Thoughts on the Confidential Fabric of Psychoanalytic Writing

… writing with the knowledge that I don't have to appear produces a space of absolute creative freedom. It's a corner of my own that I intend to defend, now that I've tried it. If I were deprived of it, I would feel abruptly impoverished …

It was probably twenty-five years ago, as a young and inexperienced clinician, that I presented my first case to a group of clinicians. I was working with a fairly psychotic patient three times a week in an outpatient setting. It would be generous to say that I was “out of my league”—while I was able to keep the patient in treatment, my capacity to contain and work with this patient's material was sorely tested. At that time, I came across a book that contained numerous case examples. I discovered that the writer's voice in the case material was different from other case material (albeit limited) that I had come across. It did not offer solutions to dilemmas or instruct on technique but, rather, descriptively and definitively spoke to moments in the analytic experience of two people talking together.

As with the patient who talks about the incredible restaurant they visited without revealing the establishment's name, I am keenly aware and conflicted as to whether to “go public” with the name of the book and the author. To reveal by identifying and naming this “private” experience into the collective conversation would not only be a breach of confidentiality but also a distraction. Whether to reveal identifying information from a private interaction into the public domain is at the heart of the issue of confidentiality in psychoanalytic writing. Confidentiality appears to have its origins in the word confidence (Latin confidenti) and, so, confidentiality is rooted in our feelings of trust, faith, and belief. This trust and faith extends into patient and analyst, the story they have created, and whether it is worth retelling in the public domain.

I was fortunate that the author of this particular vol