Letters: On the Patient's Right to Tell

January 13, 2004. I would like to offer a few thoughts about Rachel Blass's “On the Patient's Right to Tell and the Ethical Reality of Psychoanalysis” (JAPA 51/4). In her paper, Blass examines the ethical limits of free association. She discusses specific circumstances that may require someone in a nonanalytic relationship to refrain from disclosing information for ethical reasons, as when the disclosure is “something that one was told in confidence” or “something that is harmful to another person” (p. ). She then explores whether these circumstances apply to patients in an analytic relationship.

Blass's discussion has important implications for training analyses. In a training analysis, both analyst and patient are members of an intimate community rife with opportunities to breach confidences and disclose potentially harmful information about other community members. Unlike other analytic dyads, the participants in a training analysis are members of a small community that fulfills professional, educational, and social functions. Moreover, power is not shared equally among all members but rather is distributed in a hierarchical fashion based on one's role in the analytic institute. Because of these unique features, the patient/analyst-in-training may discuss people whom the analyst not only knows, but with whom the analyst is personally and professionally involved, or over whom the analyst has influence. These may include the analyst's friends, colleagues, supervisees, analysands, and spouse.

Given the shared community of training analyst and patient/analyst-in-training, the patient's disclosures about members of their community may be hurtful to those members, or to the training analyst. For example, should the patient/analyst-in-training discuss experiences in class or in supervision that reflect negatively on the teacher or supervisor? Might this disclosure adversely affect the training analyst's opinion of the analyst being discussed? If the analyst about whom the