Thirty American psychoanalysts who have published articles using clinical material from their patients were interviewed about their method for ensuring confidentiality. Almost twice as many analysts chose to disguise material (15) as regularly requested permission for the use of patients' material (8). The other analysts in the sample varied their approach, depending on circumstances, between using disguise alone and using disguise but also requesting consent. Methods of disguise, the timing of request for permission in relation to the phase of analysis, and changes in analysts' ideas about the benefits and detrimental effects of these choices are discussed and illustrated. Each decision is reconsidered in light of its potential effect on patients and their analysis. The dilemma posed by the importance of writing about patients for the health and growth of psychoanalysis as a field and the potential negative consequences for patients and their analyses is considered.