Many years before I returned to Iran, during one of my supervision meetings, Bob Bergman stopped talking, looked at me and said: You never know, one day you might start the psychoanalysis training in your country!

 

Determining words sometimes do not attract much attention at the moment of being heard. I heard Bob’s words and continued my supervision meeting with him. Perhaps some time was needed so that this idea, tempting on the one hand, and far-fetched and weird on the other, sprouts from my mind’s soil, grows taller, and finally leads to establish a psychoanalysis training center.

 

I returned to Iran in the summer of 2011. I was away from the Iranian academic and scientific atmosphere for some years. I started over my career with giving presentations and lectures at the scientific centers, and after this, I was now getting familiar with a group of students and enthusiasts for learning and extending the knowledge of psychoanalysis. This familiarity paved the way for forming our first article reading group. On Thursday evenings in the summer of 2013 in Tehran, I along with ten people who wanted to immerse themselves in the articles and the amazing world of psychoanalysis started reading a series of psychoanalysis articles. The ten-person group became in fact the first group of the center we later named the Tehran Center for Psychoanalytical Studies (TCPS).

 

Consequently, almost every year a group joined the center, and a group of scholars based in the city of Mashhad was also added to the center in 2014, and the work was expanded more. We have been following a more structured psychoanalysis training in the center since 2017, and every year we have been accepting new applicants through interviews.

 

If it weren't for the support and collaboration of my dear friends and colleagues during these years, the dream that Bob Bergman planted in my mind on a fall day would never have come true. I had the privilege of being in the warm and fruitful company of the experts in psychoanalysis and analytical psychotherapy during my return to Iran. Actually, it was a stroke of luck that the formation of the first psychoanalytical study group held by the Psychiatric Association gave me; an association Dr. Mohammad Sanati and I were its scientific secretaries. Through this, I became acquainted with Dr. Afsaneh Ali Sobhani, Dr. Elahe Sagart, and then Dr. Soheila Kiani, and Dr. Seyed Hossein Mojtahedi. The addition of Dr. Hadi Rahimi Danesh also made the Tehran Center for Psychoanalytical Studies the product of diverse thoughts and perspectives, extensive, and rich. Undoubtedly, if they were not there, the center would never have reached where it is today. As I have aimed to provide an extensive range of theories and perspectives in the training section in the field of psychoanalysis, the main core of the faculty members of the center has made possible for us to reflect the very free and multidimensional world in our professional path which psychoanalysis has always followed in order for the human psychic development; somewhere beyond the stereotypical demarcations, it was the passion of mine and my colleagues at the Tehran Center for Psychoanalytical Studies for learning and teaching, and for hearing and being heard that led us forward at every step, and has been propelling us forward to the present.

 

The training at the Tehran Center for Psychoanalytical Studies includes three levels of basic, and advanced analytical psychotherapy, and psychoanalysis. The reason for choosing these three levels is that they are actually more aligned with the needs of the volunteers who refer to the center for training. At our center, we provide training for the candidates in accordance with the standard principles of the International Psychoanalytical Association (IPA) in three sections of theoretical training, supervision, and personal therapy, hoping that if Iran's path to the IPA is paved someday, our training infrastructure will be available to achieve this important goal.

 

I hope that the Tehran Center for Psychoanalytical Studies, which is still in its productive youthful years, with the support of its companions, both its faculty members and scholars, will continue to flourish, its branches will spread in the free sky of psychoanalytical ideas and theories, and its roots will grow deeper than ever before in the fertile soil of the minds and in the dynamic psyches with unquenchable thirst for learning.

 

 

Babak Roshanaei-Moghaddam

Founding member and director of Tehran Center for Psychoanalytical Studies

 

Fall 2021

Psychoanalysis: The Story of A Story

According to the definition of the International Psychoanalytical Association (IPA), psychoanalysis is a combination of clinical work, and a theory on the human psyche. This field focuses on studying and understanding the mechanisms of the human psyche, as well as treating disorders, in four main areas:

1. Psychoanalysis as an examination of the mechanism of the psyche
2. Psychoanalysis as a therapeutic method for solving psychological problems
3. Psychoanalysis as a method for research
4. Psychoanalysis as a way of looking at cultural and social phenomena such as literature, art, cinema, performing arts, and politics, and examining the dynamics of groups.

