The PANY Bulletin

Psychoanalytic Association of New York
Volume 42, #3 Fall 2004

Ethics in Sight
by Rita Clark, M.D.
"Conflict of Interest?"

Dr. Rich Maven has been a serious art collector for many years. He has worked with others to found an art museum in his city and has enriched the museum by donations of both art work and relatively small amounts of money. Because he works in patient care, by the hour, he is not as wealthy as many of the business people who are on the board of the museum but he is well respected and enjoys his participation in museum activities as a major part of his social life. A new patient comes to him referred by a colleague in another city. The man is a major corporate leader who comes from a dynasty of wealth. Both he and his family have acquired major artworks over the years and wherever they have lived, they have been eagerly sought out to join boards of major cultural institutions. When Dr. Maven attends a meeting at the museum he hears that the development committee has recruited his patient to join the board and they are anticipating much benefit to the organization in the form of monetary and art donations. He is stunned by their rapid action and wonders if he should bow out of his position at the museum both in the interests of good patient care in terms of avoiding a real relationship, and also in the interest of the museum since his patient will certainly be able to make major financial contributions, perhaps even paying for the new wing that is so badly needed. But he feels that he would then be deprived of a major source of his own pleasurable activity in his private life. What are the ethical issues and what should be done?
Discussion: Dr. Maven has been trained in the ideals of analytic anonymity so popular forty to fifty years ago and still an important concept today. He truly believes that he must try to avoid anything that will interfere with the development of a transference neurosis as he understands it. So does that mean that he must sacrifice his interest in an activity with the beloved museum he has helped to found? There is a double whammy here. He wants to avoid "contaminating" the transference and at the same time he wants to see the new wing become a reality which is not within his personal means. So he should fade away, right? He should terminate his role as a trustee, making some excuses as best he can. What is wrong with this picture?
Dr. Maven is making all the decisions here. In doing so he is taking on an omnipotent role as the sole guardian of the analysis. He is not even considering the possibility that he could work this out with the analysand and perhaps considering all of the different factors involved and how they are impacted by the patient's life experiences, that this process might be incorporated productively into the analytic process. This could be productive analytic material, if not suppressed by Dr. Maven's wish to keep the analysis "pure" and free of outside influences. While it is ethical to avoid dual roles with patients, this sometimes cannot be avoided and must be used in the analysis. What are some other options? Perhaps he should have avoided taking on this patient knowing that there was the possibility of a dual relationship. Or, having started the analysis, perhaps he should refer the patient to someone else. Is this disruption the best way to ensure the protection of the analytic process? What about the situation of training analysts and candidates where there are unavoidable dual roles and could be conflict of interests? How is this to be addressed? Should all candidates go far away for a few years to be analyzed by people with whom they have no other contacts? If anyone proposed this idea they would be quickly told to get real. Analysis is conducted in the middle of life, not in some separate purified place. Dr. Maven and his patient can work this out together and both should learn a lot in the process.

Please send your responses to the Editor or to Dr. Clark directly.