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Just as I finished reading Bollas and Sundelson's wake-up call to psychoanalysts, I received in the mail the latest issue of Psychologist Psychoanalyst (APA Div. 39, Fall, 1995) which included a lengthy letter to the editor indicting managed-care providers for their collective disregard of patienttherapist confidentiality, a theme that was echoed in three of the articles that followed. I also received the newsletter of the Washington Psychoanalytic Society (Nov. ′95), which described a recent conference (sponsored by the Baltimore-Washington, D. C., consortium of seven psychoanalytic organizations) on problems of confidentiality in psychoanalytic research. Bollas and Sundelson should be pleased, since their goal in The New Informants is to convince readers, whether mental-health professionals, legislators, medical industy leaders, or the general public, that certain recent developments in law and in the “psy” professions have effectively destroyed patient-therapist confidentiality, that everyone should be concerned about this phenomenon, and something should and can be done.
Psychoanalytic practice, already in some degree of crisis for various reasons, cannot function without confidentiality, and while the authors of The New Informants avoid conspiracy theory, they suggest that the ease with which so many mental-health professionals routinely accommodate the loss of confidentiality is not unrelated to popular dismissiveness toward psychoanalysis. Because of its marginalized position with the medical establishment and in American culture, the psychoanalytic community cannot rely on others-judges, legislators, managed care providers, and psychiatric or psychotherapeutic associations not oriented to analysis-to protect their practices and patients or even to understand and appreciate the analytic process and therefore the unique place of confidentiality therein. Bollas the