This official and concise definition of psychoanalysis raises the question of what psychoanalysis is and what a psychoanalyst is capable of doing.

Every new discovery in the objective and subjective world puts humans in a new position in relation to themselves and the world. They recall such a great discovery as Copernicus' discovery and reclaiming the centrality of the universe from the earth. But Charles Darwin also did the same, and perhaps his blow to human egoism was heavier than ever. Humans and monkeys were more alike than it was thought. Shortly after Darwin's revolutionary discovery, Freud arrived with a fresh blow: even at home, humans are not homeowners. This is the birthplace of psychoanalysis. In Vienna, at the end of the nineteenth century, there was a young neuroscientist with an ambition to extract meaning from the materials that were not taken seriously until then: dreams, slips of the tongue, forgetting names, seemingly normal fears, and of course jokes. In fact, Freud created a significant crack in the paradigm of his time and by returning to the mundane and everyday events, he tried to examine humans not in the museum of natural sciences and through numbers and measurements, but in the form of a real and involved subject struggling with life and death. In the initial stage, he divided the psyche into three parts: conscious, unconscious, and preconscious, and in the next stage, by introducing the id, ego, and superego, he changed the previous topographical view to a structural view and focused more on the drives that unconsciously lead humans towards satisfying their instinctual needs, applying increasingly the principle of pleasure, and serving the life drive or libido. But the end of the road was not like this. During Sigmund Freud's fruitful life, important events separated the world forever from the former childlike innocence. The bloody world wars and facing the vague desire of humans to repeat pain led Freud to new results in the late stages of his life and at the time of writing Beyond the Pleasure Principle. Death is meaning-giving and an important drive in life, and the compulsion to repeat, on behalf of the death drive, plays an essential role in mental life. Freud died in London, while Hitler attacked the remaining dream of human equality and brotherhood, and one would say the Jews in forced-labor camps were the representatives of the same repetition compulsion that still holds human beings; whatever it was, the paths ahead of humans in the nineteenth century were not enough to face a new reality that was coming. A new path had to be opened towards that unknown and dark land: what humans desire and what does it mean to be human? This seemingly simple question suggests that our proximity to our humanity has been an eternal obstacle to understanding what we are, what we want to be, and what we can be. Sigmund Freud left the world in the hot summer of 1939 in an alien country and among his family, leaving behind a legacy that gradually became one of the most important sources of knowledge and expansion of human knowledge boundaries. Psychoanalysis, which once began to sprout in the ambivalent hands of a young man, facing the illness of hysteria, was now a tree rooted like an oak: it only spread its shadow and had an unquenchable thirst to expand its scope further. Psychoanalysis was a questioning child, and as the poet Shamlou says, this snow persisted in its descent.

In one of his key articles, Freud compares the role of the patient in psychoanalytic therapy to that of a traveler sitting beside a window on a moving train, who must report and speak about everything in the landscapes passing by. In other words, they must surrender themselves to the free flow of associations or thoughts that come to their minds.

Although this was the beginning of psychoanalysis and with the arrival of each new perspective or school Freud's ideas have remained an undeniable pillar in the center of this large tent, today's psychoanalysis is not just about a traveler sitting under a train window or a chess player moving pieces in black and white squares. Today's psychoanalysis is a story that is created between two minds and two psyches, and the purpose is not just to search for a pre-existing meaning but also to create a shared meaning. Today's psychoanalysis is no longer merely about what has been repressed and shown to us as anxiety but it is also about creating meanings that have been experienced before but have been beyond the capacity of being accepted. Therefore, the therapy room and the analyst’s mind are not only a space to tolerate and embrace anxieties and fears but also a hand to bring about great and neglected possibilities in the patient.

Thus, today's psychoanalysis is a story about stories and a narrative about narratives. In fact, the goal is not just to discover what story we have lived or what story we have recorded but also to know why we have come up with such a story. What is the story of our story, and are there other stories waiting to happen on this amazing journey? Behind the clouds of possibility, what shining sun awaits us from the lives that have not been lived yet?

In the meaningful contrast between human commonalities and individual characteristics, overcoming the quench for discovering the universalities, psychoanalysis is now more eager than ever to understand individual stories. Instead of the age of three, how does this three-year-old child experience the world? Instead of the neurotic, how does this man or woman experience the world? And instead of reaching a grand narrative for all people, what do these short stories of each person tell us?

