SHOULD WE OR SHOULD-NOT WE - SOME ASPECTS OF THE CONFIDENTIALITY OF CLINICAL REPORTING AND DOSSIER ACCESS

In this paper, reservations are expressed about two deviations from an alytic neutrality. when the analyst seeks the patient's permission for publication or presentation of clinical material and when the analyst allows the patient access to the dossier under access-of-information legislation. In the first case, concern centres mainly on the entangle ment of the patient in the therapist's sanctioned version of their wor k, an entanglement that might inhibit future revisions of the patient' s self-understanding In the second case, the analytic mental space, sy mbolised by the dossier, is viewed as neither uniquely the analyst's n or the patient's, a complex dialectical chamber the privacy of which m ust be respected, even by the patient whose discourse contributes to i t, in order for it to function effectively. Transparency and accountab ility in the analytic context reveal a paradox that is not exclusive t o it: the possibility of full disclosure runs counter to the expressio n of subjective truth. In a clinical example, curiosity about the doss ier is seen to have been a new version of an earlier thwarted question ing about origins and identity. A specific deficiency in the therapist 's understanding may have contributed to the patient's enactment.