Department of Educational Psychology, Counseling, and Special Education, Pennsylvania State University, University Park, PA 16802-3110, USA.
Psychotherapy (Chic). 2012 Mar;49(1):22-5. doi: 10.1037/a0026965.
The recommendations by Sieck (2011, Obtaining clinical writing informed consent versus using client disguise and recommendations for practice, Psychotherapy, 49, pp. 3-11.) are a helpful starting point for considering the ethical issues involved in the decision to seek or not to seek informed consent from clients before writing about them. Sieck makes a compelling case for the idea that there are circumstances in which the most ethical choice would be to engage in clinical writing about a client without seeking informed consent, but instead disguising the client's identity. The present response raises a number of questions not considered in the article by Sieck. First, how should one disguise a case? Moreover, how should one assess whether the disguise is sufficient to preserve confidentiality while not distorting the clinical material to the point that the material is no longer useful to the field? Second, how can we estimate the likelihood of clients reading clinical writing, particularly in the age of the Internet? Given that psychologist-authored blogs that include reference to clinical material are beginning to emerge, it is crucial that we engage in a much deeper dialogue about the ethics of clinical writing. Third, how does the presentation of clinical material influence public perceptions of psychotherapy and confidentiality? If these public perceptions, in turn, could influence the likelihood of seeking psychotherapy, might these attitudes be important to consider in ethical thinking about clinical writing? Finally, where do we draw the line between clinical writing and single case study research (which requires informed consent)?
Sieck（2011）的建议是一个有用的起点，可用于考虑在撰写客户相关内容之前，决定是否寻求或不寻求客户知情同意所涉及的伦理问题。Sieck有力地提出了这样一种观点，即在某些情况下，最符合道德规范的选择是在不寻求客户同意的情况下进行临床写作，但要伪装客户的身份。本回应提出了 Sieck 的文章中没有考虑到的一些问题。首先，如何伪装一个案例？其次，如何评估伪装是否足以保护机密性，同时又不会扭曲临床材料，以至于材料对该领域不再有用？第三，我们如何估计客户阅读临床写作的可能性，特别是在互联网时代？鉴于开始出现包含临床材料参考的心理学家撰写的博客，我们必须就临床写作的伦理问题进行更深入的对话，这一点至关重要。第四，临床材料的呈现如何影响公众对心理治疗和保密性的看法？如果这些公众看法反过来又会影响寻求心理治疗的可能性，那么在考虑临床写作的伦理问题时，这些态度是否重要？最后，我们在哪里划定临床写作和单个案例研究（需要知情同意）之间的界限？
