Tampa Bay Psychoanalytic Society Scientific Meeting 2-9-08 "Expanding the Domain: Privacy, Secrecy, and Confidentiality"

by Jack and Kerry Kelly Novick

Jack and Kerry Novick, Ph.D.s and both Child, Adolescent, and Adult Analysts, on faculty at the Michigan Psychoanalytic Institute (Ann Arbor), the NY Freudian Society, and the Tampa Bay Institute for Psychoanalytic Studies, gave a most helpful clinical paper. They discussed the increasing acceptance of the practice of seeing both child and parents, whether this is done concurrently, and how frequently, as well as what is disclosed to each. They note that D.W. Winnicott said there was no such thing as a baby, only a mother and a baby.

In working with children and adolescents, they advocated discussing early in treatment, with both patient and parents, the distinction between privacy and secrecy. Privacy is the right of every person to keep her or his inner world of thoughts and feelings to her/himself, or just between patient and analyst, and to choose when and with whom to share what is in her/his mind. Secrecy is motivated by the wish to withhold and thereby feel powerful in relation to an excluded other. Privacy is not secrecy. And any secret can be the object of analytic scrutiny. The analyst supports the privacy of thoughts and feelings while simultaneously examining, in their respective therapeutic arenas, the actions of both child and parents. As adolescents learn in therapy to better distinguish between privacy and secrecy, they discover an increased freedom to share only what is helpful with their parents and learn they need not divulge everything about their private life.

Parents, like analysts, are interested in the forward developmental movement of their child. The analyst forms an additional alliance with them by discussing the dual goals in therapy of 1) restoration of the child to a progressive developmental path, and 2) restoration of the child-parent relationship so that each may be a life-long resource for the other. The Novicks discuss parental concerns openly with the parents, e.g. the fear of losing the child. One hope of treatment is to facillitate communication between parent and child. Inclusion of parents in treatment increases the chance of both retaining the patient and the success of the treatment.

A clinical example illustrated the harmful impact on a child of a heretofore undiscussed family secret. When brought into the open during a session with the parents, the parents were then able to acquire the tools, and courage, to discuss it with their child. This greatly relieved the self-denigration which had resulted from the imagined explanation by the child of family events, and it improved the marital relationship.

When parents feel helpless, they often expect the analyst to act in their stead to police the child. The Novicks call this an externalization (of superego, a defense just as likely applied by the child). The analyst, however, promotes the parents as central in the child's life and development, as well as primary in being responsible for the child. Therapy simulataneously promotes the child's capacity to self-regulate. Dr. Novick will ask if the patient is being a good parent to her/himself. (If not, this may indicate the child's modeling of parents in their lack of parenting.) The analyst does not turn a blind eye to lack of appropriate behavior and supervision on the part of the parents. Parents need to support appropriate controls which aid in the child's development. They need to see both a child of growing strengths and competence and the need for provision of continuing parental supervision.

So how is confidentiality managed? Confidentiality is seen as a basic component of any treatment, but it is placed within a hierarchy of other values. The analyst emphasizes that therapy is a safe and private place in which to explore one's most private regions of self, and which allows for and respects competence, creativity, and love. The analyst emphasizes the difference between private thoughts/feelings and actions, which are public. Both privacy and safety are maintained. The latter includes letting the parents know of dangerous actions to aid the safety and comfort of all family member in the therapeutic situation. The Novicks enumerated some of the behaviors which arise in adolescence: drug use, unprotected sex, eating disorders, gang activity, suicide and murder, delinquency.

The Novicks redefined separation and separateness. Physical separation does not equate with psychological separateness. [I would insert here, as the Novicks intimated, that a goal of development includes both a sense of self as separate, balanced with a capacity to, not only see the other as separate but, maintain a connection between separate selves, that is, to develop both autonomy and attachment or relatedness.] When the analyst colludes with an adolescent to withhold information about the patient's dangerous activities, this secrecy impedes development by creating an illusion of separateness. The clinical example of a suicidal young man, about to embark for college, was discussed. Dr. Jack Novick had asked the youth if his parents knew of his intention to shoot himself with his father's accessible gun, encouraged the youth to tell his parents, then arranged an emergency session with parents and youth to arrange how to keep the young man safe.