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Shhh! Confidentiality in Group Therapy: It's No Joke

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

Key points

  • Many therapy groups approach confidentiality by asking members not to disclose anything that happens in their sessions to the outside world.
  • However, being able to talk about group therapy is key to helping members heal.
  • The best way for therapy groups to achieve confidentiality is to allow members to discuss the sessions outside, but without identifying details.

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

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

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 with asking members to keep a secret?

In a previous post, I 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 an alcoholic—you were likely told by your family "not to tell what goes on in this family." Then you were 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, they 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.

Achieving true confidentiality in group

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 instruction on how to share information from the group to the outside. In essence, a variety of examples are covered. A typical example would be a member who has shared 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 just 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. In my ongoing groups, the members give 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 a 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.

To find a therapist, please visit the Psychology Today Therapy Directory.

More from Dan J. Tomasulo PhD., TEP, MFA, MAPP
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