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In this technological era it is rather easy to disseminate
information through email and listserves that reach thousands of people.
Further each person that receives an email can generate many more to
groups listed in their own listserves. This is perhaps the first time
in psychoanalytic history that information can reach such a large
readership. Apart from publishing dilemmas such as subscriptions and
copyrights, a serious problem that many organized lecture forums face is
confidentiality. There is general agreement that clinical case
reporting is the most significant way for psychoanalysts to learn from
each other. Most conference formats include several case presentations
in their main panel discussions. Psychoanalytic and psychotherapeutic
institutions have always been committed to the ethic of confidentiality.
In fact, our patients rely on us for that assurance. Although
conference planners may be relatively new to technological forms of
information dissemination, they now have the potent responsibility to
insure confidentiality for those patients discussed in conference case
presentation papers.
Following is a poignant example of a mishap that disrupted a solid
and previously fruitful treatment, rendering pain to both the analyst
and a long time, devoted patient. The following story briefly
illustrates the need for careful oversight in online publishing, a
burgeoning, and mostly beneficial, form of publishing. The story is
related by Dr. Andrew Morrison in response to a request from the IAPSP
online news editor for examples. He offered the example of a complex
supervision he had undertaken with a therapist in training. The
therapist is struggling to repair a deep rupture with a patient who felt
profoundly betrayed upon discovering an online presentation of his
analytic treatment attributed to his therapist. Morrison agreed to
share his experience as a supervisor, one who experienced his own
surprise and concerns generated by the online publication of his
supervisee's paper.
Interviewer: |
How did your supervisee discover that his
paper was published online? |
Morrison: |
His patient told him. He came in horrified
one day, wielding a copy of the paper in hand, letting him
know in piercing terms how betrayed he felt. |
Interviewer: |
How did he find it? |
Morrison: |
By googling his therapist out of curiosity,
only to discover a paper recently delivered in California. What began
as idle curiosity to learn anything he could find out about his analyst,
became instead—plastered on his computer screen—a paper about his
own treatment. Apparently, the supervisee discussed the presentation
with his patient, and had had his permission to present the paper.
However, neither the patient nor the analyst had given permission to
have it published online and so widely disseminated. What made matters
worse was that the discussions of the case were also published, allowing
the patient to read how the participating analysts viewed not only the
work of his own analyst, but also how they viewed him—his psyche and
his inner self. It was humiliating and devastating. |
Interviewer: |
Is it likely that the conference planners
said nothing regarding publication? |
Morrison: |
My supervisee had no recollection of signing
anything or giving permission to put this online. He later learned that
there had been a general announcement stating that if anyone would not
give permission they should make that known, that if the conference
planners did not hear from anyone it would be assumed that permission
was given to publish accepted papers online. If the therapist heard
this, he obviously didn't retain it.
This not only took me by surprise, it floored me. Over the past 25
years I have been presenting papers and have never had to consider the
possibility of a paper appearing anywhere without specific permission,
much less on a computer network. This hit me with enormous concern as to
how my supervisee could successfully repair this breach of trust with
his patient, especially since, in his patient's description, this was an
act of unthinkable betrayal.
It has taken months for them to repair this deep injury, and in fact,
to this day they are still working on it. What was an intense and
committed therapeutic experience has been reorganized into an effort
focused on restoring trust and confidence. Whether or not they can
regain a relationship that can resume a similar place in this patient's
developmental efforts only time will tell.
Who are the culprits here? I think no one in particular. Each
person and group did what they thought was the right thing. We are in a
new order of business here, and it behooves all of us who write and plan
scientific meetings to think more comprehensively about the pitfalls of
mass distribution of case material, particularly in cyberspace.
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Andrew Morrison, M.D., is Associate Clinical Professor of Psychiatry,
Harvard Medical School; Supervising Analyst and faculty, Massachusetts
Institute for Psychoanalysis; faculty, Boston Psychoanalytic Society and
Institute; author of five books, including Shame, the Underside of
Narcissism and Essential Papers on Narcissism; and has a
private practice in Cambridge, MA.
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