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A totally appropriate warning emanating from Walt Kelly's eloquent alligator, “Pogo,” came to me upon completing Christopher Bollas and David Sundelson's important book, The New Informants. I paraphrase: “We have met the enemy and it is us.”
Rather unwittingly I believe, many of us are betraying our patients, the discipline of psychoanalysis/psychotherapy, and, perhaps
most important, the belief that confidentiality is possible in as technologically advanced and complex a society as America's in the 1990s. Before I consider the authors' arguments concerning the contemporary state of confidentiality in psychoanalysis and psychotherapy, I believe it would serve us well to trace the steps taken by many psychotherapists in the 1970s and 1980s, just as the rather successful onslaught of the insurance industry's newest oxymoron, “managed care,” came into the consultation rooms of the essentially laissez faire private practices of individual psychoanalysts and psychotherapists. The latter, practitioners of many different psychotherapeutic orientations, were witnesses to what seemed a disproportionate increase in their numbers and, so it seemed, only a limited number of potential patients. Interested in staying financially afloat, many of our fellow soul savers went into the real estate business, cashing in on that industry's phenomenal growth. At the same time that psychotherapists (and I speak here from the perspective of psychotherapy in New York City) felt the economic pressure of a glutted therapy market and the social egalitarianism of the “everyone's-a-psychotherapist” movement, we heard the cry of all socioeconomic classes for protection from the evils of the “street,” a cry that each socioeconomic group could not voice loudly enough to insure its members that they would ever be safe. The “animals on the streets” and in the schools became objects of near-paranoid bombast, and, so, what could have been more curative than an attempt to weed out the dangerous among us