On the Question of the Patient's rIght To Tell and the Ethical Reality of Psychoanalysis

Abstract

This paper calls into question the view that it is ethically legitimate for the patient to say whatever comes to his or her mind: that is, to adhere to the fundamental rule. While there have been some variations in the application of this rule since Freud's time, it remains for many the bedrock of clinical practice, and the patient's right to free-associate has never been questioned. Recent debates on the importance of the analyst's strict confidentiality have highlighted this right. Ethical problems raised by adherence to the fundamental rule are explored through an examination of the general ethical limitations on what one may say to another person, and the special features of the analytic relationship that seem to do away with these limitations. The fact that there are ethical questions about adherence to the fundamental rule draws attention to what the author calls the ethical reality of psychoanalysis. The recognition of this reality has implications for the understanding and handling of ethical dilemmas regarding disclosure, as well as for other ethical issues that may arise in the course of an analysis.

Get full access to this article

View all access options for this article.

References

Adler, E. , & Bachant, J.L. (1996). Free association and analytic neutrality: The basic structure of the psychoanalytic situation. Journal of the American Psychoanalytic Association 44:1021—1046.

Blass, R.B. (2001). On the ethical and evaluative nature of developmental models in psychoanalysis. Psychoanalytic Study of the Child 56:193—218.

Bok, S. ( 1983). Secrets: On the Ethics of Concealment and Revelation . New York: Vintage.

Bollas, C. (1999a). The Mystery of Things. New York: Routledge.

——— (1999b). On the loss of confidence in psychoanalysis. International Psychoanalysis: The Newsletter of the IPA 8:22—24.

——— & Sundelson, D. (1995). The New Informants. London : Karnac.

Busch, F. (1994). Some ambiguities in the method of free association and their implications for technique. Journal of the American Psychoanalytic Association 42:363—384.

Caruth, E.G. (1985). Secret bearer or secret barer? Countertransference and the gossiping therapist. Contemporary Psychoanalysis 21:548—561.

Epstein, G. (1976). A note on the semantic confusion in the fundamental rule of psychoanalysis. Journal of the Philadelphia Association for Psychoanalysis 3:54—57.

10.

Etchegoyen, R.H. (1991). The Fundamentals of Psychoanalytic Technique. London: Karnac.

11.

Freud, S. (1909). Notes upon a case of obsessional neurosis. Standard Edition 10:153—320.

12.

——— (1913). On beginning the treatment. Standard Edition 12:123—144.

13.

——— (1926). The question of lay analysis. Standard Edition 20:179—258.

14.

——— (1933). The question of a Weltanschauung. Standard Edition 22:158— 182.

15.

——— (1937). Analysis terminable and interminable. Standard Edition 23:209—253.

16.

Green, A. (2000). Central phobic position: A new formulation of free association. International Journal of Psychoanalysis 81:429—452.

17.

Grinberg, L. (1980). The closing phase of the psychoanalytic treatment of adults and the goals of psychoanalysis: The search for truth about one's self. International Journal of Psychoanalysis 61:25—37.

18.

Hartmann, H. (1939). Psycho-analysis and the concept of health. International Journal of Psychoanalysis 20:308—321.

19.

Hoyt, M.F. (1978). Secrets in psychotherapy: Theoretical and practical considerations. International Review of Psychoanalysis 5:231—241.

20.

Joseph, D.I. (1990). The fundamental rule: Its utilization in the conversion of psychoanalytic psychotherapy to psychoanalysis. Psychoanalytic Inquiry 10:88—106.

21.

Kanzer, M. (1972). Superego aspects of free association and the fundamental rule. Journal of the American Psychoanalytic Association 20:246—266.

22.

Kris, A.O. (1990). The analyst's stance and the method of free association . Psychoanalytic Study of the Child 45:25—41.

23.

Levinas, E. (1961). Totalité et infini. Hague: Martinus Nijhoff.

24.

Lichtenberg, J. , & Galler, F. (1987). The fundamental rule: A study of current usage . Journal of the American Psychoanalytic Association 35:47—76.

25.

Mahony, P. (1979). The boundaries of free association. Psychoanalysis and Contemporary Thought 2:151—198.

26.

Margolis, G.J. (1966). Secrecy and identity. International Journal of Psychoanalysis 47:517—522.

27.

Meissner, W.W. (2000). On analytic listening. Psychoanalytic Quarterly 69:317—368.

28.

Moore, B.E. , & Fine, B.D. (1990). Psychoanalytic Terms and Concepts. New Haven: Yale University Press.

29.

Ogden, T. (1997). Reverie and Interpretation. Northvale, NJ: Aronson.

30.

Racker, H. (1966). Ethics and psycho-analysis and the psycho-analysis of ethics. International Journal of Psychoanalysis 47:63—80.

31.

Sandler, J. & Dreher, A.U. (1996). What Do Psychoanalysts Want? London: Routledge.

32.

Schafer, R. (1976). A New Language for Psychoanalysis. New Haven: Yale University Press.

33.

——— (1983). The Analytic Attitude. New York: Basic Books.

34.

——— (1994). The practice of revisiting classics: An essay on Heinz Hartmann's Psychoanalysis and Moral Values. Psychoanalysis and Contemporary Thought 17:251—285.

35.

Seidenberg, H. (1971). Panel report: The basic rule: Free association—A reconsideration. Journal of the American Psychoanalytic Association 19:98—109.

36.

Spacal, S. (1990). Free association as a method of self-observation in relation to other methodological principles of psychoanalysis. Psychoanalytic Quarterly 59:420—436.

37.

Spruiell, V. (1989). Neglected classics: Twenty-nine years after Hartmann's Psychoanalysis and Moral Values. Psychoanalytic Quarterly 58:236— 240.

38.

Tyson, P. , & Morris, J.L. (1992). Panel report: Psychoanalysis and psychotherapy—Similarities and differences: Therapeutic technique. Journal of the American Psychoanalytic Association 40:211—221.