Deviation from confidentiality and the therapeutic holding environment

It is an accepted premise that certain ground rules of treatment are crucial to successful outcome. One such ground rule, confidentiality, has been replaced by such deviations as contact with relatives of the patient and with arrangements for other professionals to be involved with the patient. This last deviation is discussed in relationship to the "secret self" and the boundaries of the bipersonal field. During the in-patient treatment of a borderline personality, deviations from confidentiality incited an aggressivized reaction, a mixture of transference and nontransference leading to acting in and acting out. This failure to maintain the boundaries of the therapeutic relationship led the "secret self" to fear annihilation; the distance of the "rapprocher" was increased; and the "non-ego" reached a crisis. This patienterminated treatment prematurely. Some implications of this deviation from confidentiality for other settings are discussed.