The onus on therapists to seek the consent of their patients before publishing clinical material may be one reason why so few decide to write about their experience. There are inevitable and unavoidable tensions in balancing the duty of care to patients with other ethical responsibilities, including the needs of the professional community for education and scientific advancement. In this paper, we explore the context and dynamics of seeking consent from couples and families to publish material relating to their therapy and propose a way to manage some of the ethical dilemmas involved in writing about patients that is in keeping with the contemporary analytic literature on the interpersonal unconscious between patient and therapist, and the interpsychic/interpersonal dimensions of therapeutic action. Throughout this paper, the term “patient” is used to designate couples and families as well as individuals.