As the century draws to a close, information flows more generously and privacy withers. This is true of the general society but has even more ominous effects in psychology. This note is an encapsulated version of a paper delivered at the A.P.A. meeting in 1999. It surveys the present state of therepist-client confidentiality in Telehealth and makes a few modest predictions about the immediate future.

• Clients expect privacy beyond the ability of practitioners to provide it.
• Confidentiality is probably an important prerequisite to treatment.
• The United States Supreme Court has upheld its importance but
• The law forces reporting of child abuse and, in some states, elder abuse.
• Tarasoff requires warning an identified potential victim.
• The therapist may use client information involuntarily to commit.
• The therapist may use client information in legal self-defense.
• Insurance companies want client information related to payments.
• Managed care providers want even more information

The federal government, notably but not exclusively in HIPPA, has required confidentiality but has made exceptions that are very broad The Secretary of H.H.S. promulgated rules which allow overriding client confidences in areas of national priorities. Four were identified:

• to combat waste and fraud
• to control infectious diseases
• to promote research
• to assist law enforcement

The latter two are frighteningly broad although present specific interpretations are not.

Furthermore, a national register of all patients and clients is required and the federal government is to be its guardian with client/patient control sometimes limited to their being informed that their records have been provided to others.

The historic notion of a client's real control of the release of medical information seems substantially subordinated.

Perhaps Daniel Ellsberg's records could have gone to the Nixon administration if there had been such a law then. The information that can be subordinated to the national interests includes information which identifies specific patients. On the other hand, state legislation dealing with cyberpsych (Telehealth in psychology) is expressly more protective of privacy.

The California Telemedicine act expressly preserves patient confidences. It is a model for the new class of express cyberpsych legislation. Among other requirements of the Act is a requirement that records of telemedical sessions be maintained.

Other provisions of the act exclude telephone and electronic messages from the act and require real time or near real time sessions. Those provisions, plus obvious professional advantages, drive sessions toward interactive video. Arguably, tapes of those sessions would constitute parts of the required record.

We have no experience with the availability of verbatim session records. Consider what a trial lawyer in a malpractice case might do with them. Before the repressed memory cases, there was a dearth of malpractice litigation growing out of talk therapy.

Such records might change that as forensic psychologists testify about missed opportunities and damaging suggestions once they have studied the specific conversations.