The PANY Bulletin

Psychoanalytic Association of New York
Volume 42, #2 Summer 2004

Ethics in Sight
by Rita Clark, M.D.
"Home Sweet Home"

Deciding to travel abroad for his vacation, an analyst asks a realtor to find a tenant for his vacation house. A patient is offered the house and brings this up during her sessions. She reports her thoughts and fantasies and the analyst listens and interprets. But she rents the house through the realtor and the analyst signs the contract figuring that "all is grist for the mill" and if he rejects her as a tenant it might reveal to the realtor that she is a patient and this would violate her confidentiality. Are there other options for the analyst?

We encourage you to send your responses to the ethical issues raised to Dr. Clark or to the Editor.

Response to Last "Ethics in Sight" column on the sleeping analyst:

The last column dealt with an analyst who fell asleep during a difficult hour with a patient. After a few days of nothing being mentioned, the analyst asked about the hour in question, leading to associations and the question from the patient, "Did you fall asleep?"

In her discussion, Dr. Clark wrote, "The analytic relationship is based on truthfulness, both of patient and analyst and this is an integral part of treating the patient with respect. It does not mean, however, that this question must be immediately answered. Another critical aspect of analysis is to facilitate the exploration of the patient's perceptions and fantasies. Putting off an answer may be in the best long term interests of the patient. It is assumed that the patient has been well educated about the process of analysis and that there is a working alliance. The patient's ability to ask the question directly should be considered as evidence of progress in treatment. Eventually the patient's perceptions will have to be validated by the analyst, along with an apology and possibly with an explanation. This should be carefully considered by the analyst as part of the self-analysis of what happened."

Dr. Sydney Pulver responded:
I read with interest your response to the 'falling asleep' question. I agree that the patient's perceptions will have to be validated by the analyst, along with an apology and possibly an explanation. But I disagree with your timing, as indicated by the qualifier 'eventually'. Given our patients' tremendously varied responses to most things, there may be some patients who can tolerate less than an immediate answer. But my own experience is that failure to answer such a question is almost always perceived as a narcissistic blow and a superego injunction not to ask questions, regardless of how tactful the analyst tries to go on with exploration after refraining from answering. Since it is almost impossible to pick out the few in which delay might be useful, and since hurtful effects occur in so many, I now make it a policy to immediately answer such questions as soon as they are asked, with, of course, exploration afterwards.

The standard injunction that answering questions blocks further fruitful associations seems to me to be based on old ideas of neutrality and anonymity. In fact, my freedom in answering is recognized by the patient and almost always leads to extensive associations and exploration, rather than the grudging blocking that seemed all too frequent in the days when I tried to explore the question first.

We encourage our readers to add their responses to this important intersection of ethics and technique.