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Confidentiality is so central to the process of psychotherapy that we take it for granted. There are few psychotherapists, I suspect, who would quarrel with the idea. And yet, no sooner do we subscribe to the principle than we go on to breach it as a matter of course. We speak about our patients in supervision and to colleagues; some contact GPs as a routine practice. We speak about patients in professional meetings. Some people speak about them in more public fora or write about them, albeit in a disguised form. Where is the confidentiality in all this? Let me leave the question there for the moment.
‘Why have psychoanalysis and psychotherapy allowed the destruction of confidentiality between clinician and patient?’ This is the question, starkly put, that psychoanalyst Christopher Bollas and US lawyer David Sundelson set out to answer in this timely, provocative and salutary book. Unlike lawyers, journalists and priests, they argue, psychotherapists have allowed their privileged relationship to be destroyed.
In the United States, the 1976 Tarasoff judgement obliges therapists to give a warning of a patient's violent intentions. Tarasoff was a student at the University of California-Berkeley who was murdered by another student whom she was dating and who was in psychotherapy at the student health service. Tarasoff's parents successfully sued the university for negligence in failing to warn their daughter. So too child abuse reporting statutes which now exist in every one of the 50 states in the USA require a therapist to report to the authorities any physical or sexual abuse alleged, whether it was perpetrated by the patient or by another person.
Bollas and Sundelson take the profession to task for its failure to respond adequately to such developments. In particular, they argue, psychotherapists, psychiatrists and psychologists have singularly failed to explain their position; they have failed to provide the ‘detailed and theoretically coherent account’ of what the la