Joyce McDougall, quoting Henry Maddick, in her book Theatres of the Body, writes that “grief that has no vent in tears, makes other organs weep.”. In psychoanalysis, the effort is to listen to the story of each person's psyche before each body organ starts writing its own story separately. As the Poet Shamlou says, “before drowning in tears”, and before the person forgets his or her glorious role as a writer and fails to remember his or her narrative among the mass of everyday events. Perhaps we are not that traveler sitting on a moving train, but the switchman who wants to change the direction of many passengers or prevent a disaster by pressing a lever. Perhaps we are living someone else's life story without even knowing it, without even wanting it. Whatever we want and whatever we are capable of, “word” is our only asset: we must be before we will not be any longer, and psychoanalysis is the story of this being. A being that always triumphs over non-being; a being that is an eternal question in human hands. From the time of Hamlet by Shakespeare to the strange era we live in now. Psychoanalysis is born here, and a psychoanalyst is someone who thinks about this distance: the distance between to be and not to be and the distance between the story we live and the story we want to live.

Ethical Code for Psychoanalysts, Analytical Psychotherapists, and Candidates Psychoanalysts

What follows is a combination of the ethical codes of the International Psychoanalytical Association (IPA) and the American Psychoanalytic Association (APSA). In order to summarize the text and speech, we have tried to preserve the common points of both ethical codes as much as possible to create a cohesive set of items that are essential knowledge for professionals in the field of psychoanalysis, and we have added specific items from each ethical code to the overall text. Please note that the ethical code of the American Psychoanalytic Association includes two sections: general principles of ethics for psychoanalysts, and standards applicable to the principles of ethics for psychoanalysts, which have been combined in this final text for the convenience of readers. Due to the culture and society of psychoanalysis in Iran, some items have been added to or removed from them. Whenever the term psychoanalysis is used in the text, it also includes analytical psychotherapists and candidate psychoanalysts.

1. Competence:

• The psychoanalyst is committed to providing competent professional service. The psychoanalyst should continually strive to improve his or her knowledge and practical skills. Illnesses and personal problems that significantly impair the psychoanalyst’s performance of professional responsibilities should be acknowledged and addressed in an appropriate fashion as soon as recognized. In addition, psychoanalysts should strive to keep up to date with theoretical and practical changes in their profession and make appropriate use of professional consultations with experts in other fields, particularly psychology. Psychoanalysts should seek to avoid making claims in public presentations that exceed the scope of their competence. They should also refuse to engage in clinical work in areas where they have not received training. Psychoanalysts should take steps to correct any impairment in their analyzing capacities and do whatever is necessary to protect patients from such impairment.

2. Respect for Persons:

• The psychoanalyst is expected to treat patients and their families, students, and colleagues with respect and care. Discrimination on the basis of age, disability, ethnicity, gender, race, religion, sexual orientation, or socioeconomic status is ethically unacceptable. Regarding this, abiding by any organizational policies leading to bias or discrimination by the psychoanalyst is clearly rejected and unacceptable.

3. Mutuality and Informed Consent:

• The treatment relationship between the psychoanalyst and the patient (or the parent(s) or guardian(s) of a minor patient) is founded upon an informed choice leading to a mutually accepted agreement. This relationship is established based upon mutual consent and at the outset of treatment, the psychoanalyst is required to make the patient aware of the fundamental principles of psychoanalytical treatment and relevant alternative therapies. The psychoanalyst is also required to inform the patient about scheduling, fees, frameworks, and basic rules and to reach an agreement with them in the context of a humane and respectful relationship. When the patient is a minor these same general principles pertain but the patient’s age and stage of development should guide how specific arrangements will be handled and with whom. Other issues that require careful attention include:

• It is not ethical, nor acceptable for a psychoanalyst to take advantage of the power of the transference relationship to solicit patients, students, or supervisees into treatment or to receive testimonials or rewards. These principles include current or former patients. The principles mentioned also pertain to the relationship between the psychoanalyst and the parent(s) or guardian(s) of current or former minor patients. The psychoanalyst should not use his/her position of power in the analytic organization or his/her professional status to coerce or manipulate the person into treatment or any other actions.
• Careful attention should be given to the process of referral to avoid conflicts of interest. In this regard, before referring a patient to the psychoanalyst who is currently treating another member of the patient’s family (including spouse, partner, etc.), necessary investigations and scrutiny should be carried out, and also necessary disclosures should be made in the initial stages of the referral so that if possible, the patient can be referred to another person. It should be noted that the above provision can only be reviewed if there are no other practical alternatives for treatment due to special circumstances, including geographical limitations.
• All applicable aspects of the treatment contract should be discussed with the patient during the initial consultation process. In this regard, it is essential that before the application of the framework and charging the patient for missed sessions, they have a complete understanding of the conditions and reach a complete agreement on their application.
• Charging a reduced fee for therapy is a personal choice and decision of the psychoanalyst, and does not limit any of his/her ethical and professional responsibilities.
• The psychoanalyst is not allowed to unilaterally discontinue treating a patient without adequate notification discussion with the patient (and, if a minor, with the parent (s) or guardian (s)). The psychoanalyst is required to offer the patient the choice of referral to other colleagues for further treatment. The psychoanalyst should make appropriate use of professional consultation if necessary.

 

4. Confidentiality:

• Confidentiality of the patient’s communications is a basic patient right and an essential condition for effective psychoanalytic treatment and research. The psychoanalyst must take all measures necessary to not reveal present or former patient confidences without permission, nor discuss the particularities observed or inferred about patients outside consultative, educational, or scientific contexts. If the psychoanalyst uses case material in exchanges with colleagues for consultative, educational, or scientific purposes, the identity of the patient must be sufficiently disguised to prevent identification of the individual or the patient’s authorization must be obtained after frank discussion of the purpose(s) of the presentation, other options, the probable risks and benefits to the patient, and the patient’s right to refuse or withdraw consent. It should be noted that:

• Any information about the specifics of a patient’s life is confidential, including the name of the patient and the fact of treatment. The psychoanalyst should resist disclosing confidential information to the full extent permitted by law. The psychoanalyst refuses legal, civil, or administrative demands for such confidential information - even in the face of the patient’s informed consent - and only accepts if such a refusal has serious legal consequences. Needless to say that this is an ethical action and decision based on personal and professional ethical principles.
• The psychoanalyst should never share confidential information about a patient with nonclinical third parties (e.g., insurance companies) without the patient’s or, in the case of a minor patient, the parent’s or guardian’s informed consent. For the purpose of claims review or utilization management, it is not a violation of confidentiality for a psychoanalyst to disclose confidential information to a consultant psychoanalyst, provided the consultant is also bound by the confidentiality standards of these principles and the informed consent of the patient or parent or guardian of a minor patient has first been obtained. If a third-party payer or a patient or parent or guardian of a minor patient demands that the psychoanalyst act contrary to these principles, it is ethical for the psychoanalyst to refuse such demands, even with the patient’s or, in the case of a minor patient, the parent’s or guardian’s informed consent.
• Regarding a minor patient, the psychoanalyst must seek to preserve their confidentiality, while keeping their parents or guardians informed of the course of treatment in ways appropriate to the age and stage of development of the patient, and the clinical situation.
• The psychoanalyst should take particular care that patient records and other documents are handled so as to protect patient confidentiality
• It is not a violation of confidentiality for a psychoanalyst to reveal confidential information about a patient in a formal consultation or supervision in which the consultant or supervisor is also bound by the confidentiality requirements of these principles. On seeking consultation, the psychoanalyst should first ascertain that the consultant or supervisor is aware of and accepts the requirements of the confidentiality standard.
• If the psychoanalyst uses confidential case material in clinical presentations or in scientific or educational exchanges with colleagues, either the case material must be disguised sufficiently to prevent identification of the patient, in a way that it cannot be identified by the patient himself/herself, or the patient’s informed consent must first be obtained. If the latter, the psychoanalyst should discuss the reason(s) for such presentations, the possible risks and benefits to the patient’s treatment, and the patient’s right to withhold or withdraw consent. In the case of a minor patient, parent(s) or guardian(s) should be consulted, and, depending on the age and developmental stage, the matter may be discussed with the patient as well.
• Supervisors, peer consultants, and participants in clinical and educational exchanges have an ethical duty to maintain the confidentiality of patient information conveyed for purposes of consultative or case presentations or scientific discussions.
• Candidate psychoanalysts-in-training are strongly urged to consider obtaining the patient’s informed consent before beginning treatment, pertaining to disclosures of confidential information in groups or written reports required by the candidate’s training. Where the patient is a minor, the candidate is strongly urged to consider obtaining informed consent from the parent(s) or guardian(s); age and stage of development will assist the candidate in determining if the patient should also be informed.
• Using all or part of the content of therapy sessions by therapists on social networks and virtual space in a way that can be identified by the patient or their acquaintances, even with their permission is unacceptable. Disclosing therapy sessions can increase the vulnerability of patients and make the atmosphere highly unsafe for others who are readers of this content and are involved in psychoanalytic treatments.

