On the Question of the Patient's Right to Tell and the Ethical Reality of Psychoanalysis

This paper calls into question the view that it is ethically legitimate for the patient to say whatever comes to his or her mind: that is, to adhere to the fundamental rule. While there have been some variations in the application of this rule since Freud's time, it remains for many the bedrock of clinical practice, and the patient's right to free-associate has never been questioned. Recent debates on the importance of the analyst's strict confidentiality have highlighted this right. Ethical problems raised by adherence to the fundamental rule are explored through an examination of the general ethical limitations on what one may say to another person, and the special features of the analytic relationship that seem to do away with these limitations. The fact that there are ethical questions about adherence to the fundamental rule draws attention to what the author calls the ethical reality of psychoanalysis. The recognition of this reality has implications for the understanding and handling of ethical dilemmas regarding disclosure, as well as for other ethical issues that may arise in the course of an analysis.