SUGGESTIONS FOR MAKING AUDIO RECORDINGS
The Psychoanalytic Research Consortium, Inc. (“PRC”) is vitally interested in supporting initiatives and studies which would serve to enhance our understanding of psychoanalysis and psychotherapy. Such initiatives and studies can be facilitated by reviewing and analyzing audio recordings of psychoanalysis or psychotherapy sessions. This may include collecting, cataloging, safeguarding and transcribing audio recordings and other recordings relating to such therapies, and making such materials available to qualified researchers. Documenting the variable efficacy of psychoanalyses, and the relationship between the qualities of the patient and analyst, the way they work together, and the ultimate results of treatment can be accomplished, provided we have a sufficient database of recorded cases from a considerable number of analysts. The recommendations provided here derive from extensive experience in recording many patients, and have been developed and utilized over a twelve year period. Sample phraseology is provided below to permit the analyst-reader in evaluating his or her own comfort in undertaking audio recording. Phraseology would of course vary depending on individual comfort and preference.
Analysts’ hesitations to undertake recordings stem first from concern for the patient’s feeling of security in confiding in the analyst. We address this concern at two levels which are described below. We recommend that audio recording be undertaken at the very beginning of patient contact. The initial recording of sessions on audiotape may provide a useful form of data which would assist the analyst in preparing an initial note for the patient’s medical record. This level of exposure is one that most patients find consonant with their understanding of ordinary clinical work nowadays. Recording of all initial details also frees the analyst to employ higher level clinical skills in synthesizing observations in an initial note, without the need extensively to record the facts themselves adduced initially by the patient. This first step of arranging for recording without an introduction of research goals is described immediately below. The second step, of introducing the concept of audiotaping for research purposes, is described subsequently.
Accomplishing the Initial Introduction of Audio Recording
Prior to the first meeting with a patient, the analyst should decide whether there are any contraindications to suggesting recording, such as if the patient is likely to become embroiled in a custody battle. The introduction of audio recording might be unwise if the patient is very suspicious and mistrustful in general, or if the patient suffers from intense conflicts about being exposed. Another relative contraindication exists if there is good reason to anticipate that the patient would feel the procedure itself was strange, such as someone in the mental health field who expected an “orthodox” analyst and would experience the suggestion of recording as off-putting. Absent these, the audio recorder should be ready.
If such relative contraindications are not present, when the patient is first invited into the consulting room and sits down, the analyst may say immediately: “Before we begin, I want to mention that it is my custom to audio record unless a person would rather that I not.” Or, the first time (when calling it a custom would be inaccurate), “I would like to ask if I may audio record, unless you would rather that I not do so.” Any immediate inquiries from patients may be answered by telling them that the audio recording is useful for purposes of the analyst’s preparation of an initial note for the patient’s medical record (although the audio recordings will not be considered part of the medical record), and there can be other uses as well which we can speak about at a later time. Experience has shown that, in this technological age, 80% of patients readily agree to the audio recording without further questions at this point, and the machine should immediately be turned on if the patient assents. This approach avoids any extensive discussion at this beginning moment, when the patient’s concerns leading them to seek help are paramount in her or his mind. With many patients, no long-term treatment plan is agreed to, and the recordings remain simply a resource which the analyst may or may not wish to refer to for purposes of preparing an initial note, or, unless otherwise prohibited by law or otherwise, they can be discarded.
Introduction of Audio Recording for Possible Research Use
At the time that an agreement for regular sessions is reached, if no contraindication to discussing the use of audiotaping for potential research purposes has been identified, it has been found comfortable to mention to the patient, toward the end of the session in which such agreement is being discussed, “In addition to serving as a reference to the analyst for purposes of preparing an initial note, the audio recordings may also be useful for research purposes. I have materials which include a description of using the audio recordings for this purpose which you can take home and review at your leisure. We can then discuss these materials at the time of your next visit after you have a chance to read them, if you wish.” With this statement, the patient should be provided with a copy of the form entitled “Explanation of Potential Research Uses of Audio Recordings of Sessions”. On the back of this form is a consent form entitled “Consent to Audiotaping of Psychoanalysis or Psychotherapy Sessions and Possible Release of the Audio Recordings and Related Patient Information to Qualified Researchers(1).
” These documents include an explanation that the audio recordings may be useful to the analyst for purposes of preparing an initial note for the patient’s medical record, and/or for research purposes. About three-quarters of the time, the patient completes the consent form soon after receiving it. Whether the patient accepts or declines the research use of the audio recordings, and whether the patient promptly returns to the subject at the next session or avoids the topic, his or her behavior will of course reflect the patient’s wishes and conflicts, particularly as activated in relation to the analyst. The analyst needs to attend to these meanings, as to all other aspects of the analytic situation, whether introduced by the analyst (such as fee or schedule arrangements) or arising from other circumstances. Answering of all questions about the audio recording or research in a fully respectful manner has not precluded an analytic approach to the patient’s reactions as well.
In addition to the shared concern about confidentiality, we believe that hesitation to audio record may stem from an overly elevated ideal notion of the analyst’s work, generally shared in the psychoanalytic community. Perhaps all analysts will be shown to fall significantly short of this ideal, when actual work of many analysts is studied. Meanwhile, the PRC has procedures in place to protect the anonymity of those analysts who contribute materials for research purposes.
Support by the PRC for Analysts Undertaking Recording
The PRC will provide a high-quality audio recording apparatus and a pair of “PZM” microphones to analysts willing to attempt audiotape recording, along with instructions for set-up. The microphones are of a new kind which should be placed on a table or any flat surface, or attached to a wall, and consequently are not prominent in the consulting room. Two microphones are best in order to capture both participants’ voices equally well. Also, sometimes the patient may be using the chair, and at other times the couch, and with two microphones a more complete coverage is attained. Since we are interested in developing a collection of recordings of both psychoanalyses and psychotherapies conducted by analysts, recordings of psychotherapies will be beneficial as well, and we believe that most analyses begin as psychotherapies nowadays. (The recording machine is an auto-reverse machine, requiring one 60 minute tape per session. The PRC has a source of blank tapes costing only 55 cents each, so that the cost of continuing recording is not appreciable. If the PRC is successful in obtaining large-scale funding, the cost of the tapes will also be underwritten by the PRC.)
In the event the analyst decides to continue recording, with the intention of eventually donating the recordings to the PRC, ownership of the recording equipment will be transferred to the recording analyst. Otherwise, of course, the equipment should be returned to the PRC. The analyst may retain possession of the audio recordings for as long as she or he wishes, usually until after the treatment is completed. Should the patient wish for the tapes to be destroyed for any reason, this can be accomplished to the extent permitted by law. In addition, the analyst will have discretion with respect to whether or not audio recordings will be contributed to the PRC. Experience has shown that, for patient and analyst alike, the audiotape recording process only comes into occasional focus during the course of treatment, once the analyst has become accustomed to it. The PRC provides both a gift and a bequest form for the conveyance by the analyst of recordings to the PRC for which applicable research consent forms have been completed.
If only a minority of cases which are audio recorded initially are eventually added to our “library”, the result will be highly worthwhile for our field and the patients we serve.
1. These two documents have been developed with the benefit of extensive consultation with other analysts and with legal counsel knowledge-able about problems of confidentiality and consent, with funds provided by the Fund for Psychoanalytic Research and with funds provided as well from contributions made to the PRC. (May 20, 1996)