Is it Still Possible to Publish?

Dear Editor

Jane Polden's article ‘Publish and Be Damned’ (British Journal of Psychotherapy 14(3): 337-347) addresses an increasingly thorny problem in the healthcare field, and one that is particularly difficult for psychotherapists. The details omitted from physical medicine's case reports to guarantee a patient's anonymity are the very details of concern to the psychotherapist - the patient's unique personality. This echoes the philosophical difficulties in applying statistical methods to psychotherapeutic work, wherein a method that takes what is unique to every individual and disregards it is used to study a practice that selectively focuses on the very thing that is being disregarded.

Polden considers the dynamics of the current way of writing up case material for publication. The conclusion that one inevitably draws is that it is impossible. Many of the objections may be overcome by asking patients for consent, but this path is itself fraught with problems. When do you consult the patient? Anyone who has written a clinical paper knows that its conception is not easy, and a great deal of labour goes into producing it. Consent must then surely be obtained at the conception phase: but is the patient consulted again - and do they ultimately have a right of veto at the end? Indeed, should the model be one of (perhaps repeated) permission, or is there an alternative?

There may be greater scope for collaborative production of papers (such as with Mary Barnes and Joe Berke), where the patient is a co-creator of the narrative, and contributor to the theoretical points that are made. This collaboration might challenge the ‘paternalistic’ model, which seems implicit in Polden's article (since it reflects current practice), where it is the therapist alone who does the writing and determines the content. Methodologically, however, a change to a dyadic method could open up a new way of producing rigorous analytic theory, at the same time as elegantly solving many ethical prob