Listed here are a number of position statements issued by The American Psychoanalytic Association (APsA) and endorsed by the New Center for Psychoanalysis (NCP). Each statement is carefully developed by an expert APsA Committee and reviewed by the organization's governing body. If you have questions about any of these position statements, please visit the American Psychoanalytic Association website.
- Crisis in Ukraine
- Condemning Texas Governor’s Attacks on Trans Children and Their Families
- Addressing Racism
- Physical Punishment
- Veterans Families
- Gays, Lesbians and Bisexuals in the Military
- Gay Marriage
- Patient Control of Computerized Records
- Veterans of the Iraq and Afghanistan War
- Essential Privacy Principles for Quality Health Care
- Gay and Lesbian Parenting
- Reparative Therapy
- Sexual Orientation, Gender Identity, and Civil Rights
The American Psychoanalytic Association (APsA) and the New Center for Psychoanalysis (NCP) condemn the use of physical punishment (corporal punishment) in the discipline of children and recommends alternative methods which enhance children's capacities to develop healthy emotional lives, tolerate frustration, regulate tensions, and behave in socially acceptable ways.
A Social Problem
Physical punishment is a serious public health problem in the United States, and it profoundly affects the mental health of children and the society in which we live. Studies show that over 60% of families use physical punishment to discipline children. Yet, the research shows that physical punishment is associated with an increase in delinquency, antisocial behavior, and aggression in children, and a decrease in the quality of the parent-child relationship, mental health, and the child's capacity to internalize socially acceptable behavior. Adults who have been subject to physical punishment as children are more likely to abuse their own child or spouse and to manifest criminal behavior
Spanking is a euphemism for hitting. One is not permitted to hit one's spouse or a stranger; these actions are considered domestic violence and/or assault. Nor should one be permitted to hit a smaller and even more vulnerable child. Hitting a child elicits precisely the feelings one does not want to generate in a child: distress, anger, fear, shame, and disgust. Studies show that children who are hit identify with the aggressor and are more likely to become hitters themselves, i.e., bullies and future abusers of their children and spouses. They tend to learn to use violent behavior as a way to deal with disputes.
Internationally, there is increasing consensus that physical punishment of children violates international human rights law. Significantly, 24 countries have prohibited physical punishment in all settings, including the home. Among these countries are Sweden, Germany, Spain, Greece, and Venezuela. More than 100 countries have banned physical punishment in the schools. The United States has not banned physical punishment, but approval of physical punishment in the United States has declined gradually and steadily over the past 40 years. The United States has signed, but not ratified, the United Nations Convention on the Rights of the Child (CRC), an international treaty which expressly prohibits all forms of physical or mental violence.
Effective alternatives to physical punishment exist to help children tolerate frustrations, regulate tension, behave in socially-acceptable ways, develop appropriate ethical and moral standards, and improve self-esteem. The New Center for Psychoanalysis and the American Psychoanalytic Association join other mental health and medical organizations in strongly condemning the use of physical punishment with children. The American Academy of Pediatrics concludes: "Corporal punishment is of limited effectiveness and has potentially deleterious side effects. The American Academy of Pediatrics recommends that parents be encouraged and assisted in the development of methods other than spanking for managing undesired behavior."
Defining Physical Punishment
Physical punishment has been defined as "the use of physical force with the intention of causing a child to experience bodily pain or discomfort so as to correct or punish the child's behavior". This includes: spanking, hitting, pinching, squeezing, paddling, whipping/whupping, swatting, smacking, slapping, washing a child's mouth with soap, making a child kneel on painful objects, and forcing a child to stand or sit in painful positions for long periods of time. Physical abuse can be characterized by "the infliction of physical injury as a result of punching, beating, kicking, biting, burning, shaking, or otherwise harming a child." Behaviors which cause pain but not physical injury are considered physical punishment, whereas behaviors which risk physical injury are termed physical abuse. Both physical punishment and physical abuse must be condemned. Alternatives exist which are more effective in enhancing the healthy development of children.
These suggested alternatives provide parents with greater understanding of their children's development; present strategies which can lead to less violent behavior in children and adults, and decrease the frustration and helplessness in parents which often lead to physical punishment.