5. Truthfulness:

• The psychoanalytic treatment relationship is founded on thoroughgoing truthfulness. The psychoanalyst should deal honestly and forthrightly with patients, and patient’s families in the case of those who are minors, students, and colleagues. Being aware of the ambiguities and complexities of human relationships and communications, the psychoanalyst should engage in an active process of self-monitoring in pursuit of truthful therapeutic and professional exchanges. In addition, the candidate psychoanalysts-in-training are strongly urged to inform psychoanalytic training patients and prospective psychoanalytic training patients that they are in training and supervised, and as may be expected, where the patient is a minor, the parent(s) or guardian(s) should also be informed. If asked, candidate psychoanalysts-in-training should not deny that they are being supervised as a requirement of their training. Moreover, the psychoanalyst should speak candidly with prospective patients or the parent(s) or guardian(s) if the patient is a minor about the benefits and burdens of psychoanalytic treatment. The psychoanalyst should avoid misleading the public, patients or parents, or guardians of minor patients with statements that are knowingly false, deceptive, or misleading.

6. Avoidance of Exploitation and Abuse:

• In light of the vulnerability of patients and the inequality of the psychoanalyst-analysand dyad, the psychoanalyst should scrupulously avoid any and all forms of exploitation and abuse of patients and their families, current or former, and limit, as much as possible the role of self-interest and personal desires.

• Sexual relationships involving any kind of sexual activity between the psychoanalyst and a current or former patient, or a parent or guardian of a current or former patient, or any member of the patient’s immediate family whether initiated by the patient, the parent or guardian or family member or by the treating psychoanalyst, are unethical. Physical touching is not ordinarily regarded as a technique of value in psychoanalytic treatment. If touching occurs, whether of the patient by the psychoanalyst or the psychoanalyst by the patient, such an event should alert the psychoanalyst to the potential for misunderstanding of the event by the patient or the psychoanalyst. and consequent harm to the future course of treatment and consultation should be considered. Consultation should be considered if there is concern about the future course of treatment. With children before the age of puberty touching between the patient and the psychoanalyst is likely to occur as in helping or during a patient’s exuberant play. Also, a disruptive or out-of-control child may need to be restrained.
• The psychoanalyst needs to be alert to the multiple meanings for both parties of such touching. Keeping parent(s) or guardian(s) informed when this occurs may be useful. Consultation should be considered if the touching causes the psychoanalyst concern.
• Marriage between a psychoanalyst and a current or former patient, or between a psychoanalyst and the parent or guardian of a patient or former patient is unethical, notwithstanding the absence of a complaint from the spouse and the legal rights of the parties.
• Finally, requesting or having a sexual relationship with the patient or the candidate psychoanalyst who is under psychoanalytic treatment or supervision, is not permitted.
• It is not ethical for a psychoanalyst to engage in financial dealings with a patient, or in the case of a minor patient, the parent(s) or guardian(s) beyond reimbursement for treatment; or to use information shared by a patient or parent(s) or guardian(s) for the psychoanalyst’s financial gain.
• It is not ethical for a psychoanalyst to solicit financial contributions from a current or former patient or the parent/guardian of a current or former patient for any reason; nor should a psychoanalyst give the names of current or former patients or their parents/guardians for purposes of financial solicitation by others.
• If a current or former patient or the parent/guardian of a current or former patient, gives an unsolicited financial gift, or establishes a trust or foundation or other entity for the benefit of his/her psychoanalyst, or for the benefit of the professional or scientific work of said psychoanalyst, or for the benefit of the psychoanalyst’s family, or the gift is placed under the control of the psychoanalyst, even if not directly beneficial to the psychoanalyst or his/her family, it is not ethical for the psychoanalyst to accept any financial benefit or to control its disposition.
• It is ethical for a psychoanalyst to accept a bequest from the estate of a former patient, provided that it is promptly donated to an organization or cause from which the psychoanalyst or his/her family do not personally benefit and over which the psychoanalyst has no direct control.
• It is unethical for a psychoanalyst to use his or her professional status, special relationship, or position of power in an analytic organization to solicit gifts or funds, sexual favors, special relationships, or other tangible benefits from patients, the parent(s) or guardian(s) of minor patients, members of the patient’s immediate family, psychoanalysts-in-training or supervisees. Sexual relationships between current supervisors and supervisees are unethical. This relationship between supervisees and former supervisors is not professionally acceptable.
• Candidates should not be supervised concurrently by the spouse, partner, or other relative of their analysts. This would jeopardize the independence and objectivity of both the supervisory and analytic processes.
• A patient’s psychoanalytic treatment with a psychoanalyst is voluntary and the patient may discontinue treatment or seek other treatment or advice at any time. In addition, termination of analysis or other treatment should usually be by mutual consent. If a psychoanalyst decides to discontinue a treatment attention must be given to the patient’s treatment needs and reasonable requests for information about possible alternative sources of treatment.
• A psychoanalyst must not use a professional or institutional position to coerce patients, supervisees, or colleagues. Neither must confidential information be used for this purpose.

