Privates Practices (Paperback)

This book is not interesting psychologically--there is nothing going on here psychologically but jejune sketches of ordinary notions.

If the protagonist's therapeutic work and psychological insight are insipid and uninspired, though, his obsession with patient confidentiality is off-the-wall. Since that is a central, oft-repeated plot device, I found the plot strained, at best.

I've practiced psychotherapy for a long time, written a lot of reasonably well respected stuff about it, and known a lot of heavyweights pretty well. I have never met anyone who sees confidentiality the way that Dr. Gregory, and presumably the author, see it. At the very least, for most practicing mental health professionals confidentiality is a much more complex, murky area than for Dr. Gregory.

And some of Dr. Gregory's grand ethical principles--well, folks, it just don't work like that. Everybody I know would consider Dr. Gregory ridiculously officious, lacking in judgment.

Here's a fact--we talk to each other, and to our significant others, about our patients. That's how we stay sane, and how we learn.

We don't just talk to supervisors or consultants--most of us don't have supervisors after we've gotten a few years of experience under our belts, and we only use consultants on especially vexing cases. For the day-to-day work of keeping our own heads clear and our attitudes balanced, we are like everyone else in the world--we rely on ordinary conversations with our colleagues and loved ones.

No therapist is more dangerous than the one who does not, as a matter of course, talk of his work to the people he knows and cares about, whose judgment he trusts, and who know him well enough to tell him when he's getting off track. At best that therapist stays stuck within his own perspective, failing to learn on a day to day basis from others. At worst, he comes to take for granted his deep wisdom--since he has no, and feels no need for, routine correctives as part of the texture of his day--and gets lost in a solipsistic sense of his self-importance.

Here's another fact: Murderers and dead people have very little standing in malpractice suits.

And no one I know is so arrogant about the sanctified absolute importance of therapy completely overruling all other moral obligations that he or she would not help the cops when the only people whose confidentiality is in question are either victims or probable killers-on-the-loose. (There are plenty of ways to release information without violating any laws, hence fulfilling the moral obligations that transcend one's professional role AND abiding by professional strictures.)

I'm not sure that patient confidentiality even survives the patient's death, in at least some states.

Oh--and I believe it is the case, in at least the states I know about, that a therapist has an obligation to report malpracticing therapists, whether or not the patients give permission. The reasoning is that the therapist is a danger to others, hence must be reported. Not for dear Dr. Alan Gregory.

The one live malpracticing therapist whose malfeasance Dr. Gregory thinks he must keep from the authorities would fall under "must report" statutes, in the places I know--and you can be pretty sure that no Board of Examiners in the world would impose any meaningful censure on a therapist who revealed the bad work of this monster.

And the other (now dead) "malpracticing" therapist, whom Alan Gregory somehow believes committed a grave ethical offense by not reporting child molestation ten years after it happened, illustrates the complexities that escape Dr. Gregory. Legally, this therapist would probably NOT have been able to report what Gregory thinks he should have--precisely because of confidentiality. The patient would have had a pretty strong civil case for being reported after the statute of limitations had run out. (It's hard to defend one's self, as a confidentiality-breaking therapist, when there is no evidence of imminent harm AND no legal basis for the report!) Nonetheless, it would not be likely that the therapist would have suffered grave sanctions from his Board of Examiners if he had made the report. Civil liability and professional sanctions do not march in lockstep.

So Alan Gregory, it seems to me, doesn't understand much about confidentiality, though he thinks it somehow forms a bedrock of his ethics.

Of course, without his weird beliefs, he wouldn't have any reason to arrogate to himself the role of detective--he would cooperate with the cops, assuming that they know more than he about what they do for a living, just as he knows more than they about his profession. So this is a necessary plot device, but unfortunately it makes no sense.

As a human, Dr. Gregory didn't really capture my sympathies, either. I thought he was pretty shallow, even feckless, really. He surely lacks insight into his boundless arrogance.

I'm sorry I wasted my time on this one.

While the book would've benefited from fewer characters (I had to go back and find where one was introduced to find out what her importance was), it was still enjoyable and had me reading well past midnight.