Rudnytsky: Response to Bernstein

Dear Stephen,

I am honored to have been invited to engage in dialogue with you, and indirectly also with Judy Kantrowitz and the wider analytic community. Her book certainly furnishes an important stimulus for questioning, and I like very much your notion of “deepening,” not simply

the treatment (Hall 1998), but the conversation about the treatment as well.

Part of your response addresses issues raised in our informal discussions rather than what I wrote in my original review, and space permits me here to touch on only a few points.

I do not dispute that everything in life is “ambiguous, contextual, and relative.” But this does not mean that all points of view on a phenomenon are equally valid.

I am struck by your statement that Roth was “betrayed” by his analyst. This is an ethical judgment. But what Kleinschmidt did in publishing his vignette was perfectly consistent with the mainstream position that analysts are not obliged to seek consent from their patients before using their clinical material in disguised form. Thus, if Kleinschmidt betrayed Roth, why should we not use the same word about other analysts who do the same thing?

To be sure, Kleinschmidt got into hot water when Roth discovered what he had done. Kantrowitz mentions several analysts who told her they had been sued by their patients under similar circumstances, though none successfully.

Analysts who favor a disguise-only policy are, of course, aware of the danger that their patients will read what they have written, especially in our age of the internet. When the patients are candidates or other mental health professionals, the risk is even greater.

But do we want to defend a policy that depends on not being caught for its justification? I find this troubling. I am also made uncomfortable by the implication that there should be a two-tier system consisting of “VIP patients” about whom it is considered inadvisable to write, because the risk of discovery is unacceptably high, and the regular folk who do no