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Saks, E.R. (2016). Confidentiality and Its Discontents: Dilemmas of Privacy in Psychotherapy. By Paul W. Mosher and Jeffrey Berman. New York: Fordham University Press, 2015, xiv + 343 pp., $125.00 hardcover, $37.00 paperback.. J. Amer. Psychoanal. Assn., 64(5):1081-1088.
    

(2016). Journal of the American Psychoanalytic Association, 64(5):1081-1088

Confidentiality and Its Discontents: Dilemmas of Privacy in Psychotherapy. By Paul W. Mosher and Jeffrey Berman. New York: Fordham University Press, 2015, xiv + 343 pp., $125.00 hardcover, $37.00 paperback.

Review by:
Elyn R. Saks

Paul Mosher and Jeffrey Berman's Confidentiality and Its Discontents: Dilemmas of Privacy in Psychotherapy is a wonderful account of these dilemmas. The title is telling: playing on Freud's “Discontents” title, it

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highlights that therapists are faced with unwelcome and painful demands that may pull against the patient's therapeutic interests.

Mosher and Berman rightly point out how vital confidentiality would seem to be to psychoanalysis and psychoanalytic therapy. Patients will be loath to follow the “fundamental rule” to “say everything that comes to mind” unless they are confident that what they say will never leave the room. A condition of full disclosure is confidentiality. If this cannot be promised—or if the patient is actually warned of the limits of confidentiality—he or she will not be fully forthcoming.

A couple of things can be said here. First, it is just an article of faith that confidentiality is necessary. Logically it would seem to be. But often things that seem likely theoretically don't pan out that way empirically. Consider that it is a reality that confidentiality is not absolute, and yet treatments, good treatments, happen anyway. The idea that confidentiality is not absolute may not affect many people, though there is good evidence, seen in some of Mosher and Berman's case studies, that actual breaches of confidentiality do.

Does lack of confidentiality introduce complications? Maybe. Perhaps it

[This is a summary excerpt from the full text of the journal article. The full text of the document is available to journal subscribers on the publisher's website here.]

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