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Jerome Winer, Chair of the IPA Committee on Ethics, opened the panel with the statement: ‘Respect for the confidentiality of the patient's information and documents is the bedrock principle of the psychoanalytic profession’.
The first IPA Principles of Ethics were adopted 3 August 1998 by the Executive Council. These contained the following provision: psychoanalysts shall respect the confidentiality of their patients' information and documents, within the contours of applicable legal and professional standards (my italics).
In 2000, the IPA's Executive Council struck this limiting clause. The limiting provision and its deletion raise many issues which were presented and heatedly discussed during the panel's proceedings.
Romulo Lander was the only presenter who discussed the intrapsychic factors which may cause a ‘well-trained analyst to break the promise of confidentiality’ made to the patient. According to Lander, when the analyst is exposed to the effects of ‘chain signifiers’1 and ‘routinely’ identifies with the patient's material, he/she thereby places him/herself in ‘symmetry with the analysand’. This increases the analyst's anxiety, activates his/her ‘ideals and value judgment’ determining whether what he/she has introjected is ‘good or bad’. Such factors interfere with the correct flow of the analytic process.
According to Lacan , by whom Lander is greatly influenced, ‘symmetry’ exists in the analytic dyad. Only an extensive, indepth, thorough analysis can help to prevent it. It will also enable the analyst to work primarily in ‘asymmetry’. The analyst in this preferable mode can maintain free-floating attention, avoid identification with the analysand, have a non-judgemental stance and make appropriate analytic interventions.
Freud's concept of the Mystic Writing Pad is utilised by Lander as a metaphor to describe the analyst's capacity to ‘automatically erase’ the material of a previous session from his/her consciousness, keeping it in the ‘forgotten preconscio