- One of the most useful ways to achieve healthy child development is to promote words instead of actions. Increasing the child's capacity to put words to feelings and actions results in increased tension regulation, self-awareness, and thoughtful decision-making. This process is accomplished by:
- Talking and using words instead of actions – talk rather than hit. Talk with the child about what behaviors are acceptable or not, what is safe or dangerous, and why.
- Listening to the child – find out why he/she did or did not do something.
- Explaining your reasons – this will enhance the child's decision – making capacities.
- The word "discipline" comes from the Latin word for "teaching" or "learning." Children's behaviors have meaning, and behaviors are directly connected to inner feelings. Thus, discipline is a process which addresses behaviors and the feelings which cause them.
- Help the child label his or her feelings with words as early as possible. The nine inborn feelings (interest, enjoyment, surprise, distress, anger, fear, shame, disgust, and dissmell should be labeled with words. This will facilitate tension regulation and aid the transition to more mature ways of handling emotion.
- Reinforcement – rewards and praise – will enhance the child's self-esteem when appropriate standards are met. Reinforcement is more effective in obtaining long-term behavioral compliance than frightening and shaming punishments.
- Set a good example for the child. The child wants to be like the parents. Children identify with their parents, and they will put feelings and actions into words when they see their parents doing this. Who the parents are, and how they behave, will have a profound impact on the development of their children. Your child will follow your lead.
>The Inner Wars Come Home: The Traumatic Impact on Families and Children When Our Veterans Return
Approximately 1.4 million children have parents who are active military personnel and 1.6 million U.S. troops have been deployed to Iraq and Afghanistan since 2001. It has been estimated that at least one third or 500,000 troops will be in need of mental health services to address symptoms of depression, post traumatic stress disorder (PTSD), and traumatic brain injury (TBI).
Research has shown that these syndromes have significant negative impact on family relationships and on children in particular who are the most vulnerable. This vulnerability has been exacerbated by parents being deployed more than one time and in some cases when both parents have been deployed.
In addition to human costs, it is estimated that the societal cost (treatment and productivity) during a two year post-deployment period will range from $4.0 to $6.2 billion. These estimates do not include costs of mental health needs of children as they develop towards adulthood. A recent study funded by the National Institute of Mental Health showed that adult children of depressed parents have a much higher risk of mental and physical illness. Incidence of aggressive behavior, academic problems, and related symptoms in children can be expected to be very high due to the greater incidents of diagnosed and undiagnosed PTSD and TBI. Almost 50% of veterans in need of mental health services do not seek treatment which could create greater costs later on.
The New Center for Psychoanalysis and the American Psychoanalytic Association support the following actions to prevent a devastating public health crisis that could impact our children and families for generations to come:
- Greater public and private access and support for mental health services to veterans, their families and children.
- Guaranteed privacy (a foundation of effective treatment and patient right) with release of information only with patient's permission or legal compulsion).
- Preventative support services for children and families when a family member is deployed.
- Education of mental health students and providers about the long term effect of parental trauma on children.
- Support for public awareness and education through the media of the impact of depression, PTSD, and brain injuries not only on the veteran but on his or her family and children.
- Advocacy for any legislation that will support diagnosis, immediate, and longer term care for veterans, their children and families.
Gays, Lesbians and Bisexuals in the Military
The American Psychoanalytic Association (APsA) and the New Center for Psychoanalysis (NCP) oppose the military policy mandated by Title 10 of the United States Code (Section 654) which prohibits an individual's service in the military on the basis of sexual orientation. Section 654 bans openly gay, lesbian and bisexual individuals from serving in the military. NCP and APsaA strongly advocate that the United States Government overturn the current policy.
It is the position of APsaA and NCP that sexual orientation is not germane to any aspect of military effectiveness, including unit cohesion, morale, recruitment or retention. Empirical evidence, as well as comparative data from foreign militaries and domestic police and fire departments shows that when lesbians, gay men and bisexuals are allowed to serve openly there is no evidence of disruption. NCP and APsaA recognize and abhor the many detrimental effects the policy has had on individual service members, the military and the United States society since the enactment of Title 10 section 654 in 1994. Years of psychological research and experience have shown the extensive mental toll of keeping one's sexual orientation hidden. Mandating a ban on self disclosure of sexual orientation for personnel in uniform is thus unnecessarily harmful to their mental health and well being. It also creates ethical dilemmas for military mental health providers.
