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We psychoanalysts have implicitly so taken confidentiality for granted in our work that for much of our history the topic has been deemed hardly worthy of comment. In fact, before the year 1960 the word confidentiality fails to appear a single time in the title, text, or bibliography of any article in our major journals (Archive I, 1996). And yet, because psychoanalysis has such a stringent requirement for “the strictest discretion” (Freud 1940), our ethical and technical insistence on protecting our patients and the treatment situation has had ramifications that have influenced the development of law applying to various forms of psychotherapy, as well as the ethics and practices of other groups of psychotherapists.
In the 1960s attention to the subject of patients' privacy began to increase as the U.S. health care system began to feel the effects of increasing litigiousness, third-party insurance coverage, Cold War security issues, and governmental and other bureaucratic involvement in financing and regulation. In 1960 an influential organization in American psychiatry, The Group for the Advancement of Psychiatry, suggested that the relationship between patient and psychiatrist should be protected from legal discovery by the establishment of what was then called a psychiatrist-patient privilege. In 1966 Ralph Slovenko, a Senior Assistant District Attorney in New Orleans, and Gene Usdin, a Tulane psychiatrist, published Psychotherapy Confidentiality and Privileged Communication. In a preface to that book, a U.S. district judge called it “the first serious attempt that has been made to expose the whole problem of privilege created by the psychotherapist-patient relationship.” The 1966 book systematically explained in a series of chapters the concept of privileges in general,