Psychoanalysis Ethical Standards and Practice 3 — Questions and Answers
Question 1: A psychoanalyst is invited to testify as an expert witness about a current patient in a custody dispute. What is the primary ethical concern?
- The disruption to the analyst's schedule
- The compromise of therapeutic confidentiality and the analytic relationship (Correct answer)
- The lack of forensic training in most analysts
- The potential for the analyst to be paid for testimony
Correct answer: The compromise of therapeutic confidentiality and the analytic relationship
Serving as both treating analyst and forensic witness creates an irreconcilable role conflict that compromises confidentiality and the therapeutic frame.
Question 2: In the context of psychoanalytic ethics, 'abstinence' most accurately refers to the analyst's obligation to:
- Refrain from sexual contact with patients
- Avoid satisfying the patient's transference wishes outside the analytic work (Correct answer)
- Abstain from self-disclosure in all circumstances
- Avoid discussing the analyst's personal theoretical orientation
Correct answer: Avoid satisfying the patient's transference wishes outside the analytic work
The rule of abstinence means the analyst refrains from gratifying the patient's transferential wishes so that those wishes remain available for analytic exploration.
Question 3: Which of the following represents an appropriate management of a patient who cannot afford the analyst's standard fee?
- Terminate treatment immediately and refer to a community mental health center
- Offer a reduced sliding-scale fee after clinical and ethical consideration (Correct answer)
- Continue treatment for free indefinitely to demonstrate beneficence
- Require the patient to pay the full fee and seek reimbursement through insurance
Correct answer: Offer a reduced sliding-scale fee after clinical and ethical consideration
A thoughtfully arranged reduced fee can be ethical and clinically sound, though the meaning of the fee arrangement should be explored analytically.
Question 4: An analyst encounters a former patient at a social gathering. The most appropriate response is to:
- Introduce the person to others using their professional relationship
- Greet the person warmly and engage in extended personal conversation
- Follow the former patient's lead regarding acknowledgment and privacy (Correct answer)
- Avoid the situation by leaving the gathering immediately
Correct answer: Follow the former patient's lead regarding acknowledgment and privacy
The former patient has the right to control whether the therapeutic relationship is disclosed in social settings, and the analyst should defer to the patient's lead.
Question 5: A psychoanalyst learns through a referral network that a colleague has had sexual contact with a former patient. The analyst's ethical obligation is to:
- Maintain confidentiality and take no action to avoid gossip
- Report the concern to the appropriate licensing board or ethics committee (Correct answer)
- Confront the colleague directly and demand they self-report
- Inform the harmed patient that they have grounds for a lawsuit
Correct answer: Report the concern to the appropriate licensing board or ethics committee
Ethical codes require analysts to address colleague misconduct through appropriate channels such as licensing boards or professional ethics committees.
Question 6: When treating adolescent patients, which complicates confidentiality most significantly?
- Adolescents are generally more talkative than adult patients
- Parents or guardians may have legal rights to treatment information (Correct answer)
- Adolescents tend to form stronger transferences more quickly
- Insurance companies require more detailed documentation for minors
Correct answer: Parents or guardians may have legal rights to treatment information
The legal rights of parents or guardians to access a minor's treatment records create tension with the clinical need for a confidential therapeutic space.
Question 7: According to the ethics of psychoanalytic practice, self-disclosure by the analyst is:
- Always prohibited as it violates the principle of anonymity
- Freely encouraged to build therapeutic alliance
- Used judiciously when it serves the patient's therapeutic goals (Correct answer)
- Required when the patient directly asks a personal question
Correct answer: Used judiciously when it serves the patient's therapeutic goals
Contemporary analytic ethics view selective self-disclosure as permissible when it clinically benefits the patient, not as a social norm or obligation.
Psychoanalysis Ethical Standards and Practice 3
A psychoanalyst is invited to testify as an expert witness about a current patient in a custody dispute.
What is the primary ethical concern?