Personnel in uniform are currently at war and find the love and support of their families to be essential in supporting them in carrying out their missions. Under the current government policy, lesbian, gay and bisexual military members must be vigilant not to inadvertently disclose their sexual orientation. They are unable to contact their partners and loved ones openly via phone or e-mail when away from home for fear of being discovered. On military forms they cannot list their partners as "next of kin" when they are to be notified in an emergency. At such specific times of distress or emergency, these individuals are isolated and restricted from having equally unguarded and honest access to the support of their loved ones and families.
The U.S. military is capable of integrating members of groups historically excluded from its ranks, as demonstrated by its success in reducing both racial and gender discrimination. Where openly lesbian, gay and bisexual individuals have been allowed to serve in the U.S. Armed Forces there has been no evidence of disruption or loss of mission effectiveness. NCP and APsaA thus reaffirm their support for men and women in uniform and dedication to promoting their health and well-being. NCP and APsaA endorse the amelioration of the negative effects of the current law through the training and education of mental health professionals and the dissemination of scientific knowledge and professional expertise relevant to implementing this resolution.
This statement is part of NCP's and APsaA's strong ongoing commitment to removing the stigma of mental illness that has long been associated with homosexual, bisexual and transgender behavior and orientations; promoting the health and well-being of lesbian, gay, bisexual and transgender adults and youth; eliminating violence against lesbian, gay, bisexual and transgender armed service members; and working to ensure the equality of lesbian, gay, bisexual and transgender people, both as individuals and members of committed same-sex relationships, in such areas as employment, housing, public accommodation, licensing, parenting and access to legal benefits.
In 1997 the American Psychoanalytic Association (APsA) endorsed the following Marriage Resolution: "Because marriage is a basic human right and an individual personal choice, RESOLVED, the State should not interfere with same-gender couples who choose to marry and share fully and equally in the rights, responsibilities, and commitment of civil marriage."
The adoption of this resolution was a response to the passage of the federal Defense of Marriage Act, signed into law by President Clinton in September 1996. The Marriage Resolution was drafted and circulated by Lambda Legal, a gay/lesbian legal advocacy organization, and has been endorsed by hundreds of professional organizations and individuals.
Since APsaA's endorsement of Lambda Legal's Marriage Resolution, reactionary social and political groups across the country have taken aim not just at same-sex civil marriage, but also at same-sex unions. At this writing, 18 states have passed constitutional amendments banning same-sex marriage, and 27 states have enacted legal statutes defining marriage as between a man and a woman. Recognizing that this blatant discrimination is having a significant adverse impact on the psychological and social well-being and stability of gay and lesbian couples, their children and families, APsaA's CGLI and Executive Committee and the New Center for Psychoanalysis (NCP) think that at this moment in the political discourse of the United States, they have an ethical, moral and social responsibility to issue a more comprehensive statement about same-sex marriage.
Civil marriage provides a legal framework for the creation and dissolution of committed relationships; it socially sanctions a relationship, defining its legal rights, benefits and responsibilities. Marriage thus functions as stabilizing force. Government sanctioned discrimination against gay and lesbian couples denies them the 1.049 rights, benefits, and protections that, according to the General Accounting Office of the federal government, civil marriage confers in areas of health care, insurance, property, finances, and inheritance. Research is now emerging that outlines the benefits that accrue to married same-sex couple and their children. Discriminatory marriage laws adversely affect the children of same-sex couples. The APsaA has previously issued a position paper on same-sex adoption that was also ratified by NCP. Although some states now allow second parent adoptions, children of same-sex couples in most of the United States are not permitted to be adopted by their second parent and thus are more vulnerable than children of married parents. For example, health benefits may not be available to the child if the non-biological or non-adoptive parent is the only parent with health insurance. If relationship dissolution occurs, the non-biological or non-adoptive parent may lose parental rights, subjecting the child to potentially traumatizing loss, instability and financial insecurity. Further, socially sanctioned discrimination adds to the burdens of both the children of same-sex couples as well as gay and lesbian youth (who have higher rates of suicide attempts than heterosexual youth).
