The issue of confidentiality in Psychoanalysis

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Reilly, Declan
Issue Date
MA in Psychoanalytic Psychotherapy
Dublin Business School
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This paper begins with a rationale for why the issue of confidentiality in psychoanalysis is worthy of discussion. Before addressing the specifics of this issue in a modern context, a view is first taken of what confidentiality means, both in terms of definition and in historical terms. A myth or folktale is referred to in the opening chapter highlighting the antiquity and complexity of the nature of trust and betrayal. The beginnings of medical ethics in the Hippocratic oath and the church's sacrament of confession, introduce both rationality and religious justifications for keeping secrets. This leads to the modern era and the professional code of practice and the legal aspects of privilege. The assertion that confidentiality is relative in some areas while more absolute in others is discussed in relation to different professions and different legal jurisdictions. In particular, the growing trend in some areas for mandatory reporting laws to undermine the practice of psychoanalysis. This leads to difficulties in justifying absolute confidentiality in the face of the good of society. In light of such difficulties a look at ethical traditions is undertaken in order to discover the deeper principles at work in the governing of confidential material. A brief account and criticism of three ethical traditions are related to the issue of confidentiality. The final chapter deals with the ethics of psychoanalysis. Initially, classical psychoanalysis was taken in by traditional ethics. But later, a reminder came that the discovery of the unconscious brings into question the ethical traditions that have, until recently, dominated the profession. This questioning succeeds in restructuring the ethics of psychoanalysis. But the question remains as to how the issue of confidentiality is dealt with by psychoanalysis. The paper ends with a concluding section that attempts to tie together some of the more essential points in an effort to address the rationale that was established in the introduction.