Anonymity

Anonymity

Many psychiatrists associate the principle of relative anonymity with Freud’s advice to psychoanalysts (Freud, 1912):

The doctor should be opaque to his patients and, like a mirror, should show them nothing but what is shown to him.

Freud argued that it was dangerous for psychoanalysts to expose their own mental problems or intimate life details in a spurious attempt to place themselves on an “equal footing” with patients (Freud, 1912, pp. 117–118). The merit of this recommen-dation extends beyond its origin in psychoanalytic technique to a fundamental boundary issue applicable to all forms of psychiatric treatment. It serves as a reminder to both patient and clinician of the professional purpose of the relationship. Avoiding unnec-essary personal disclosure to patients protects both patient and practitioner from a reversal of roles – one of the critical themes recurring in boundary violations in general (Peterson, 1992). Many patients experience excessive self-disclosure by the psychiatrist as seductive and it has been frequently observed to be a precursor to subsequent sexual involvement (Schoener and Gonsiorek, 1990, p. 403). By maintaining a policy of relative anonymity, the patient receives the following message about the treatment:

This is a place where I can bring my issues. The doctor doesn’t burden me with his/her stuff.

Certain forms of self-disclosure are indicated in the course of work with psychiatric patients, including appraising patients of the clinician’s qualifications and treatment methods as part of in-formed consent, discussing reality factors about the psychiatrist’s health status or intentions regarding retirement that will impact on the patient’s treatment decisions, and using “reality checks” to help patients contain disturbed and frightening fantasies.