WHEREAS homosexuality is a normal variant of adult sexuality and,
WHEREAS gay men and lesbians possess the same potential and desire for sustained loving and lasting relationships as heterosexuals and,
WHEREAS same-sex couples are raising children and have the same potential and desire as heterosexual couples to love and parent children and,
WHEREAS existing marriage laws in the United States discriminate against same-sex couples and,
WHEREAS same-sex couples and their children are adversely affected by these discriminatory marriage laws and,
WHEREAS the milestone of marriage moves a couple and its children into full citizenship in American society and,
WHEREAS discriminatory marriage laws deprive gay and lesbian couples of over 1000 federal rights and benefits and,
WHEREAS the denial of such benefits has been demonstrated to have significant psychological and social impact on gay and lesbian couples and their families, and the converse, that research is now substantiating the benefit that accrues to married same-sex couples and their children
The American Psychoanalytic Association (APsA) and the New Center for Psychoanalysis (NCP) support the legal recognition of same-sex civil marriage with all the rights, benefits and responsibilities conferred by civil marriage, and opposes discrimination against same-sex couples, and the denial to same-sex couples these same rights, benefits and responsibilities.
Patient Control of Computerized Records
The American Psychoanalytic Association (APsA) and the New Center for Psychoanalysis (NCP) strongly support the rights of psychoanalytic and psychotherapy patients to restrict their personal health information (other than minimally necessary administrative data) from being entered, stored, used or disclosed in networked electronic record keeping systems.
Requiring patients to authorize or give consent for their personal health information to be entered into a networked electronic system, whether such information is derived from psychotherapy or psychoanalysis evaluation or treatment, should not be a condition for patients obtaining or of clinicians providing psychotherapy or psychoanalysis. Personal health information derived from psychotherapy or psychoanalysis evaluation or treatment may be entered into computerized electronic networks only if accompanied by the patient's non-coerced informed consent or authorization.
Rationale and Discussion
The intent of this position statement is to heighten members' awareness of, and develop a policy to minimize the potential negative impact of, networked electronic information systems on psychotherapy and psychoanalysis. This position statement aims to address this serious issue by establishing a policy that will enhance and preserve a robust patient privacy as a necessary cornerstone of effective and ethical psychodynamic psychotherapy and psychoanalysis.
Historically, APsA's ethical standards and advocacy efforts for medical record privacy are based on a fundamental premise: Effective psychotherapy and psychoanalysis depend on the patient's ability to openly communicate with his/her analyst or therapist about intimate personal issues, thoughts, memories and feelings. This requires trust, made possible by the patient's expectation of confidentiality. The latter was affirmed by the US Supreme Court in its landmark 1996 Jaffee v.Redmond decision ( Jaffee v. Redmond, 518 U.S. 1, 116 S.Ct. 1923 (1996), which recognized the importance of maintaining the psychotherapist-patient privilege as a necessary precondition for effective psychotherapy.
Networked computerized record systems that now exist within the health care system have an immense capacity to disperse private health information far beyond the patient's or treating professional's control, and there is evidence that these systems are not secure. Although the HIPAA Privacy Rule provides guidelines that cover uses and disclosures of personal health information, it was not intended to be a 'best practices standard,' was not intended to override more stringent state law privacy protections, does not include or recognize the psychotherapist-patient privilege as defined in Jaffee v.Redmond and was never intended to supplant standards of professional ethics. Damaging information may still fall into the hands of employers, private investigators, insurance data pools (affecting future insurability), law enforcement agencies without due process, and others who may abuse the information and harm the patient. Recent legislative proposals to establish a nation-wide electronic medical information network will further erode patient privacy, if enacted.
As has long been recognized in the U. S. Supreme Court's Jaffee v. Redmond decision, under conditions of eroded or uncertain privacy protection, patients will avoid or delay necessary care and the common good will suffer. Absent strong privacy protections, psychotherapy or psychoanalysis, if obtained at all, will be compromised and effective treatment will be significantly weakened if not impossible.
