidentiality in a psychoanalytical setting. The book is divided into four sections. The first one begins with trying to explain why confidentiality is not merely an ethical or a legal concept, but an integral part of the of analytical process. Jonathan Lear, in the first chapter, writes beautifully about the patient’s need to construct his own narrative in private. He explores the importance of not disturbing the post-analytic period for the patient, the analysts’ need for recognition, and the questions that must be asked before writing or publishing case histories. Arnold Modell contributes with a compelling piece on the emotional significance of the private self , invoking Winnicott’s ideas of how the false self is protecting the true self. Charles Levin, still number 3 on my personal blacklist of analysts, seems to overvalue the analyst’s judgment at the expense of the patient’s. He argues that clinical materials should not be vetted by patients prior to publication, claiming that it helps advancement of psychoanalytical knowledge. Levin states that the problem of patients who finds themselves in their analyst’s publication is clearly in the existence of the analyst as a separate person with a separate life. His snobbery makes his chapter a difficult read.
The second section discusses confidentiality in psychoanalytic training and research. It is by far the most interesting section of the book. It includes a literature review and a discussion for the possible solutions to resolve the dilemma of confidentiality. For example, the claim that as long as patients remain unaware of the publication, they are not hurt by it. Or that informed consent at the beginning of the treatment will make the patients aware that absolute confidentiality is an illusion. The section also addresses the confidentiality of the psychoanalytic candidate. Is it threatened by training analysts? How do candidates learn explicitly or implicitly about discussing case histories in analytical courses and seminar? What records to keep or destroy once a practitioner retires?
The third section starts with a historical look of confidentiality during Freud’s time. It includes a personal account from a psychoanalyst who was asked to turn over her notes about a patient, and the ordeal that followed. A lawyer contributes a sad story about the “cascade of betrayals” often experienced by those whose confidentiality has been breached.
The final section discusses the legal and the professional ramifications of practicing psychoanalysis in North America including key landmark cases.
The book offers an engaging experience. It leaves the reader pondering the fate of confidentiality in the digital age, about the ethics of writing about deceased patients, and why some psychoanalysts change details in their case histories when republishing their work.