The other day, I received a call from a colleague who had just read the section of my new book (Pepper, 2014) on dual relationships in group psychotherapy. In that section, I make the argument that since dual relationships involve outside the group contact, they are by definition unethical; they violate confidentiality. My colleague suggested that I read an article entitled,” Confidentiality in group therapy: empirical findings and the law” (Roback, Moore, Bloch & Shelton, 1996). He said that the authors’ thesis goes well beyond my own. I must admit that I was not familiar with the article, as an expert on boundaries and ethics in group psychotherapy, I should have been. In fact after having read the article, I wondered why every professional group psychotherapy organization doesn’t make this article required reading for all members be they seasoned clinicians or neophyte group therapists. The implications of this obscure and overlooked little piece are mind-blowing.
The authors, two of whom were lawyers, point out that from a legal perspective confidentiality in group therapy is not protected by law. One might infer therefore that group psychotherapy is inherently unethical because not only is confidentiality, in group therapy not protected , it is actually precluded by it. To quote: ” Historically under law, communications are usually considered not confidential if made in the presence of third parties…if the world knows about it, why not the court” (Roback, et. Al. pp.118-119). At the time that this article was written only two jurisdictions in the United States, the District of Columbia and Illinois, had passed legislation protecting confidentiality in group therapy.
That the very nature of group psychotherapy, consisting of more than two participants, excludes it from confidentiality laws may turn our professional belief system on its proverbial head. I can’t emphasize just how this is an alarming and earth-shaking realization. According to the authors, while many group leaders, but not all, ask group members to keep “everything in the room”, by far the vast majority of us don’t inform members that nothing that they say in group is actually confidential. Further, the authors assert there is a discrepancy between what leaders think that they inform members about in regard to confidentiality and what members report that they have heard the leader say. I know some group leaders who have prospective group members sign agreement documents about the rules of group treatment. But what good are confidentiality agreements and informed consent affidavits if they hold no legal weight in the first place? How many members sign these agreements and talk about members outside the group anyway? And how many prospective group members are put off by these formalities and then decide to not join group as a consequence? We await future empirical research to fill in the facts.
In my book, I write about the discrepancy between what group leaders and members believe about confidentiality—that most members agree, in principle, to keep it but don’t really understand the clinical reasons for it. Many members and leaders alike know that leakage occurs, despite the fact that this matter is rarely addressed in our groups. However, the Roback article goes well beyond that. It’s essentially saying that the belief that confidentiality, as an ideal to strive for in group, is actually a collective delusion. It doesn’t really exist. So in light of this– what are we to do? Should we all immediately disband our therapy groups and practice only individual psychotherapy? Is that the article’s implication? I think not.
There is no need to panic or dissolve our practices. If nothing else, this article reinforces the need for secure frame group treatment. That is, group members should be known to each other only on a first name basis and otherwise be anonymous to each other outside the group. Consequently, the article fortifies my thesis that dual relationships not only dilute the group treatment but also contaminate it. When members have outside-the-group relationships, breaches of confidentiality are inherent in the group treatment. Further, it is ironic that the Modern Analytic school’s concept of the contract is not only the best clinical model but the best ethical one as well. (It is ironic because of the Modern school’s notoriously apparent disdain for secure treatment boundaries through the endorsement of dual relationships.) The contract is “Say how you feel toward the members in the group and why you feel that way.” Leaders who encourage the group members to focus on the here and now and not on the there and then minimize the potential for disclosure of compromising personal facts. Group therapy conducted along the lines of a combination of group members’ anonymity, and the establishment of a group ethos that feelings take precedence over facts, extinguishes the possibility of looping (Pepper, 2014). Abiding by this type of blended contract may serve to reduce members’ apprehension that revealing compromising facts about their lives could come back to haunt them in another context, or, equally as untoward, wind up in litigation against the group leader.
References
Pepper, R.S. (2014). Emotional incest in group psychotherapy—A conspiracy of silence. Lanham, MD: Rowman & Littlefield
Roback, H., Moore, R., Bloch, F.S., Shelton, M. (1996). Confidentiality in group psychotherapy: Empircal findings and the law. International Journal of Group Psychotherapy, 1, 117-135.
I find your argument unrealistic. In this day and age even knowing someone’s first name can produce their identity. Telling members not to google each other is like telling them not to think about a pink elephant. Focusing on the here and now is essential but not being able to give some background is not workable.
I appreciate your thoughtful comments. It seems that you may be confusing to different types of breaches of confidentiality. The first is actually part of the treatment. There are some members who seek out information about others in the group without their knowledge. These members tend to act out ‘incestuous fantasies’ of having secrets on other members. It’s a character flaw. The leader’s goal is to help them to understand what emotions underlie this need for excitement. The second type, and more undermining of the group dynamic, is where breaches of confidentiality are inherent to the group structure, as in the case of dual relationships where members know each other outside of group.
Confidentiality is an illusion. Attempts by the therapist to enforce the rules of it only leads to more acting out.
Once again, there seems to be some confusion. The group leader expects members to default on the contract. While total privacy in group is not realistic, nor even expected, it is an ideal to strive for. I believe that only in instances where breaches of confidentiality threaten to undermine the emotional well-being of the group and its members, should the leader then ‘enforce the rules’. We, group leaders, function best when we are helping members understand how they feel toward each and why the feel that way. This works most effectively in a secure frame environment. Only in extreme instances are we called upon to step in hard and act as policemen when violations of confidentiality have iatrogenic consequences for the group.
Of course, I agree that is entirely appropriate for members to share emotionally charged experiences from their personal lives. It’s a matter of balance. The prime focus should be on the here and now rather than on the there and then; but if a member is having a real life crisis, it is important for them to share this with the group for support, comfort and understanding.