As a psychotherapist, writing about the very private experience of what happens in the consulting room is a rather strange endeavour. It feels like facing inwards and outwards at the same time, simultaneously being both highly introspective about the therapeutic process and highly public in trying to communicate this process to the reader. Confidentiality and privacy are so vital to the trust that the patient feels in the therapist that it is very difficult to write about therapeutic experience unless there is a great deal of thought about clinical ethics (McFarland Solomon and Twyman 2003).
There are a number of ways in which this difficult issue has been addressed in my past publications and in this book. Above all, I hope that should by any chance a patient, relative or friend of a patient recognise anyone in my writings, they will feel that I have described what took place between us in a humane and respectful manner. The only reason for writing about the therapeutic process is to add to the knowledge, understanding and necessary debates that must go on within psychoanalytic practice, if it is not to be accused of being secretive and not open to scrutiny.
Practically, I have thought carefully about the issue of confidentiality at the time of writing, on an individual basis for each of the children discussed in this book. As the papers span a period of 18 years, there has been dramatic change in general professional guidance about how to protect patients' confidentiality. The internet was only in highly restricted use when three of the papers were written in the mid to late 1980s. At that time, papers published in professional journals were likely to be in very limited circulation. There was of course still careful attention to disguise patients' identities, but there was certainly less likelihood that patients would come across these journals. The situation is entirely different now, and this presents our profession with major dilemmas, which are constantly under discussion (Gabbard 2000; Tuckett 2000).
The question of whether patients can give informed consent to their therapy being written about is particularly thorny and complicated when considering child patients, where it is the parents or carers who have to be consulted. Advantages and disadvantages of asking for patient consent are