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ETHICS S CASE BOOK OF THE
A MERICAN
P SYCHOANALYTIC A SSOCIATION SECOND EDITION
EDITED
BY
P A U L A . D E WA L D , M . D . A N D R I T A W. C L A R K , M . D .
}
ETHICS CASE BOOK OF THE AMERICAN PSYCHOANALYTIC
ASSOCIATION
EDITED BY PAUL A. DEWALD, M.D. AND RITA W. CLARK, M.D. Associate Editors Subcommittee on Ethics Revision
S APsaA AMERICAN PSYCHOANALYTIC ASSOCIATION 309 East 49th Street New York, NY 10017
SUBCOMMITTEE ON ETHICS REVISION Marvin Margolis, M.D., Ph.D., Chair Katherine A. Brunkow, M.S.W. Murray T. Charlson, M.D. Glen O. Gabbard, M.D. Dorothy E. Holmes, Ph.D. Irving L. Humphrey, III., M.D. Jacob G. Jacobson, M.D. Margaret C. Keenan, M.D. Paulina F. Kernberg, M.D. Katherine Macvicar, M.D. Malkah T. Notman, M.D. Cynthia Rose, M.D. Bernard Rubin, M.D. Evangeline J. Spindler, M.D. Ernest Wallwork, Ph.D.
S Grateful acknowledgment is made to Frenkel & Company for its generous support of the publication of the Ethics Case Book. All rights reserved. Copyright © 2008 American Psychoanalytic Association Second Printing March 2002 Revision and Third Printing September 2005 Second Edition October 2007 This book may not be reproduced in whole or in part, in any form whatsoever, without permission. For information, address: American Psychoanalytic Association 309 East 49th Street • New York, NY 10017 Phone: 212-752-0450 • Email:
[email protected] • http://www.apsa.org/
ETHICS CASE BOOK OF THE AMERICAN PSYCHOANALYTIC
ASSOCIATION
THE PRINCIPLES AND STANDARDS OF ETHICS FOR PSYCHOANALYSIS (“PRINCIPLES”) OF THE AMERICAN PSYCHOANALYTIC ASSOCIATION EVOLVE OVER TIME TO REFLECT ONGOING RESEARCH AND STUDY IN THE FIELD AND THE IDENTIFICATION OF NEW AREAS OF CONCERN FOR MEMBERS AND THEIR PATIENTS.
THE VERSION OF THE PRINCIPLES IN THE FRONT OF THIS CASEBOOK WAS CURRENT AS OF 2007. FOR THE CURRENT VERSION OF THE PRINCIPLES, PLEASE VISIT http://www.apsa.org/
CONTENTS FOREWORD I.A PRINCIPLES AND STANDARDS OF ETHICS FOR PSYCHOANALYSTS* AND
i
I.B PROVISIONS FOR IMPLEMENTATION OF THE PRINCIPLES AND STANDARDS OF ETHICS FOR PSYCHOANALYSTS*
xvii
II. INTRODUCTION TO THE AMERICAN PSYCHOANALYTIC ASSOCIATION CASE BOOK ON ETHICS
xxxi
III. CASE VIGNETTES AND DISCUSSION OF ISSUES IN APPLYING PRINCIPLES OF ETHICS TO CLINICAL PRACTICE
1
A. PSYCHOANALYTIC COMPETENCE 1. 2. 3. 4. 5. 6. 7.
TEMPORARY ILLNESS PROGRESSIVE ILLNESS RECURRENT ILLNESS DYING AGING LIFE STRESS MAINTAINING COMPETENCE
*These revised Principles and Provisions were approved by the Executive Council and the Board on Professional Standards of The American Psychoanalytic Association in December 2000.
3 6 8 9 11 12 16
B. CONFIDENTIALITY 1. 2. 3. 4. 5. 6.
DUTY TO REPORT PATIENT PROTECTION SCIENTIFIC ISSUES LEGAL TESTIMONY EDUCATIONAL SETTING ANALYST’S PERSONAL ISSUES
23 27 29 31 34 37
C. AVOIDING EXPLOITATION 1. SEXUAL BOUNDARY ISSUES THE SEXUAL PREDATOR COUNTERTRANSFERENCE ENACTMENT THE “LOVE-SICK” ANALYST
44 46 48
2. NON-SEXUAL BOUNDARY ISSUES FEES PHYSICAL CONTACT CONFLICT OF INTEREST DUAL RELATIONSHIPS GIFTS SOLICITATION OF PATIENTS ABANDONMENT OF PATIENTS