Disguise or consent. Problems and recommendations concerning the publication and presentation of clinical material

The author argues that the use of clinical material for educational purposes or for publication presents the analyst with a conflict of interest between the protection of the patient's privacy and the educational and scientific needs of the field, and also that it places analysts in the position of using confidential patient material in the service of their own professional advancement. The strategies of dealing with this dilemma can be classified as follows: (1) thick disguise, (2) patient consent, (3) the process approach, (4) the use of composites and (5) the use of a colleague as author. Some of these options may, of course, be used in combination with one another. All of these methods have a place, and the author argues against a uniform approach. Each of these strategies is discussed in terms of its advantages and disadvantages. While no choice is without various risks, some guidelines are offered to assist analysts who wish to present or write about clinical cases.