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Wilson, M. Harasemovitch, J.C. (2004). On Confidentiality. Fort Da, 10(2):39-53.

(2004). Fort Da, 10(2):39-53

On Confidentiality

Mitchell Wilson, M.D. and In Conversation with Jeanne C. Harasemovitch, LCSW

Mitchell Wilson is a member of the San Francisco Psychoanalytic Institute and Society. His paper, “The Analyst's Desire and the Problem of Narcissistic Resistances,” won the Heinz Hartmann Award and the JAPA Journal Prize in 2003. We invited Dr. Wilson to join fort da in a dialogue on confidentiality and sent him a list of questions in advance, which included the topics of disguise, informed consent, the use of composites, and the analyst who writes.i

JH: Perhaps we can begin with the overarching question that I posed to you: How do we navigate the tension between protecting a patient's privacy and the analytic relationship, and our need to maintain the quality and depth of clinical reporting necessary for our development and the development of our profession?

MW: What I ended up thinking about that question is not entirely consistent with what I've done so far, but it's somewhat consistent. I think that the reality of clinical reporting in our journals is that it's meant to persuade, that it's fundamentally rhetorical. At best, it's meant to illustrate one or a number of points that the author is trying to make. So, I don't think that “verbatim” or “accurate” reporting—in terms of it being exactly the way it was clinically in the consulting room, even if one were taking pretty close to verbatim notes—is essential to transmit key ideas that other people can learn from. Now, even with saying that, there's part of me that does privilege the verbatim, precisely the verbatim, especially dreams. I tend to report dreams, and I like to report them unabridged. But, that's actually in contradiction to my overall feeling and judgment that what we report in terms of clinical cases is meant to persuade the reader. There's another reason why I say it's fundamentally about persuasion, and that's because there is nothing veridical or valid in a scientific sense about a single case.

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