PERSONAL PERSPECTIVE : The Neurotic Need of Psychotherapists to Exploit Their Patients

Was Anne Sexton, the acclaimed poet who killed herself in 1974, well served by her psychotherapists?

A new biography, to be published this fall, uses information about her life that was provided to the biographer by Sexton’s first therapist. The information, contained in hours and hours of audiotapes, encompasses years of therapy. The material was turned over to the biographer many years after Sexton’s death.

Did the therapist have the right to do that? Whose information is it, anyway?

Apparently, Sexton’s daughter consented to the release of the tapes. But was that sufficient, or is Sexton’s own explicit consent required?

According to professional codes of conduct, information a therapist learns from his or her clients or patients is considered confidential. This extends to information in any form--letters, tapes, notes, etc. It even includes mentioning that such-and-such is in therapy with you.

Moreover, confidential has a capital “C”--client-related information is not to be left lying about on desktops or in unlocked filing cabinets; it is not to be discussed in elevators or at cocktail parties; it is not to be mentioned in the therapist’s autobiography and certainly not to be handed out to journalists, authors, TV talk-show hosts or any other of the insatiable curiosity-seekers who cluster around the famous and talented, or around their grave sites.

Why this iron-clad secrecy rule? In some ways, it’s common sense. Would you go to a therapist and honestly talk about your triumphs and your humiliations, your fears and your wishes, your guilty habits and habitual guilt if you thought anyone else was going to hear?

I wouldn’t. My problems are burden enough without the additional worry that everyone knows about them.

But, actually, there’s another, more important, reason to regard confidentiality as a linchpin of psychotherapy. Ethics are all about power and how it ought to be used. The first law is always to do no harm. Professional ethical codes protect people against harm arising from the misuse of power.

The role of therapist gives power. I have more information than the people who seek my help; they tell me secrets about themselves and I don’t reciprocate; they need me in ways that I don’t need them. The vulnerability is asymmetrical, and it is my responsibility not to abuse this imbalance.

Why, in the first place, would someone tape their psychotherapy sessions?

I’ve had clients who wanted to do that. Maybe it’s because I talk too fast. Maybe it’s their perfectionism in wanting to get as much from every session as possible. Maybe the tape is, in effect, a bit of me they can take home with them and listen to when they’re frightened or lonely. Or maybe it’s for complicated or screwy reasons I never even learn about. Whatever the case, I cannot even imagine giving such tapes to a client’s biographer.

The ethical codes stipulate that the confidentiality of therapy can be broken in a few limited instances. If a client threatens to murder or otherwise endanger someone and you think there’s a good chance he or she might carry out the threat, you, as therapist, are required by law and ethical duty to take steps to warn and protect the intended victim.

Do you tell your client that you’re going to do this? Yes.

Might it interfere with the client’s confidence in you? Possibly, but you do it. “The protective privilege ends where the public peril begins,” says the court.

But was there any such justification for Sexton’s therapist to give her biographer her audiotapes?

For the life of me, I cannot think of one. I assume he did it for his own greater glory, so everyone would forever associate him with the award-winning poet. I assume it’s yet another instance of a man taking control of something belonging to a woman and, of course, saying she would have wanted him to do it.

Therapists have needs, like everyone else, and, unfortunately, sometimes their needs for recognition or accomplishment are not satisfied unless people know all about the famous people they are treating. A second psychiatrist Sexton consulted is alleged to have had a sexual affair with her. Is this form of exploitation that much different?

Psychotherapy is about empowering the client. If you want to be a fool or famous, earn it on your own, rather than on the backs of the people who turn to you for help.