A Gift in Return: The Clinical Use of Writing About a Patient

I have titled this paper “A Gift in Return” because I consider it to be a gift to the analyst when a patient grants permission for clinical material to be used in writing, presenting, and publishing, and because those instances in which the patient actually benefits from the analyst's writing strike me as an incidental repayment of the kindness.

I do not intend my message in this paper to be “Go forth and write about all your patients because it will do them good.” It may or may not. Writing about one's patients is a project full of responsibilities and fraught with risks. We cannot and ought not rely on any all-purpose assumptions about the positive or negative effects on our patients when we write about our work with them. I have chosen to relate two treatments in which the patients benefited dramatically from being written about because I thought it would be of interest to share that such things have occurred in practice. First, though, I review some of the hazards and problematics that must be kept in mind when we undertake to make use of clinical material in our writing.

First, we must remain sensitive to potential misuses of the power asymmetry in the analytic relationship. As we weight the choice of writing about a particular patient, at a particular point during or after the treatment, we need to juxtapose the relative benefits of reporting the clinical data to our colleagues with the relative costs to the patient or the therapeutic process. When we use clinical material for such