Response piece from a delegate at the symposium

Abstract

In this collection of papers, I feel we are privileged to hear how colleagues shape their internal flow of thoughts and ideas, based on clinical encounters, into something that can be expressed creatively in words and therefore shared in publication. With sensitivity and rigour, the authors engage with the question of how we might go about gaining informed consent and other important aspects of writing and publishing clinical material. Anagnostaki (2022) draws our attention to the importance of ‘trust’ in the psychoanalytic relationship with our patients and their families, and colleagues. This put me in mind of a parent I got to know very well, over several years, in a previous role working in a hospital school, before my clinical training, and whose nursery aged child I had imagined I’d like to write about one day. When I approached the parent about the possibility of gaining consent to publish, it was given with total compliance, verging on passivity. They agreed I could write whatever I liked about the child, now or in the future. As Anagnostaki asks in relation to ‘Jason’s’ family, was ‘agreement’ in fact a sort of denial? And if so, if it was a way of avoiding something, how can this be understood as ‘informed’ in any way? This concerned me. In my case, I had not asked the child how they felt about the idea of me writing about them one day. In retrospect, these events had undermined my own trust in my relationship to the family. My experience of trying to communicate my ambition to write about them posed questions in my mind about the power differentials between a professional and a family, who had become institutionalised, having been in hospital for months at a time, dependent on professionals. Whilst still working actively with a patient, Holloway (2022) suggests that one way of engaging our patients in the process of gaining informed consent and writing for publication is in the collaborative act of ‘co-writing’. This offers an opportunity for the experience to become an aspect of the therapeutic encounter. Yet, Holloway acknowledges that this will not always be appropriate, particularly within the context of abuse or serious psychotic illness. This reminded me of one of my own intensive training cases. I’d often had the thought, ‘what a brilliant case this would be to share with colleagues’, and yet I felt visceral unease about even entertaining the idea. ‘In whose interest would this be?’ I thought when probing deeper. There will be instances when we need to face the reality that not all patients’ stories can be told, for important clinical and ethical reasons. To get around these issues we may create composite cases.