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This Article reviews both the giving and the taking away: the protections afforded to confidentiality by privileges and legal duties, and the way those protections are eroded. The duties of professionals and others to maintain confidences are noted, but testimonial privileges are emphasized. This Article proposes reforms in the way we try to protect confidentiality and suggests that the protection of therapy confidences be dealt with as a coherent whole (privileges and obligations of confidentiality should be dealt with together). Exceptions to privileges should be reduced and narrowed, and federal law should recognize the desirability of a consistent approach to confidentiality. Perhaps most importantly, the transmission of some confidential information to third parties should carry with it a duty which would require the recipient to maintain confidentiality ("extended confidentiality").