Blass Rachel B
Clinical Psychology Faction, Department of Psychology, Hebrew University of Jerusalem, Mount Scopus, Israel.
J Am Psychoanal Assoc. 2003 Fall;51(4):1283-304. doi: 10.1177/00030651030510040501.
This paper calls into question the view that it is ethically legitimate for the patient to say whatever comes to his or her mind: that is, to adhere to the fundamental rule. While there have been some variations in the application of this rule since Freud's time, it remains for many the bedrock of clinical practice, and the patient's right to free-associate has never been questioned. Recent debates on the importance of the analyst's strict confidentiality have highlighted this right. Ethical problems raised by adherence to the fundamental rule are explored through an examination of the general ethical limitations on what one may say to another person, and the special features of the analytic relationship that seem to do away with these limitations. The fact that there are ethical questions about adherence to the fundamental rule draws attention to what the author calls the ethical reality of psychoanalysis. The recognition of this reality has implications for the understanding and handling of ethical dilemmas regarding disclosure, as well as for other ethical issues that may arise in the course of an analysis.
本文对患者想到什么就说什么（即坚持基本规则）在伦理上是合理的这一观点提出了质疑。自弗洛伊德时代以来，虽然这一规则的应用存在一些变化，但它对许多人来说仍是临床实践的基石，患者自由联想的权利从未受到质疑。最近关于分析师严格保密重要性的辩论凸显了这一权利。通过审视对他人说话时一般的伦理限制以及分析关系中似乎消除这些限制的特殊特征，探讨了坚持基本规则所引发的伦理问题。关于坚持基本规则存在伦理问题这一事实，让人们注意到作者所称的精神分析的伦理现实。认识到这一现实对理解和处理与信息披露相关的伦理困境以及分析过程中可能出现的其他伦理问题都有影响。
