Confidentiality: Ethical perspectives and clinical dilemmas (original) (raw)

Book Reviews necessarily a straightforward process nor does it necessarily provide an accurate description of events in the past. The interaction of the history of trauma, symptoms, and the relationship of the patient with the therapist is complicated, dynamic, and changing and cannot be formula-driven. Furthermore, talking about trauma does not usually relieve symptoms, and on occasion, may exacerbate them. The author's treatment approach is hardly innovative and advocates supportive company, bibliotherapy, cessation of smoking, regular exercise, recovery from chemical dependence, sleep restriction, morning light, and spirituality, in addition to individual and group therapy. One is struck by the similarity to substance abuse programs in which something is done to or recommended to be done to or for the patient. The diagnostic omissions are striking. Never mentioned are current stresses, job losses, marital conflicts, psychotic disorder, family history of affective disorder, severe and current traumas such as rape, violence and harassment, all of which are extremely relevant and usually bring the patient to treatment. As an addictionologist, the author uses simplified formula such as in a recovery program. There is an implied denial of psychiatric evaluation and treatment. Nowhere does he recommend seeking a psychiatrist, the person best trained to recognize complex biological, psychological and sociological factors and place them in a meaningful formulation and treatment decision. Instead he advises seeking a licensed, qualified clinician. If I were a potential patient to whom this book is directed, what would I think of it? I might feel that someone finally understands me. I might feel that my therapist missed my trauma history, even if I couldn't remember it. I might feel that the antidepressant medicines I've been taking were not helpful and may be harmful, even if they greatly reduced my symptoms. (Interestingly, there are other medicines, such as adenergic agents which control symptoms of PTSD of which the author seems unaware.) I might avoid ECT, in spite of suicidal thoughts driven by delusions or hallucinations. The oversimplicity, partial truths, distortions and omissions of this book do not support its title, The Truth about Depression. Instead, they support the author's theories which are clearly incomplete.