Maintaining Patient-Analyst Boundaries in Psychoanalysis

"I don't know what to do about this because we do have to use clinical material. It's the best tried and true method in which to inculcate analytic thinking in our students and supervises. On the other hand, we are so indebted to our patients and their trust in us and our responsibilities as ethical practitioners not to divulge their privacy. Principles are what we're trying to teach, we're not trying to teach people, we are not trying to teach that person, the case is not what we are teaching, but the principles in the case." 

Episode Description: We begin by acknowledging the tension between our commitment to patient confidentiality and our need to learn, teach and advance our field through the sharing of intimate information. We discuss the difference between using clinical examples to reveal particular individuals as opposed to illustrating principles in psychoanalysis. Barbara describes the well-known case of a famous author whose analyst revealed identifiable details of his analysis in a publication. She shares why she feels that co-writing with one's analyst about one's treatment is problematic - "it stretches the concept of co-construction to a clinical breaking point." We consider how presenting a patient publicly impacts the analyst's interiority and lives on in the treatment. We close with recognizing the challenge of confidentiality and appreciating "the insuperable predicament posed by the mutually exclusive imperatives of protecting patient privacy and educating the next generation, as well as ourselves. Remembering that ego ideals are only approximations is our most effective balm."

Our Guest: Barbara Stimmel, PhD, is an adult and child psychoanalyst in New York city where she has practiced for the past several decades. She teaches and supervises widely and has contributed to psychoanalytic journals as well as editing and contributing chapters in several books. She has also presented papers, discussion groups and workshops in the wide world of psychoanalysis. She has held offices in psychoanalytic institutions on the local, national, and international level.  Barbara is involved at Mt. Sinai Medical Center in New York, where she sits on committees, has taught residents, and serves on the Palliative Care team.  She is on the President’s Council of Sanctuary for Families, an organization devoted to women and families surviving domestic violence and trafficking. She also sits on the Shakespeare Council of The Public Theatre in New York.  This diversity of interests is reflected in the variety of topics within psychoanalysis and psychotherapy about which she has written, presented, and taught.  In some sense, confidentiality is part and parcel of any clinical topic, regardless of theory and patient population.

Recommended Readings:

Crastnopol, M. (1999). The analyst's professional self as a third influence on the dyad: When the analyst writes about the treatment. Psychoanalytic Dialogues,  9,  445-470.

Gabbard, G. O. (1997). Case histories and ««confidentiality»». International Journal of Psycho-Analysis,  78,  820-821.

Gabbard, G. O. (2000). Disguise or consent? Problems and recommendations concerning the publication and presentation of clinical material. International Journal of Psychoanalysis,  81,  1071-1086.

Kantrowitz, J. L. (2004a). Writing about patients: I. Ways of protecting ««confidentiality»» and analysts' conflicts over choice of method. Journal of the American Psychoanalytic Association,  52,  69-99.

Kanwal, G. (2024) To Reveal or not to Reveal, That is the Wrong Question: Thoughts about Clinical Writing in Psychoanalysis. Psychoanalytic Quarterly 93:135-156.

Stein, M. H. (1988b). Writing about psychoanalysis: II. Analysts who write, patients who read. Journal of the American Psychoanalytic Association,  36,  393-408.

Stimmel, B. (2013). The Conundrum of Confidentiality.  Canadian Journal of Psychoanalysis,21(1):84-106