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This is a surprising and thought-provoking book. It came about as the result of a conference on “Confidentiality and Society” held in Montreal under the auspices of the International Psychoanalytic Association. The conference took up the erosion of personal privacy and confidentiality that all therapists have experienced and the ways in which outside agencies seek to use therapeutic material for their own non-analytic ends. The book posits that one of the reasons for this is that we as psychoanalysts have not been active enough in developing our own ideas about what constitutes confidentiality. Not since the late 1960s when Dr. Joseph Lifschutz, a psychoanalyst in Berkeley, risked prison when he refused to reveal the name of a patient has there been a serious effort to defend our ideal of confidentiality. The book seeks to define and discuss psychoanalytic confidentiality and to distinguish it from the broader and legally oriented notion of privacy as a right of the individual. I am going to select some areas that particularly struck me as instances in which making the distinction is terribly important.
Confidentiality as a central tenet of our profession is rather different from privacy. Authors in this volume assert that confidentiality is best regarded as an essential part of the practice of psychoanalysis, one of the cornerstones or basic virtues that make the whole enterprise possible. Privacy, on the other hand, is a right conferred by law that is always weighed against other rights, such as the right of the courts to collect evidence or a patient's wish to waive his privacy. If we equate confidentiality with privacy, we leave ourselves open to consenting to intrusions and thereby undermine our own foundation.
From the point of view of a clinician, some of the most harrowing papers concerned patients’ wishes to sacrifice confidentiality by getting the analyst to testify or provide records to courts or other outside agencies. This is a major disruption of the wor