7. Maintenance of standards, professional impairment, and sickness:

• A psychoanalyst must be committed to Continuous Professional Development and must maintain appropriate levels of contact with professional colleagues. This is to ensure that an adequate standard of professional practice and current knowledge of relevant professional and scientific developments are maintained. It is expected that psychoanalysts are committed to advancing scientific knowledge and teaching colleagues and students. Psychoanalytic research should generally adhere to accepted scientific principles and research integrity, and be based on a comprehensive understanding of the relevant scientific research background. Regarding human subjects and the use of clinical material, utmost caution must be taken to respect the rights of patients, especially confidentiality, and to minimize potential harm.
• The psychoanalyst should take every precaution in using clinical material to respect the patient’s rights and to minimize the impact of its use on the patient’s privacy and dignity. In the case of minor patients, the impact on parent(s) or guardian(s) needs to be considered. Particular care should be exercised in using material from a patient who is still undergoing treatment.
• It is unethical for a psychoanalyst to make public presentations or submit for publication in scientific journals falsified material that does not refer to actual observations drawn from the clinical situation. Such clinical material must be disguised sufficiently to protect the identification of the patient. The psychoanalyst should exercise caution in disguising patient material to avoid misleading colleagues as to the source and significance of his or her scientific conclusions.
• If the training analysis of a psychoanalyst was corrupted and therefore not satisfactorily completed or if they were abused during analysis, and with no presumption of blame or fault on the part of the victim, a new analysis for the psychoanalyst would usually be required. Needless to say, the psychoanalyst is responsible and the analysand has no responsibility.

