The author discusses her experience in seeking consent from 16 patients to use clinical material for publication. Sharing narrative case examples from her practice, she elucidates her process with patients and focuses on the beneficial and detrimental effects on the therapeutic relationship. Seeking consent raises issues of confidentiality and stimulates wide-ranging, layered and linked emotions and meanings for patients, including feelings of closeness, envy, and shame, which in some cases may lead to treatment interruptions. If the analyst actively employs this process as a therapeutic tool, across time, with openness to unexpected meanings, it may advance the therapeutic conversation and developmental possibilities. When there is a negative effect on the patient or the process, analysts' shame and guilt may be invoked and consultation is recommended.