Psychic Fallout from Breach of Confidentiality

Abstract

The author, a psychoanalyst, explores the psychological and professional repercussions of discovering that her analyst breached the confidentiality of her analysis with a patient with whom he had engaged in sexual misconduct. Using actual events, conscious reflections, dreams, and dream-associations, the author traces the progression of traumatic deidealization from the abrupt end of the analysis through the process of filing a lawsuit that ultimately went to trial before a jury. The accused analyst was found liable for negligence and breach of fiduciary duty. The author highlights some aspects of psychic disruption for patients whose confidentiality is violated, including generalized mistrust, disidentification, an intensified collision of love and hate, and disturbances in professional and personality identity. The author's account is given to help clinicians understand the destructive consequences of boundary violations, so that we may practice caution at the beginning of the “slippery slope.”