Who Owns the Countertransference?

A recent series of articles published in the Journal of Clinical Ethics (Harvard Ethics Consortium 2003) presents a published case study of a patient in psychotherapy, along with the responses of a number of readers, including a response from the patient himself.1 The basic point of these essays has to do with the patient's consent for the publication of his case and the repercussions that ensued from his reading about himself from his psychiatrist's point of view. The latter report included a good deal of the psychiatrist's feelings about treating this patient, feelings that he had not previously shared with his patient and that turned out to be quite hurtful to the patient. Although the patient had given his consent to have his case published, this consent had been agreed to long before the case was written up, and indeed, the patient hardly remembered that moment of agreement until presented with the finished product.

The Journal includes essays by both the psychiatrist and the patient, with discussions by a number of ethicists who themselves seem quite committed to the dual task of allowing a patient to read what is said about him or her, while ensuring that such a reading will not be harmful or injurious to the patient. Most readers will probably conclude that the delicate effort at a balance to the problem has not resulted in a happy solution.