CHRISTOPHER BOLLAS AND DAVID SUNDELSON: The New Informants: A Betrayal of Confidentiality in Psychoanalysis and Psychotherapy. Jason Aranson, Northvale, NJ, 1995, 232 pp., $22.00, ISBN 156 8215959.
One of the salient social issues of our time is the debate over privacy. From the television talk show circuit to the debate over Internet free speech, how to maintain one's privacy in this increasingly public global village has lawyers and social scientists all aflutter.
It is not surprising, therefore, that the mental health field should get swept up in the debate. In psychotherapy, the analog to privacy is called confidentiality. Confidentiality is crucial in psychotherapy and psychoanalysis. To get a patient to reveal herself without fear of recrimination from friends, neighbors, and family, can only come about if there is a privileged confidential relationship between patient and therapist. Moreover, even to get the patient to free associate about censoring painful fantasies requires a confidential patient-therapist relationship. With the changing social context of psychotherapy, in a world where there are no secrets or private thoughts and conduct, confidentiality is under attack.
Bollas and Sundelson's The New Informants is a frightening little book about the encroachment of the social context of psychotherapy onto the private patienttherapist relationship.
The book is well written and well reasoned. The first area discussed is the new fields of forensic psychiatry and psychology. The whole purpose of these fields is to provide information to others outside the doctor-patient relationship.
New legal decisions about the duty to warn and duty to protect actually compel psychiatrists and psychologists to warn authorities. How can patients be honest with a psychotherapist if they know that the information is not privileged? How can a mother get help for her propensity to be a child abuser if she knows that her doctor might have her arrested?
Another problem is the new power of managed care organizations. This new breed of insurance companies requires disclosure about the patient and the patient's treatment, beyond what would have been the case 20 years ago.
Even the cognitive set of the mental health field has changed. At professional meetings, psychologists and psychiatrists discuss their old cases, sometimes betraying the confidence of a celebrity patient who has committed suicide.
These are all signs of our times. Psychotherapy and psychoanalysis have always operated in a specific social context. Now is no different. The field of psychoanalysis has repressed the awareness that the social context of an analysis or a therapy has not vanished just because the analyst deals only with fantasies. …