On: Writing about patients III

Dear Sirs,

I welcome Judy L. Kantrowitz's contribution to your continuing exploration of this important subject (2004).

Kantrowitz includes comments from analysts on the refusal by patients to agree to publication of written material about the analysis (2004, pp. 696-7). She notes that in only one instance did the analyst elaborate his reflections and what he learned from the process (p. 697). Lipton (1991), cited by Kantrowitz, reviewed the then existing analytical literature on confidentiality, and noted the lack of comment on the difficulties involved in asking patients for permission to publish clinical material.

Elphis Christopher (2003), a UK-based Jungian analyst, has written a compelling account of her experience of seeking permission from a former patient to write about their work, some time after analytical psychotherapy with the patient had been concluded. What followed was an extended dialogue in which both parties relived painful aspects of the therapy. In the end, it was decided not to publish an account of the therapy itself.

Christopher concludes, ‘It might be questioned whether asking the patient's permission to publish … was worth the struggle and pain involved. Paradoxically, perhaps, I think that for this patient the answer is an affirmative one’ (p. 322).

However, that is only the therapist's view. The patient's view is not recorded.

What concerns me in such situations is that the dialogue about publication is generally initiated by the therapist—not out of a sense of what might be beneficial for the patient, but because therapists need to share information about their work.

The experience of Christopher and her patient reinforced this concern. I had considered asking a former patient of mine for permission to write about our work. I decided that my contacting him unexpectedly, with a request of this kind could undermine any sense of closure he had achieved through the ending we made—and that I would be doing this for reasons other than my understandin