Ethical Considerations in the Writing of Psychoanalytic Case Histories

Abstract

An essential principle of psychoanalytic practice is the maintenance of strict confidentiality, and yet the presentation and publication of psychoanalytic case histories necessitate considerable public disclosure of the lives of our patients. Inasmuch as psychoanalysis is a particularly frequent, intensive, and lengthy process, a report of the unfolding of an analysis necessarily entails considerable revelation concerning patients, their inner worlds, and their life circumstances. This use of confidential material raises innumerable ethical concerns, and psychoanalysis, with its unique emphasis on unconscious mental processes, also adds to the complexity of ethical considerations by demanding that we take unconscious factors into account. When we speak, for example, of “informed consent” as an ethical principle, we as psychoanalytic clinicians must grapple with the problem of whether to take a patient's manifest acquiescence at face value. This article explores such ethical considerations along with other ethical and clinical complications in the presentation of analytic material for professional purposes.