Guarding confidentiality in clinical groups: the therapist's dilemma

Damaging Experiences in Therapeutic Groups

Many consumers who are seeking support and affiliation are treated in a variety of group settings. Yet, even with sustained popularity, groups are not always helpful and can be dangerous. This article uses clinical case studies to delineate the transactional dynamics of damaging group experiences. Interviews with 33 individuals who met the criteria for being considered group casualties were analyzed to understand what factors precipitated dangerous group events. Three interrelated domains are discussed: individual attributes and actions that place group members at risk of becoming group casualties, group attributes and actions that create a toxic atmosphere, and leader attributes and actions that cause damaging group experiences. Damaging leader behavior, characterized by what the leader does or does not do, was the most destructive of the three domains. Implications for practitioners and guidelines for preventing damaging group experiences are suggested.

Confidentiality Dilemmas in Group Psychotherapy

This article examines how 100 experienced group psychotherapists report that they would manage problematic ethical incidents related to confidentiality. Findings suggest a relation between therapist gender, office location (private practice, public outpatient, hospital), degree of societal threat explicit in the incident (e.g., threats ofphysical endangerment), and management strategies. There is also some indication that psychoanalytically oriented group therapists are less likely than non-analytically oriented clinicians to contact authorities when confronted with psycholegal issues. Limitations in the study and directions for future research are discussed.

Confidentiality and Privileged Communication in Group Psychotherapy

The concept of confidentiality is fundamental to all forms of psychotherapy. The idea of protecting confidential material goes as far back as the Hippocratic Oath in ancient Greek history. Centuries later, authors continue to assert that "only by maintaining confidentiality can the essential groundwork of trust in treatment be developed" (Hough, 1992, p. 106). Others have even argued that without confidentiality, psychotherapy has no value (Epstein, Steingarten, Weinstein, & Nashel, 1977). Confidentiality in group psychotherapy is more complicated than in individual therapy because self-disclosure is at the core of group therapy and there are numerous people hearing the disclosures. Confidentiality in group therapy, once ignored in the literature on ethics, is gaining more attention as this modality becomes more widely practiced; so too is an acknowledgement that ethical dilemmas surrounding confidentiality in groups are commonplace. This article discusses the major considerations and dilemmas on confidentiality in group psychotherapy. We first review confidentiality broadly and discuss the ethical principles that are related to confidentiality. In the next section, we discuss the complexities of confidentiality in group psychotherapy. Finally, we review research on confidentiality in groups and describe common ethical dilemmas.

A prática grupal e o discurso sobre a ética em documentos oficiais

Os profissionais envolvidos na prática grupal enfrentam desafios éticos característicos do contexto grupal. Buscando contribuir para a reflexão sobre o discurso ético nas práticas grupais, esse artigo tem por objetivo compreender de que forma as normatizações éticas de organizações voltadas à prática grupal descrevem e propõem a ética em grupo. Metodologicamente, realizamos uma análise crítica dos principais temas presentes nos documentos da American Group Psychotherapy Association, International Association for Group Psychotherapy and Group Processes e Association of Specialists in Group Work. A análise identificou: a) princípios de bioética principialista em todos os documentos; b) diferentes descrições de grupo, coordenador e participante; e c) ênfase ética no terapeuta como profissional, mais do que na prática grupal. A análise realizada sugere que os documentos buscam contribuir com a institucionalização da profissão e respondem a uma demanda social por responsabilização pela prática profissional.

Ethical hot spots of combined individual and group therapy: applying four ethical systems

Abstract Combined therapy presents ethical quandaries that occur in individual psychotherapy and group psychotherapy, and dilemmas specifically associated with their integration. This paper examines two types of ethical frameworks (a classical principle-based framework and a set of context-based frameworks) for addressing the ethical hot spots of combined therapy: self-referral, transfer of information, and termination. The principle-based approach enables the practitioner to see what core values may be served or violated by different courses of action in combined therapy dilemmas. Yet, the therapist is more likely to do justice to the complexity and richness of the combined therapy situation by supplementing a principle analysis with three additional ethical frameworks. These approaches are: virtue ethics, feminist ethics, and casuistry. An analysis of three vignettes illustrates how these contrasting ethical models not only expand the range of features to which the therapist attends but also the array of solutions the therapist generates.

The group psychotherapy movement at the millennium: some historical perspectives

Although almost a century old, group psychotherapy has experienced an unprecedented expansion over the last 50 years. By the 1970s, human helping groups had found application in virtually all the human services, including the media. The growth of professional organizations for group work specialists was accompanied by a burgeoning literature and by accelerated research endeavors. The recent advent of the managed health care "revolution" has shaken the very foundations of this prospering group psychotherapy movement. Undue pressure from third-party payers for greater accountability and for cost-containment has come to threaten the traditional autonomy and dedication to quality of care by group therapy practitioners. Professional organizations have begun to meet these challenges by educational endeavors addressed at insurers, legislators, and the public. Current training programs and literature for clinicians have focused on the need for a new "business orientation" and on less costly group treatment measures (i.e., short-term and combined). Given group therapy's proven effectiveness, coupled with its practitioners' flexibility, the movement is bound to regain its secure footing at the dawn of the new millennium.

Confidentiality in group psychotherapy: empirical findings and the law

Empirical research suggests that group therapists generally discuss with prospective clients the importance of maintaining confidentiality, but are unlikely to inform them of the significant potential for violations of confidentiality. Therapists believe information about the risk of unauthorized disclosures will reduce the number of patients willing to enter group therapy and will inhibit the therapeutic dialogue. Therapists' failure to provide information sufficient to obtain informed consent, however, produces serious ethical problems and potential legal problems as well. The law of informed consent varies in different jurisdictions such that identical factual scenarios could produce different legal outcomes depending on the jurisdiction in which the case occurs. In spite of the proliferation of group interventions, empirical studies of confidentiality in group therapy have lagged behind similar research in individual psychotherapy.