Collaborative Reading of Medical Records in Psychotherapy: A Feminist Psychoanalytic Proposal about Narrative and Empowerment

The authors explore the undertheorized question of sharing patients' medical records as part of the therapeutic process in psychoanalytic psychotherapies. They argue that, especially with more seriously disturbed patients and those with significant personality disorders, collaborative inspection of such records can strengthen the therapeutic alliance, increase mutual understanding of the patient's problems, support the patient's self-respect, and contribute to a sense of emancipation and personal empowerment. Feminist writing about the ethics of power relationships, attention to the possibilities for misuse of power in the psychoanalytic situation, clinical and anecdotal reports of the consequences of sharing medical records, and relevant empirical investigations are considered in the context of exploring numerous aspects of mutual attention to the patient's records, both current and past. Material from the treatment of a woman with borderline personality organization and a history of destructive enactments is presented in the context of theorizing the value of looking with patients at their medical files. The authors consider potential problems and limitations of collaborative record-reading and share recommendations about integrating that process with the goals of psychotherapy.