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Shhh! Confidentiality in group therapy: It's no joke

What's so wrong about asking members to keep a secret?

Members of an ongoing therapy group are often asked to keep what happens in the group quiet. They are asked to keep a secret. Therapist and agencies alike seem to think this is is a good idea, with the notion that when someone shares in a group their story would not get out.

But the is exactly the wrong way to go about confidentiality, and yet my experience has been when consulting for agencies and hospitals, that this is the standard. "We do not talk about what happens in group." Is the mantra the members receit.

But they have to and need to talk about what is going on in group in an effort to heal. The problem is members need guidelines.

What's so wrong about asking members to keep a secret? In a previous post I've identified corrective recapitulation of the primary family as the cornerstone of therapeutic gain in group. This means that we will (hopefully) correct the original dynamics present in the family. When this happens members of the group learn how to assimilate the projections instilled by their family, and relate to people in the group, then the world, in a different way.

But if your family of origin had a family secret, if dad was an abuser, if mom was alcoholic, and you were told by the family "Not to tell what goes on in this family," Then you are stuck with having to keep the family secret.

Group members who are told not to tell what is going on in group are then given the same message. Instead of a corrective experience of their family of origin, theny are getting the same old thing. Keep quiet about what we are doing here. As you are probably aware this is the central pathology of cults as well. We don't tell outsiders what we do.

True confidentiality then must take into account the fact that members must honor the anonymity of people in the group, while being taught how to speak up outside the group about their issues and needs. Here is how this can be done.

At the beginning of a new group being formed the members are given an instruction on how to share information from in the group to the outside. In essence a variety of examples are covered. A typical example would be for a member who has hared deeply in the group that her father's alcoholism ruined the family. He was physically and sexually abusive, and eventually lost his job because of it. In this type of sharing other members would talk about the pathology they encountered in their families.

To maintain confidence, while still being able to share members would be taught that when talking about the group to others you leave all the identifying material about the other member out of the conversation, and you say what got activated for you as a member in the group. Your reaction is yours to share, and the origin of it, the details of it, are kept confidential.

In the above example the member wanting to talk about her reaction to it would say something like: " My group was talking about problems with addiction in the family growing up, and got me to thinking that my mom was actually addicted to prescription drugs. I'd never thought about it before, but our lives were in orbit around her mood."

In this way the confidentiality of the member sharing the information initially is protected, while the work of the individual talking outside the group can continue. The opportunity to give other examples of the group is done regularly through the sessions, with particular emphasis on reasserting the examples and expectations each time a new member joins. With my on-going groups the members give the examples to the new person.

Finally, one of the duties of the facilitator is to be clear about what happens if a member breaks confidentiality. This can include being removed from the group, being sanctioned by the group, or being removed from the group for a period of time so that the infraction can be more thoroughly reviewed. Members are encouraged to talk about the issue in group if it feels safe enough to do so, and with the facilitator privately if it is not.

For facilitators the general rule is not to reveal anything in group that you are currently struggling with yourself in your own life, and if you do reveal anything be certain it is an issue you are willing to let out into the world. When I train facilitators of group I explain to them that while they are part of the group, the way the members treat the facilitator is more like a parent, and if the parent has defaults, part of the healing process for members may be to identify them to the outside world.

I encourage them to reveal only those issues they would feel comfortable publishing in their memoir. In this manner everyone, including the therapist, can feel safe in the group.