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Suspense Novel Probes the Limits of Confidentiality

By Susan Moses, American Psychological Association Monitor, Volume 5, number 3 (1991)

Twenty-one years ago, Stephen White was a college student with his eye on a creative-writing major. Then he got two D's and an F in his first writing course.

He quickly shelved that dream and turned towards psychology.  In the intervening years, he's earned his PhD in clinical psychology, been a researcher, professor, hospital psychologist and independent practitioner.  He wrote several journal articles, but never another word of fiction.

Until "Privileged Information", that is. 

That's the title of his suspense novel, which was released by Viking Press in July.  It's a psychological drama that reaches into the darkest corners of the issues of confidentiality between psychotherapists and their clients.

When psychologists ask what the book is about, White tells them, "It's about your worst nightmare arriving in your waiting room."

The novel's main character, Alan Gregory, is a Boulder, Colorado, practitioner with a string of attractive female clients who are mysteriously ending up in the morgue.  Gregory is quickly mired in a public battle that threatens his practice and his reputation, and he must wage it while handcuffed to his former clients' privilege of confidentiality. 

Gregory also harbors a suspicion that another one of his clients may be the murderer and may strike again— perhaps closer to home.  But is that grounds for abrogating the client's privilege, or merely the countertransferential delusion of an exhausted therapist facing an unruly client?

In writing the book, White was worried that his colleagues would frown on his pulling deeply private issues of psychotherapy into the public domain.  But at least a hundred psychologists read it before it was published, and "their response has been very gratifying, almost all the way along," White said.

Practitioners have been especially responsive to the specter of fear the novel raises, he added.  "It's a real fear.  All of us feel vulnerable."

In the writing, he tried "not to trivialize the work that we do, and I hope I've been successful in that.  I like to think that I am writing about an experience that's at least partly universal for those of us who work with patients."

White, 39, is a full-time independent practitioner who sees mostly adult clients. He is especially interested in the effects of marital separation and divorce, though early in his career he worked with terminally ill children.  He is married and has one child.

The hardest part of writing the novel, he said, was attempting to translate complex issues into lay language without oversimplifying them: transference, countertransference, the subtleties of a client's privilege and a therapist's duty to protect the public.

That legal duty was outlined by the landmark 1976 case, Tarasoff v. Regents of the University of California, which justified breaking a client's privilege when the client makes an immediate threat against a readily identifiable victim.  Other courts have expanded the duty, but some states, including Colorado, have limited it to the provisions of Tarasoff.

His fiction mirrors his life in several ways. White and Gregory are close in age, and both practice in Boulder, although White lives in Denver. Gregory also "sees a population that's not unfamiliar to me, and in that sense, there are shared experiences," White acknowledges. 

But "I bent over backwards to leave any patients I've ever seen out of this book," he maintains.  And while some of his real patients have been frightening, "if any of this stuff had ever happened to me, I would have gotten out of this business," he joked.

If he were caught in Gregory's exact dilemma, White believes he might cope a bit differently. 

"I wanted him to do some things that were less than perfect," he said.  "One of the things I wanted to create was a character who was under a tremendous amount of stress."

In addition to its roots in White's practice, the novel grew out of his work as a member of the Colorado Psychology Association's ethics committee in the late 1980s.  During that time, he turned the Tarasoff ruling over and over in his mind, and began to wonder what would happen if a psychologist, based on clear intuition rather than a clear threat, believed that a patient was going to commit a violent act.  Where would the therapist's responsibilities to the patient and the public lie?

"If this dilemma had not been so clear in my mind, I don't think I would have started writing," White said.

Though he hasn't written other fiction since his undergraduate days, he describes himself as a voracious reader of a wide range of novels, including mysteries. 

White cut back on his practice in order to do the work, writing in the early mornings while taking care of his young son.  However, he didn't set out to write a full-length novel.  It was not until about two months into the writing that he sat back and realized he had created a mountain of paper.  "I said, 'this sort of looks like a book,'" he recalled. The final draft of the novel took about 6 months; the rewriting, another year.

White then spent a year making queries to literary agents in New York, trying to find one who would take on the task of selling the novel to a publisher.  When that didn't pan out, he sent a copy of the manuscript to "anyone who would agree to read it, and one of those readers had a friend at Viking and passed it along."

"Viking was the first publisher to see it, and they bought it," White said.  "People tell me [then] that it's a real Cinderella story and I certainly feel fortunate."

Indeed, White felt fortunate enough that he's "within pages of finishing book two" – another psychological thriller.  But this time, the questionable character is not a rogue client but "a therapist," he said.

"I think it was a pretty psychotic act to start writing," he added.  "I had no sense of what I was up against and that's probably pretty fortunate. It's really just been fun."      

 

Line of Fire by Stephen White

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The Last Lie (paperback) by Stephen White

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