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This slim, extremely thought-provoking and disturbing volume addresses the evolution and effect of mandated reporting laws and managed care (with its emphasis on record keeping and reporting) on the spirit, climate, and practice of psychoanalysis in the United States. In their collaboration the authors, an eminent psychoanalyst and a lawyer who has taught courses in psychoanalysis, attempt to answer three questions: “How did the loss of privacy come about? What does it mean for clinical practice? What, if anything, can we do about it?” (p. x). The authors remind us in the preface that there are still professional relationships, such as between lawyer and client or reporter and source, where the notion of privilege is legally and socially binding.
Historically, psychotherapeutic communications were generally considered privileged in the United States until 1976 when the Tarasoff decision mandated that a therapist treating a patient with violent intentions protect the potential victim through appropriate action. This action might entail warning the victim or contacting the authorities. A further, more serious erosion of confidentiality took place with the advent of laws that mandated the reporting of suspected or confirmed cases of child neglect or physical or sexual abuse. These laws apply not only to all of the professional disciplines from which psychoanalysts are drawn, but to others, such as teachers and pediatricians. Finally, with the advent of managed care in the United States, many Insurance companies are making psychotherapy coverage contingent on extensive outpatient treatment reviews. These OTRs include descriptions of the patients' symptoms and the course of the therapy.
Simply put, the authors believe that these Incursions into confidentiality are inimical to the practice of psychoanalysis. The “first rule” of psychoanalysis demands that the patient tell the analyst, to the extent that it is possible, everything that comes to mind. The psychoanalyst, in a