Ethical Considerations in Psychoanalytic Writing Revisited

Abstract

The author updates a previous survey (Aron, 2000) of clinical and ethical concerns in the presentation and publication of case histories. Recent professional and social developments provide patients with greater access to psychoanalytic writing and increase the complexity involved in the decision to publish case material. The author presents a series of vignettes culled from professional experience and psychoanalytic history, illustrating potential pitfalls in the publication of case material with and without patient consent. Although asking for informed consent may risk alienating a patient, a series of cases demonstrate the ways in which patients perceive the request as collaborative or benefit from reading the publication. Editorial guidelines from mainstream psychoanalytic journals are compared and analyzed relative to those of the International Committee of Medical Journal Editors. Summarizing a range of opinions from most conservative to radical, the author advocates for an individualized approach. He concludes with a series of ethical, educational, legal, and clinical considerations applicable from beginning student to advanced psychoanalyst. The author advocates that therapists presenting and publishing extended case histories seek consultation before proceeding, as our case presentations should be regarded as forms of participation in meaningful clinical enactments. The author emphasizes the urgency for psychoanalytic educators to raise these questions and concerns with students from the start of their clinical education.

Keywords:

• ethics
• writing
• case history
• informed consent
• confidentiality

Acknowledgments

My thanks to Benjamin A. Rubin, PsyD, for his skillful help in editing and revising this paper.

Notes

¹ The reader should consult my earlier article (Aron, 2000) for an examination of these fundamental questions.

² This is an excellent illustration of Freud’s early concept of nachträglichkeit, often translated as “afterwardness” or “deferred action,” where earlier memories are reworked in accordance with later experiences and circumstances. See Laplanche and Pontalis (1973).

Additional information

Notes on contributors

Lewis Aron

Lewis Aron, PhD, is the director of the New York University Postdoctoral Program in Psychotherapy and Psychoanalysis. He has served as president of the Division of Psychoanalysis (39) of the American Psychological Association, founding president of the International Association for Relational Psychoanalysis and Psychotherapy (IARPP), and founding president of the Division of Psychologist-Psychoanalysts of the New York State Psychological Association (NYSPA). He was one of the founders, and is an associate editor, of Psychoanalytic Dialogues and is the series editor of the Relational Perspectives Book Series (Routledge).