Implications for HIPAA (Health Insurance Portability and Accountability Act)
The HIPAA Privacy Rule has two provisions that relate to this position statement: 1. Under the Rule, patients have the "right to request restrictions" on the use/disclosure of their protected health information. Further, the Privacy Rule has been interpreted by the Department of Health and Human Services to provide that the covered entity that holds the information retains the discretion to decide whether information should be disclosed. APsaA and NCP strongly urge psychotherapists/psychoanalysts to discuss this issue with their patients, and abide by patients' request to keep information out of a networked electronic system. 2. Second, the Psychotherapy Notes provision of the Rule establishes heightened protection for such notes, provided they are kept separate from the rest of the general medical record. To ensure that psychotherapy notes are only disclosed in accordance with the patient's express authorization (some exceptions specified in the HIPAA rule apply), these notes should not be entered into a networked general medical record.
The American Psychoanalytic Association (APsA) and the New Center for Psychoanalysis (NCP) join with other mental health and medical professional organizations in strongly condemning the use of torture.
As organizations of psychoanalysts who have devoted their lives to helping people undo the effects of trauma in their lives, APsaA and NCP strongly protests all torture, including any governmentally administered and governmentally approved torture of people who are detained. Torture degrades those tortured and those torturing. The effects of that physical and moral degradation, we know, are transmitted to the families and offspring of both victims and perpetrators.
APsaA and NCP also strongly condemn the participation or oversight by any mental health or medical personnel in any and all aspects of torture. Such actions are contrary to the basic ethical principles fundamental to the helping professions.
Veterans of the Iraq and Afghanistan War
The American Psychoanalytic Association (APsA) and the New Center for Psychoanalysis (NCP) join with other mental health professional organizations to urge strong and comprehensive government and private support for the mental health treatment of returning veterans from the Iraq and Afghanistan wars, and their families. A recent study published in the Archives of Internal Medicine estimates that one third of all returning veterans are suffering from serious mental health and psychosocial disorders. Of those, 56% were diagnosed with more than one disorder including post traumatic stress disorder (PTSD), depression, and substance abuse. The highest rate of mental health problems was among veterans in the 18-24 year old range, often those most exposed to front line combat.
As organizations of over 3,000 psychoanalysts committed to helping those who have suffered psychological problems often related to trauma, APsaA and NCP believes any lack of acknowledgement and appropriate treatment of this critical mental health issue will have a devastating impact on our soldiers, their families, their children, and society at large. Psychoanalytic research on transgenerational transmission of trauma has shown that children of traumatized and depressed parents often develop serious psychological and behavioral problems themselves. APsaA and NCP support effective, comprehensive and well funded efforts to address this critical public health issue.
Essential Privacy Principles for Quality Health Care
The American Psychoanalytic Association (APsA) and the New Center for Psychoanalysis (NCP) are committed to protecting patient privacy in order to safeguard the privacy of our patients, to protecting our ethical standards, and to assuring a future for our profession. These Privacy Principles, essential for quality health care, are based on the Privacy Amendment to H.R. Bill 4157 which APsaA developed with Congressman Ed Markey and the ethics based medical privacy bill developed by APsaA. APsaA's legislative counsel, Jim Pyles, has developed the privacy principles based on: APsaA's ethics standards, the ethics based medical privacy bill APsaA developed, and the Privacy Amendment APsaA developed with Congressman Ed Markey.
Federal legislation should include at least the following basic principles to preserve the individuals' right to health information privacy.
Basic Privacy Principles for Quality Health Care
Federal legislation should include at least the following basic principles to preserve the individuals' right to health information privacy.
- Privacy provisions in federal legislation should recognize that individuals have a right to health information privacy.
- Individuals should be permitted to exercise their right to health information privacy by choosing whether or not to give their written or electronic informed consent for disclosures and re-disclosures of their identifiable health information, unless otherwise mandated by law.
- Individuals should be allowed to limit the disclosure of certain especially sensitive health information (such as mental health, genetic testing, HIV/AIDS, and drug and alcohol treatment information) to only designated practitioners or for specific purposes.
- The privacy protections should apply to any individual or entity that handles personal health information.
