Writing about people you have treated
The ethics here are stricter than most trainees are taught, and disguise alone is not sufficient.
Psychotherapy’s entire literature of case material was built on writing about identifiable people, mostly without their consent, frequently without their knowledge. Freud’s "Dora" was eighteen and did not consent. The standard has changed, and the change is not negotiable.
The current position
- 1Obtain written, informed, specific consent from the person, wherever it is possible to do so. Journals in medicine and increasingly in psychology require a statement that consent was obtained, and many require sight of the form.
- 2Consent must be informed about the actual risk: that the material may be read by people who know them, that publication is effectively permanent and indexed, and that they cannot reliably withdraw it later.
- 3Consent obtained during treatment is complicated by the power asymmetry and by the patient’s wish to please you. Where possible, seek it after termination, and make refusal genuinely costless and explicitly so.
- 4Show the person what you have written before submission, and take their corrections seriously. Journals increasingly expect this and patients frequently identify things you did not realise were identifying.
- 5Where consent cannot be obtained — the person has died, cannot be traced, or lacks capacity — publication of identifiable material is generally not justified by the value of the case.
Three options, with their costs
| Approach | What it permits | What it costs |
|---|---|---|
| Consented individual case | Full clinical detail, verifiable, publishable under CARE | Requires consent; consent may be refused or withdrawn; power asymmetry complicates it |
| Composite case | Teaching without any individual’s exposure | Cannot be presented as an actual case; must be labelled as a composite; no evidential weight |
| Heavily disguised individual case | Detail without consent | Frequently inadequate; ethically contested; many journals now decline it |
Every case in Praxical.Psych is a composite, labelled as one, for exactly this reason. A composite has no evidential value and considerable teaching value, and it exposes nobody.
If the person consents, what should be in the write-up
- A statement that written informed consent was obtained, and from whom
- What identifying details were altered, in general terms — so the reader knows the account is disguised without knowing how
- The patient’s own perspective on the treatment, where they are willing to give it; the CARE guideline asks for this
- Anything the patient asked you to change or remove, if they are content for that to be noted
Sources
Gabbard, G. O. (2000). Disguise or consent: Problems and recommendations concerning the publication and presentation of clinical material. International Journal of Psychoanalysis, 81(6), 1071–1086
The standard reference, and it concludes that disguise alone is generally inadequate.
articleClifft, M. A. (1986). Writing about psychiatric patients: Guidelines for disguising case material. Bulletin of the Menninger Clinic, 50(6), 511–524
article