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A ‘Clinical Conversation about Confidentiality’ between Lesley Mur din and Julian Stern was presented in Clinical Commentary XXXIV (BJP 21(4)). Dialogue was placed at the heart of that commentary, the conversational format reflecting the dialogue between those involved. It was conceived as a way of breaking out of the practitioners' isolation within the consulting room. This was part of a strategy to involve the reader more in the clinical commentary. So the Clinical Commentary Editors for the ‘Conversation’ were pleased that the following piece has arisen as a further contribution to the debate.
Sue Robinson
The recent publication in the Clinical Commentary series, ‘A Clinical Conversation about Confidentiality’, prompts this contribution to the debate. Using the concept of absolute confidentiality, advocated by Bollas and Sundelson in their book The New Informants (1995), I look at the arguments for this stance and then draw attention to difficulties and contradictions in taking this position. I end by making a plea for uncertainty and all the anxieties inherent in not having absolute answers to questions of ethics.
There is more agreement about the similarities of psychoanalysis with analytic psychotherapy than there is over what differentiates these ways of working. Use of the couch, number of sessions per week, depth of work, training of the practitioner; all these factors come into the picture. However, the concept of the unconscious as a way of thinking about the communications made by patients is particular to both and differentiates these practices from other therapies.