The value of having ethical guidelines for psychoanalytic research seemed self-evident to the Committee on Scientific Activities. The fact that none existed suggested either that all the issues were too obvious or that the need had been overlooked. In any case, when the members of the committee, under the leadership of Alfred Stanton, set to work to prepare a guide for members of the American Psychoanalytic Association, it became quickly apparent that few of the issues were obvious and that the task was a formidable one. Thus, it is with a sense of accomplishment that the committee, now under the chairmanship of George Klumpner, can announce to the membership that after many revisions, a final draft has been completed. This report was approved by the Executive Council at the recent December meeting. It will be published in the Bulletin of the American Psychoanalytic Association.
Since legal cases involving research were being adjudicated through the courts, and bills that could affect psychoanalytic research were being introduced into legislatures, the committee concluded that individual members and the association as a whole might be on a more solid footing if we had a set of formal ethical standards. It became clear that, although psychoanalysts doing research would be our primary audience, the language used should be such that people outside our field could read and understand it.
Broadly speaking, some of the guidelines can be classified as timebound, while others are timeless. The former, owing to changing perceptions in values and technological and methodological advances, may require periodic updating. The latter are issues having their roots in the specific characteristics of psychoanalysis and in the patient-doctor relationship.
In establishing these guidelines, the committee considered three general types of research—research having to do with the content of the analysis, research having to do with the method used, and research applied to subjects other than patients and to other procedures (such as types of psychotherapy).
Three broad principles govern the ethical practice of clinical psychoanalysis and psychoanalytic research. The first is an ancient guideline for medicine: Primum non nocere. The second follows from the first: The research worker, like his clinical colleague, will never knowingly betray the patient's trust, and will under all circumstances respect confidentiality. The third principle is that the analyst must have the primary responsibility for dealing with the management and judgement of ethical issues in the conduct of psychoanalytic research.
The guidelines include a detailed discussion of the problem of reporting research material from a psychoanalysis. The analyst is ethically free to publish clinical records without the patient's knowledge provided their publication has no effect on the patient, his relatives or associates, and provided they reveal no confidential material relating to the patient. While the material from case studies can never be made unrecognizable in an absolute sense, appropriate disguise may be achieved by abstraction
or condensation procedures which omit large amounts of information that would identify the patient, but retain the essential point being illustrated. If the patient's material can reasonably be subject to recognition by any other person than the patient, the patient's agreement to its being published in its final form should be obtained prior to publication.
When there is some likelihood of only the patient's identifying the material, a more specific clinical decision is required. What would be the effect on the patient, good or bad, of hearing “accidentally” that material from his analysis had been used in a publication as compared with being approached with a request for the publication? In the committee's view,- experience suggests that in either instance the likelihood of benefit (in the sense of opening up new material for exploration) may be as great as the likelihood of damage to the analytic situation. Thus, each occurrence and its ethics should be decided on an individual basis.
The propriety of different methods of data collecting was discussed at length. While it is considered within the scope of accepted practice to take handwritten notes, electronic recordings for research purposes should not be conducted without the patient's knowledge and agreement. However, it was suggested that in time the commonplace usage of such equipment could lead to a change in the ethical standards under which this prohibition is now made.
One section of the guidelines deals with the analytic researcher's relationship with other medical and psychiatric societies and research institutions. Each of these organizations may have regulations governing ethical practices, and review boards to oversee research. Although he is often required to conduct research under the guidelines of other governing bodies, the research psychoanalyst cannot ethically substitute the responsibility of another board or reviewing group for his or her own responsibility.
Obtaining the patient's consent to conduct research places the research analyst in a ticklish position. When clinical psychoanalysis is significantly altered for research purposes, the effect on the analysis should be discussed and the patient's consent obtained. But how much discussion is needed and beneficial or minimally detrimental? And how should the consent be obtained? In psychoanalysis, patient consent is a process and not a single event. Transference responses place a constantly varying constraint on the analysand's grasp of information about alterations in the treatment.
Thus how the patient is informed and his consent obtained is an integral part of the therapeutic process and requires sensitive psychoanalytic work by the ethical careful researcher. The analyst may find himself pulled between the need to document the patient's consent to protect himself and his institution by meeting externally imposed requirements and the need to preserve an optimal therapeutic climate. The guidelines state that once the patient understands and agrees to the research, there is no ethical obligation derived from the practice of psychoanalysis requiring the investigator to obtain a written documentation of the patient's consent. While usually it will prove expedient and not too damaging to comply with mandated documentation of consent, in some cases requirements could make it dubious to conduct the research at all.
What is meant by an alteration in technique for research purposes? On the one hand, psychoanalysis consists of relatively well-defined procedures, accepted and understood internationally. On the other hand, just as Freud changed from a hypnotic to a free association technique, analysts are continually altering their technique (for example, there are variations in the frequency and duration of hours, the forms and applications of the basic rule, the use of electronic recording, and other even more radical ones.) Nonetheless there is some degree of variation beyond which a claim of practicing psychoanalysis is so misleading as to be unethical. This caveat excepted, controversial as many deviations may be, or appear to be, the guidelines state that the essential value of the experimental spirit in the development of psychoanalysis as a science overrides the danger which most creative efforts unavoidably bring with them.
Another area covered has to do with psychobiographic studies. The major ethical consideration here lies in the likelihood that irresponsible, poorly supported ideas about political or literary figures may bring psychoanalysis into disrepute. Although there are those who say they would never give an opinion about a person whom they have not examined, suggesting it is unethical to do so, the enrichment to psychoanalysis from the study of Dostoevski and Schreber, for example, point to the benefit of such efforts. In these and other enriching studies, the depth of the analyst's pursuit of the biographic background of the subjects under consideration, provide convincing scholarly warrant for the conclusions formed.
It is the hope of the Committee on Scientific Activities that these guidelines will provide a background for research in the field of psychoanalysis and a spur for a continuing discussion of our ethical standards.