Responsibility and Redress Revisited

Dear Editor

Carola Thorpe (BJP 18(1): 144-7) raises important issues about the unconscious dynamics in matters of confidentiality, and of a therapist's unfitness to practise. Using the Wynne Godley case she points out that he was in no position as a regressed patient to make sensible decisions about his analysis or analyst. This is a difficult, and perhaps common, problem associated with transference. Freud counselled his patients not to make important life decisions whilst in analysis. And therapists are counselled to beware of this kind of regression - which presumably Masud Khan did not heed.

When a therapist is so unethical or unprofessional as to be barred from membership of his organization, then what is the ethical responsibility of the organization? Carola Thorpe believes that the organization should inform patients of their therapist's debarment. This sounds harsh but in a way realistic.

However, some patients must be judged as incapable of making good decisions on the basis of reality, even when informed of it. Also I question Carola Thorpe's suggestion to compare the situation to when a therapist dies or becomes disabled? An abusive therapist is not dead and cannot easily be prevented from continuing his practice, in the way that death would prevent him! So, simply to inform patients might absolve the organization, but it does not fully address the problem, i.e. the patient's problem of his transference. Despite her integrity in facing and raising these issues, her solution may not be adequate.

Of course, it is hard to see what else could be done - other than requiring the debarred therapist to stop practice with his patients. However, once removed from his organization, the organization has no authority to stop the therapist. In this sense we are handicapped compared to the medical and nursing profession, where it is illegal to practise if removed from the statutory register (and also compared to psychotherapists in some other countries). It would seem this