During my training as a psychoanalyst, candidates and analysts have talked earnestly about ways to engage our lay community and professional peers in an era where branding and marketing have become primary forms of communication. We struggle with wanting to demonstrate what we do and how our treatment effects change, without revealing details of our work that might place patient confidentiality at risk. We also want to be able to refer and recommend psychoanalysis, where appropriate, and find ways to reach colleagues in locations remote from our own. For these reasons, I was delighted to be invited to a professional conference, traditionally heavily focused on psychopharmacology, to present psychoanalytic case material to fellow psychiatrists. This seemed an ideal format to teach what we do, hear feedback from other psychiatrists, and to gauge the interest in and acceptance of our work.
What my co-presenters and I had not realized, however, was that we would also be asked to sign a consent form that included a request to have our materials recorded by a third-party vendor for potentially wider dissemination, marketing, or sale. In fact, we were asked to sign and return a two-page agreement “by close of business day,” which meant most of us simply skimmed and signed it. On closer review, I was surprised to learn that by agreeing to be recorded, our material might be “captured … delivered in various formats … not limited to purchase online, on a USB drive, the Internet …” While this may be innocuous where generalizable pharmacology data is concerned, it raises significant risks for breaches of confidentiality if therapeutic case material, however well disguised, were to be shared with a wider, unknown audience.
The purpose of our conference panel was to elicit a discussion about how we listen to and may come to understand our patients and our relationships with them through the process of psychoanalysis. The material I offered included narratives enacted in two young children’s play sessions that theoretically only they might recognize and had no factual relationship to the patients. But the risk remains that a patient might recognize his play, his dream, his fantasy. And for that reason, any accidental discovery of the material now or in the distant future, could potentially break trust in confidentiality and our work.
As a member of APsaA’s Committee on Confidentiality, I have posted regularly on the need to judiciously protect patient identities and personal information in email and on listservs. Similarly, APsaA maintains guidelines for presentations we sponsor, balancing the need for clinicians to share and learn from one another’s work with the imperative to protect patients’ identities. However, other institutes and organizations may have differing thresholds and practices, and it is up to each individual clinician to carefully assess the confidentiality safeguards around work we present.
In my situation, a quick call to the conference coordinators assured us that, at our specific request, we would not be recorded. On the day of our presentation, the room was packed, and we enjoyed several hours of enthusiastic conversation about psychoanalysis and its clinical application with predominantly non-analyst psychiatrists from across the country. It was a wonderful opportunity to share our work. But such collaboration does require proactive attention to the novel environments we may enter, and steps to ensure safeguards will meet the particular confidentiality needs of psychoanalysis. You may be recorded. Don’t inadvertently sign away confidentiality.