Clinical Commentary XXXIV

The situation of clinicians facing legal or procedural challenges is under researched in psychotherapy. Initial studies suggest that strong responses are engendered and that no matter how subtle or complex the material may have appeared in the consulting room, once it is the subject of legal process or institutional inquiry it rapidly becomes very concrete. Within organizations there is often acting out, even when there is not an actual complaint on the table. Those in the know may feel they stand as mute witnesses. In a fragmented profession like psychotherapy, it is not surprising that the scant existing research suggests that the personal experience of trying to understand and handle such issues can be a profoundly isolating one.

For these reasons dialogue has been placed at the heart of this commentary. Some time ago the joint editors, Sue Robinson and Jan Lee, began talking about the increasing threat posed to psychotherapy by litigation and complaints about practice and confidentiality. We asked two colleagues to hold a conversation on the subject of the exposure of clinical notes, as a way of furthering the discussion. Lesley Murdin (LM) and Julian Stern (JS) were selected because both have an interest in, and have published in the area of confidentiality and professional ethics. The dialogue theme was also reflected in the collaboration and conversations between the joint editors during the process of transcribing the conversation and preparing it for publication.

The rationale for this conversational format was also driven by the exigencies of the subject matter. In an area which is emergent and poorly understood, the illusion of relative certainty and closure fostered by authored comments seemed inappropriate. We saw value in using a conversation, in putting clinicians on the spot, as in professional practice and as in life. Hopefully, showing practitioners exploring uncertainty around questions that are potentially difficult and painful, and enabling reader