- The privacy protections should provide individuals with a right to obtain damages and other relief where a reasonable person would have known that a disclosure was improper.
- The privacy protections should require notification of actual or suspected privacy breaches to individuals whose privacy has been compromised.
- Nothing in the privacy protections should be construed as superseding, altering, or affecting (in whole or in part) any statute, regulation, order, or other interpretation in effect in any State or any standard of professional ethics that affords any person privacy and security protections greater than the privacy and security protections in federal law.
- Health information privileges recognized under federal and state law should not be supplanted or limited by federal law. Any disclosure of health information for the purposes of obtaining health insurance payment or coverage should not result a waiver of any privilege.
- The terms health information privacy, confidentiality and security should have the following meanings: Health information privacy should mean an individual's right to control the acquisition, uses, or disclosures of his or her identifiable health data.
Confidentiality should mean that those who receive personal health care information are obliged to respect the privacy interests of those to whom the data relate.
Security means the physical, technological, or administrative safeguards or tools used to protect identifiable health data from unwarranted access of disclosure.
Gay and Lesbian Parenting
The American Psychoanalytic Association (APsA) and the New Center for Psychoanalysis (NCP) support the position that the salient consideration in decisions about parenting, including conception, child rearing, adoption, visitation and custody is the best interest of the child.
Accumulated evidence suggests the best interest of the child requires attachment to committed, nurturing and competent parents. Evaluation of an individual or couple for these parental qualities should be determined without prejudice regarding sexual orientation. Gay and lesbian individuals and couples are capable of meeting the best interest of the child and should be afforded the same rights and should accept the same responsibilities as heterosexual parents.
With the adoption of this position statement, APsaA and NCP support research studies that further our understanding of the impact of both traditional and gay/lesbian parenting on a child's development.
The American Psychoanalytic Association (APsA) and the New Center for Psychoanalysis (NCP), amidst the crisis of violence in our country, take the following position:
- Although recent tragic shootings in schools, churches and community centers have brought the crisis of violence under intense public scrutiny, APsaA and NCP view this crisis as long-standing and occurring each day in our communities. Violence is a major public health issue. In depth studies of its roots are often neglected by experts and the media.
- Psychoanalytic treatment and research have shown that violent behavior is often rooted in childhood trauma connected to environmental factors such as poverty, child abuse and neglect. These factors cause early developmental problems in relationships. Biological factors must also be considered.
- Many forms of violent behavior are treatable and can be prevented with appropriate intervention.
- Because of the human potential for aggression, rage and loss of impulse control, the accessibility of guns in our country significantly contributes to the public health problem of violence, including homicide, suicide and mass murder.
- The impact of violence is extremely harmful to the lives, development and growth of our children thereby contributing to the cyclical nature of this critical social problem.
- That the psychological roots of violence in our communities cannot be seen in isolation to the violence being committed around the world in the form of war, genocide and ethnic cleansing often perpetrated by destructive but charismatic leaders.
- The American Psychoanalytic Association and New Center for Psychoanalysis, through their membership, public information, lobbying, educational programs, research, and liaison programs in our communities, are committed to working with other groups and experts to create viable solutions to the problem of violence in our country.
The American Psychoanalytic Association and the New Center for Psychoanalysis affirm the following positions:
Same-gender sexual orientation cannot be assumed to represent a deficit in personality development or the expression of psychopathology.
- As with any societal prejudice, anti-homosexual bias negatively affects mental health, contributing to an enduring sense of stigma and pervasive self-criticism in people of same-gender sexual orientation through the internalization of such prejudice.
- As in all psychoanalytic treatments, the goal of analysis with homosexual patients is understanding. Psychoanalytic technique does not encompass purposeful efforts to "convert" or "repair" an individual's sexual orientation. Such directed efforts are against fundamental principles of psychoanalytic treatment and often result in substantial psychological pain by reinforcing damaging internalized homophobic attitudes.
This document is based on ethical principles. The American Psychoanalytic Association and the New Center for Psychoanalysis endorse these principles for consideration by policymakers, legislative bodies, and third-party payers.
- The right to privacy in health care must be expressly recognized and protected.
