ABSTRACT
There are extreme situations in which it may not be possible to maintain confidentiality for clinical, ethical, social, or political reasons. Otto Kernberg, who over the years has been an astute commentator on the internal organization of psychoanalytic institutions, as well as a noted theoretician, reviews these situations and ventures into larger social issues pertaining to the field. Kernberg argues that whereas confidentiality is a fundamental aspect of the psychoanalytic frame, it may be justifiable in certain circumstances for the analyst to stand “outside an unjust law” in order to maintain the therapeutic commitment to the patient. For the same reason, Kernberg asserts that the profession as a whole is justified in resisting medically inappropriate health-industry intrusions on the patient's privacy. He also points out that confidentiality requires a sharing of basic social values in the analytic partnership; when this is not possible, as in totalitarian societies, psychoanalysis will be difficult or impossible to practice.
