As fragments of a vessel: On anonymisation and the ethics of clinical case writing

Case-writing is always poised between the wish to convey clinical truth and the duty to protect the patient's privacy. In the digital age, where clinical material circulates widely and remains permanently accessible, this tension has become more acute. We argue that anonymisation should not be reduced to the concealment of details regarding our patients but understood as a transformation process akin to mentalisation: a way of reshaping raw experience into a narrative that can be shared without falsifying the therapeutic encounter. Preserving clinical truth requires placing the therapeutic alliance and the patient's trust at the centre of the writing process. Yet we must also remember that anonymisation is never neutral. For patients belonging to minoritised communities, such as LGBTQIA+ individuals, alterations intended to protect privacy may risk reproducing forms of misrecognition, thereby committing epistemic injustice. We propose that case-writing must be guided by a relational ethic: cultivating humility, openness, and disciplined curiosity to sustain trust and safeguard the therapeutic alliance, while distributing responsibility for confidentiality across the psychotherapeutic community as a whole.