• A psychoanalyst has a duty to inform the founding members of the psychoanalytic organization or the officials in charge of the institute in which a delinquent psychoanalyst works or is being trained if they see evidence that another psychoanalyst is behaving in a manner that contravenes the code of ethics.
• A psychoanalyst has a duty to seek advice from a senior colleague if in doubt about their capacity to practice and a duty to inform and assist a colleague if the colleague’s capacity to discharge their professional obligations appears impaired. In the event of significant concerns about the capacity of a psychoanalytic colleague which the colleague is not willing to address, a psychoanalyst must inform the founding members of the psychoanalytic organization, the officials in charge of the institute in which the person is learning psychoanalysis or the one in which he/she is doing clinical work.
• A psychoanalyst must, with due regard for patient confidentiality, make provision for each patient to be informed (including options for continuing treatment) in the event of the psychoanalyst’s death or unavailability.
• The psychoanalyst should seek consultation when, in the course of treating a patient, the work becomes continuously confusing or seriously disturbing to either the psychoanalyst or the patient, or both. On occasion in the treatment of a minor, the relationship between the psychoanalyst and parental figure may cause sustained disturbance or confusion for the psychoanalyst. In such a situation consultation is indicated.
• A psychoanalyst who undergoes a serious illness and extended convalescence, or whose analyzing capacities are impaired, must consult with a colleague and/or medical specialist to clarify the significance of his or her condition for continuing to work.
• A request by a patient, a parent/guardian of a minor patient, or a colleague that the psychoanalyst seeks consultation should receive respectful and reflective consideration.
• If a psychoanalyst is officially notified by a representative of an institute or society that a possible impairment of his/her clinical judgment or analyzing ability exists, the psychoanalyst must consult with no less than two colleagues, one of whom may be a non-analyst medical specialist, each acceptable to the notifying body. If impairment is found, remedial measures be followed by the psychoanalyst in order to protect patients from harm and to prevent degradation of the standards of care in the profession.
• It is ethical for a psychoanalyst to hold a session with the patient of a colleague without giving notice to the colleague if the consultation has been requested by the patient.
• It is ethical for a psychoanalyst to intervene on behalf of a colleague’s patient if he or she has evidence from direct or indirect consultation with the colleague’s patient or from supervision of the colleague’s work with the patient that the colleague may be conducting him/herself unethically toward the patient or may be so impaired as to threaten the patient’s welfare.
• It is ethical for a psychoanalyst to accept for treatment the current patient of a colleague if consultation with a third colleague indicates that it is in the best interest of the patient to do so.
• In the event that a credible threat of imminent bodily harm to a third party by a patient becomes evident, the psychoanalyst should take reasonable appropriate steps to protect the third party from bodily harm, and may breach patient confidentiality if necessary only to the extent necessary to prevent imminent harm from occurring. The same applies to a credible threat of suicide.
• In the case of a minor where the psychoanalyst is concerned that a credible threat of serious self-injury or suicide is imminent, the psychoanalyst should take appropriate steps. This would include the notification of parent(s) or guardian(s) even if a breach of confidentiality is required. Under these circumstances, any breach of confidentiality should be restricted to the minimum necessary to prevent harm to the minor child.
• When a psychoanalyst becomes convinced that abuse is occurring the psychoanalyst may report adult or child abuse of a patient or by a patient to the appropriate governmental agency in keeping with local laws. Should the patient be minor, informing parent(s) or guardian(s) needs to be considered. In these circumstances, confidentiality may be breached to the minimum extent necessary. Given the complexities of these matters, a psychoanalyst who is concerned that abuse of an adult or child is occurring is encouraged to continue to explore the situation and to consider utilizing consultation to determine what course of action would be most helpful.
• Local psychoanalytic societies and institutes have an obligation to promote the competence of their members and to initiate confidential inquiries in response to ethics complaints.

8. Social Responsibility:

• A psychoanalyst should comply with the law and with social policies that serve the interests of patients and the public. The Principles recognize that there are times when conscientious refusal to obey a law or policy constitutes the most ethical action. If a third-party or patient or in the case of minor patients, the parent(s) or guardian(s) demands actions contrary to ethical principles or scientific knowledge, the psychoanalyst should refuse. A psychoanalyst is encouraged to contribute a portion of his or her time and talents to activities that serve the interests of patients and the public good.
• The psychoanalyst should make use of all legal, civil, and administrative means to safeguard patients’ rights to confidentiality, to ensure the protection of patient treatment records from third-party access, and to utilize any other ethical measures to ensure and maintain the privacy essential to the conduct of psychoanalytic treatment.
• The psychoanalyst is urged to support laws and social policies that promote the best interests of patients and the ethical practice of psychoanalysis.
• The psychoanalyst is encouraged to contribute his or her time and talents, if necessary without monetary compensation, to consultative and educational activities intended to improve public welfare and enhance the quality of life for the mentally ill and economically deprived members of the community.

9. Personal Integrity

• The psychoanalyst should do his/her best to be thoughtful, considerate, and fair in all professional relationships, uphold the dignity and honor of the profession, and accept its self-imposed disciplines. He or she should accord members of allied professions respect due to their competence.
• Psychoanalysts and candidate psychoanalysts-in-training should also be familiar with the principles of ethics and standards, other applicable professional ethics codes, and their application to psychoanalysis.
• Psychoanalysts should strive to be aware of their own beliefs, values, needs, and limitations and to monitor how these personal interests impact their work.
• Finally, psychoanalysts should cooperate with ethics investigations and proceedings conducted in accordance with the Provision for Implementation of the principles and standards of ethics for psychoanalysts. Failure to cooperate is itself an ethics violation.

The Tehran Center for Psychoanalytic Studies has a policy to select qualified individuals without discrimination based on political or religious beliefs, marital status, race, gender, nationality, physical disabilities (that do not limit professional competence), sexual orientation, or age.