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Whatever, in connection with my professional practice or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret.
This excerpt from the Hippocratic Oath (as translated by Francis Adams) may be the first recorded evidence of the developing principle of the confidentiality that generally ought to exist between physician and patient, and by extension between other therapists and their patients, ‘clients’, analysands. In addition to this professional ethical tradition of respecting the privacy of clinical communications, the legal concept of ‘privilege’ was extended from the religious confessional and from the attorney-client relationship to the doctor-patient and psychoanalyst-analysand dyads. However, this extension of privilege was never absolute, as it is for the pastor, priest, or rabbi, and attorney, nor is it the doctor's/therapist's: in most jurisdictions it belongs to the patient and can be implicitly or explicitly given up. For example, if an analysand files a malpractice suit against a former analyst, privilege is implicitly relinquished; the analyst is entitled to speak of that ‘which ought not to be spoken of abroad’ in order to mount an appropriate defence.
A confluence of events over the last two decades have resulted in a series of incursions, and threats of further erosion, of both the concepts of ethical confidentiality and legal privilege for analysts and therapists. Bollas & Sundelson attempt to answer three important questions about this crucial issue: ‘How did the loss of privacy come about? What does it mean for clinical practice? What, if anything, can we do about it?’ (p. xii)
They begin with a remarkably lucid exposition of some of the relatively recent and influential California judicial decisions, stressing the role of the courts in mediating between conflicting values: the value of total privacy of treatment, which encourages those