The International Psychoanalytical Association has functioned without a definitive ethics code since its founding in 1910. On August 3, 1998, in London, the Executive Council of the IPA unanimously approved the principles of ethics for IPA members submitted by the nineteen-member Committee on Ethics after twelve months of intensive work. This document is now part of the official IPA procedural code.
As part of the reorganization taking place under the presidency of Otto Kernberg, the newly appointed Committee on Ethics began its work in Barcelona in the summer of 1997. Its mandate included updating the draft ethics document carefully prepared by the previous committee in 1993, when Paulina Kernberg was chair. To accomplish the revision, the committee established a system for rapid communication between its members, mostly using e-mail and some faxing.
The committee's plans for the future include ongoing e-mail correspondence with a designated liaison person in each constituent organization. This correspondence will help clarify questions and issues about ethics that arise locally and add to the centralized body of pertinent information. Appropriate local elaborations of the ethics principles and the subsequent provisions for implementation are anticipated to be in place by the end of 1999 or earlier. To those familiar with the usual pace of change and innovation in psychoanalytic organizations, this would be lightning speed at modest cost.
After some months carefully considering the twenty-three-page 1993 draft and supervising the revision of the first half of it, I became convinced that a shorter and more general document would allow for greater flexibility to accommodate continually changing times and widely varying local conditions and norms. After decades of stasis, ethics (pertaining to professional conduct; morals refer to conduct in general) has become a rapidly evolving field. For example, not long ago, advertising by physicians was broadly considered to be unethical. Now newspapers and radio commercials contain all kinds of inducements to consult a board-certified or self-proclaimed expert for change of the body or the mind.
Certain principles, however, seem to be basic to the psychoanalyst profession, and it is these that we wished to elucidate. Because the IPA is a global organization, a number of details regarding ethics are viewed differently in different practice locales. It became clear to us that these details are best left to each constituent organization to include in its own local ethics principles and code. Local codes would have to be consistent with the broader code, however, which the committee chose to call “Principles of Ethics for Psychoanalysts.” These principles, as accepted and endorsed by the Executive Council of the IPA, represent the product of a long process of debate and discussion among a number of colleagues from each region. These colleagues are experienced in the formulation and implementation of ethics and ethical principles within their analytic societies.
Over the years, the APsaA has developed a relatively detailed document applicable to its institutes and societies. Although in the United States local professional norms seldom vary significantly, this is not the case with the international psychoanalytic community for which the IPA must articulate standards.
For example, in the United States the concept “once a patient's analyst, always a patient's analyst” holds true with regard to sexual involvement. In continental Europe, a two-year waiting period after a treatment is terminated is widely believed to be adequate for sexual involvement to be ethically permissible. As another example of local variability, in some areas of Latin America, some psychoanalytic groups have only recently begun active study of applicable ethical principles and procedures for their implementation. Situations have arisen where there is a local code but the constituent organization has been paralyzed by intense conflicts over alleged ethical violations by prominent members. In such a situation, the presence of a standing Ethics Committee at the level of the constituent organization serves to prevent or forestall the appointment of an ad hoc local committee to “hang” the alleged offender or, on the other hand, to attempt to whitewash the situation.
Given persistent local paralysis, however, the new IPA Ethics Committee has been charged with establishing mechanisms for direct expulsion from the IPA of a grievous offender after careful review of the facts. Provisions for establishing such procedures have been made in a proposed revision of the IPA constitution and by-laws that will be put to a mail ballot of all IPA members early in 1999.
IPA Counsel Thomas Asher, an attorney based in Massachusetts and Washington, D.C., has extensive experience with non-profit organizations and in international law and has been serving as an invaluable resource to the committee. Asher convincingly demonstrated circumstances that would have been significantly complicated by a number of clauses in early drafts. For example, in most of the United States, the Tarasoff decision imposes a duty to warn potential victims of a dangerous patient. Such a rule does not exist in other nations and probably would not have been agreed to by many colleagues, some of whom felt that confidentiality must override all other considerations. In another area, some Committee Members felt that public criticism of an analyst for the analyst's professional views should be considered unethical. It became clear, however, that it was impossible to prohibit criticism of one's colleagues without running into trouble regarding free speech. The Ethics Committee recognized that rules regarding solicitation of patients is a further example of the wide variations in practice from culture to culture. Consequently, the principles document remains silent on that issue. Any type of ethical surveillance or
Jerome A. Winer, M.D., chairs the IPA's Ethics Committee and is the director of the Chicago Institute for Psychoanalysis, where he is a training and supervising analyst. Editor of The Annual of Psychoanalysis, he is also a professor of psychiatry at the University of Illinois College of Medicine.
monitoring of ethical conduct of IPA members was considered anathema by committee members who live or have lived in countries where totalitarian regimes have flourished. Adequate local screening of those who wish to train as psychoanalysts was highly recommended, however.
The new “Principles of Ethics for Psychoanalysts” calls for each IPA constituent organization to be responsible for high ethical standards consistent with the new principles and to take reasonable measures ensuring that every psychoanalyst and each training facility maintains these standards. The document goes on to require that each constituent organization establish and make available to interested parties a written code of ethics. The new IPA principles thus serve to validate the protests of IPA members whose constituent organizations have been slow to attend to ethical violations and who have been insisting on local standards that are written and freely available to any person with a need to know. The requirement that constituent organizations have a written ethics code also stipulates that complaints be first referred to the local group unless it is a matter of great urgency or serious risk. Not only does this avoid costly IPA site visits and long delays, but it also allows those most familiar with local customs and practices to investigate complaints and to apply standards systematically.
A copy of the IPA “Principles of Ethics” is included here. It is now being circulated throughout the psychoanalytic world for further input from constituent organizations. TAP readers interested in responding to the text may contact any member of the Ethics Committee listed in the box on page 20. Respondents can also e-mail me at or write to me c/o the Department of Psychiatry (m/c913), University of Illinois at Chicago, 912 South Wood Street, Chicago, IL 60612. In formulating your response, please remember that these are guiding principles and that the provisions for implementation are still in the early stages of preparation.