- Confidentiality may be defined as an understanding between patient and analyst that the analyst will not disclose anything about the treatment to anyone else and will not take any action outside the treatment situation based on what he or she hears inside the treatment situation. It is a fundamental right of the patient and a necessary condition for the viability of the treatment.
- Privacy and confidentiality are absolute preconditions for the responsible and effective conduct of psychoanalysis and psychoanalytic psychotherapy. As recognized by the United States Supreme Court in Jaffee v Redmond, "reason and experience" lead to the conclusion that protecting the confidentiality of communications between therapist and patient serves both the individual's private interests and the public good by fostering the provision of appropriate treatment. No patient in psychotherapy or psychoanalysis should be required to consent to the release of any information protected by the psychotherapist–patient privilege, either as a condition for receiving such treatment or as a precondition to insurance coverage of treatment that falls within the privilege.
- We strongly oppose the development and use of a unique, universal health identifier on a national or regional basis. We strongly oppose the mandatory reporting of treatment contacts to a national, regional, or local health care database and believe such reporting would diminish access and be incompatible with treatment.
- Privacy is the right of the patient, and confidentiality may be relinquished only with the patient's prior, non-coerced, informed consent. When such consent is obtained, the information released may be used only for designated, specific purposes with clear limits and with stated safeguards to prevent further dissemination. Release of information under these circumstances for a specific purpose should not require or be construed to imply waiver of the patient's total right to privacy and confidentiality.
- When a patient's right to privacy conflicts with needs external to the treatment relationship, such as administrative, research, or technical requirements, patient confidentiality and privacy must take precedence. The analyst should use all legal means to safeguard confidentiality.
- Clinical research is essential to the advance of mental as well as other health care and treatment. But without adequate safeguards for privacy and confidentiality, patients will not reveal and their caregivers will not record accurate information. This will be nowhere more evident than in the therapist/analyst–patient relationship. Any gathering of identifiable mental health information for research purposes without patient consent would jeopardize both an individual's rights and that individual's welfare, as well as pose a greater than "minimal risk" to the subject. In those rare instances where personally identifiable treatment information is essential to research, there must be valid patient consent, and privacy and confidentiality must be protected. Researchers should obtain a certificate of confidentiality. Researchers should not maintain identifying information in a database beyond the specific research project for which they obtained consent.
- Any and/or all settings in which clinical information is stored or maintained should have policies identifying those persons who may access that information and should have systems in place which restrict access to that information to such specifically authorized individuals. Patients have a right to know the identity of all persons and/or entities that have access to their clinical information; the identity of persons actually accessing such information should be recorded in approved logs. Identifiable information obtained during treatment encounters should not be entered into computer systems. Patients also have the right to know that information about them is being stored and the content.
- Law enforcement officials should not be permitted to access treatment records in the absence of a compelling concern for public health and safety. Such access should in no event be permitted without a court order and notice to the affected patient, issued upon a showing of good cause and specific evidence of the threat to public health and safety necessitating access and establishing the inability of law enforcement to obtain the information sought from other, non-privileged sources. Any such order shall be as narrow in scope and content as possible, shall describe the portion of the treatment record sought and the name and title of the requesting person and agency, and shall specify those persons authorized to view the records in question. No one should be allowed to view records within the scope of the court's order until the issuing court has ruled on any claims of privilege raised by the holder of the records. No seized records shall be disseminated or retained in law enforcement files for purposes other than those specified in the court order authorizing their seizure.
- The patient's treatment record will not be considered or used as a commodity in the marketplace and should not be made available for purchase or sale by any individual or entity.
Sexual Orientation, Gender Identity, and Civil Rights
The American Psychoanalytic Association and the New Center for Psychoanalysis oppose and deplore public or private discrimination against male and female homosexually oriented individuals.
It is the position of the American Psychoanalytic Association and the New Center for Psychoanalysis that our component institutes select candidates for training on the basis of their interest in psychoanalysis, talent, proper educational background, psychological integrity, analyzability and educability, and not on the basis of sexual orientation. It is expected that our component institutes will employ these standards for the selection of candidates for training and for the appointment of all grades of faculty including training and supervising analysts as well.