Should We or Shouldn't We? Some Aspects of the Confidentiality of Clinical Reporting and Dossier Access

In this paper, reservations are expressed about two deviations from analytic neutrality: when the analyst seeks the patient's permission for publication or presentation of clinical material and when the analyst allows the patient access to the dossier under access-of-information legislation. In the first case, concern centres mainly on the entanglement of the patient in the therapist's sanctioned version of their work, an entanglement that might inhibit future revisions of the patient's self-understanding. In the second case, the analytic mental space, symbolised by the dossier, is viewed as neither uniquely the analyst's nor the patient's, a complex dialectical chamber the privacy of which must be respected, even by the patient whose discourse contributes to it, in order for it to function effectively. Transparency and accountability in the analytic context reveal a paradox that is not exclusive to it: the possibility of full disclosure runs counter to the expression of subjective truth. In a clinical example, curiosity about the dossier is seen to have been a new version of an earlier thwarted questioning about origins and identity. A specific deficiency in the therapist's understanding may have contributed to the patient's enactment.