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Book Forum: TREATMENT   |    
Psychotherapy and Confidentiality: Testimonial Privileged Communication, Breach of Confidentiality, and Reporting Duties
THOMAS G. GUTHEIL, M.D.
Am J Psychiatry 1999;156:1830-b-1831.
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by Ralph Slovenko. Springfield, Ill., Charles C Thomas, 1998, 602 pp., $79.95.

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The author of this monograph is a nationally known attorney in the field of mental health law. As the subtitle of the book suggests, the subject matter is surprisingly wide-ranging in view of the apparent narrowness of the main topic. This range is a major strength of the work and a central element of the book’s value to clinicians and scholars alike.

The book is divided into six parts (subdivided into chapters) as follows: Testimonial Privileged Communication (addressing patient’s rights to exclude medical/psychiatric material from legal settings); Psychotherapy and Privilege Problems (addressing particular areas of concern, such as child custody, group therapy, and criminal cases); Termination of Privilege; Psychotherapy and Confidentiality (covering a spectrum of topics from treatment of minors to fee collection as they impinge on confidentiality); Recordkeeping and Accountability; and, finally, Evidential Use of Therapist Versus Forensic Expert Testimony.

The three appendixes contain statutes on medical and psychotherapeutic privilege; the oral argument before the U.S. Supreme Court in Jaffee v. Redmond, an important case involving psychotherapist privilege; and the text of the decision in that case. The appendixes will likely be of greater interest to legal and forensic scholars than to the practitioner.

Although some of the content will be of legal and scholarly interest, Professor Slovenko excels in taking the reader through the theoretical background to the practical applications of the subject matter. The content is exceptionally valuable, usually clear, far-reaching, and liberally sprinkled with witty and relevant cartoons drawn from a wide variety of sources. The prose itself is similarly sprinkled with allusions to literature, movies, ancient Rome, and O.J. Simpson.

Some particular strengths of the book are its sophisticated discussion of the topic of record-keeping and several chapters covering issues almost never discussed in a systematic manner, such as confidentiality in groups and in the context of fee collection. The excellent chapter on confidentiality in group therapy, moreover, is rendered even more unusual by the author’s inclusion of a verbatim interview he conducted with members of a therapy group, exploring their views on confidentiality.

I have only two criticisms of any significance. The chapters at times seem to have the paragraphs placed at random; the linear and logical development of an idea is sometimes missing. Second, the author has an occasionally annoying tendency to resolve a paragraph describing conflicting views with a final rhetorical question rather than a recommendation from his vantage point as a highly knowledgeable attorney as to what strategy would be best. These cavils aside, this textbook is an excellent resource on an important and often sensitive subject that covers material essentially unavailable elsewhere.

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