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Group vs. Individual Confidentiality

In individual therapy, the client, whom is disclosing the information that must be kept confidential, and the therapist are the only ones involved in the treatment process so the burden of ensuring confidentiality is maintained is on the therapist and the therapist alone (Lasky, 2006). In a group setting, the burden of confidentiality is shared amongst all members of the group, as well as the therapist. Each member of the group is disclosing information and listening to the information disclosed, and the therapist cannot force all group members to keep the information shared confidential. Thus, there is significantly more room for a breach in confidentiality. This is problematic because, where individual therapeutic success relies on the client developing the trust and relationship necessary to share personal information with the therapist, group therapeutic success relies on group members developing that same level of trust with the entire group. Therapists can guarantee that shared information will be kept confidential in individual therapy, but in groups, group members may breach that confidentiality accidentally or may have outside relationships that motivate them to do so purposefully.

Ensuring Confidentiality in an HIV/AIDS Group

In order to promote confidentiality, I would start my initial group meeting by detailing the concept, importance, and process of maintaining confidentiality, and I would work with the group to establish consequences for breaching group confidentiality so that members could hold one another accountable (Lasky, 2006). At the end of each meeting, I would reiterate how confidentiality acts as a form of mutual respect among group-mates and give a brief example of what breaching confidentiality looks like and how to avoid it. For example, if the group discussed the negative associations with their HIV/AIDS status (Plummer, 2014), I might relate that to an example of unintentional negative consequences associated with breaching confidentiality in the group (Lasky, 2006).

Informed Consent

Informed consent is another way of addressing confidentiality in a group setting. It outlines what confidentiality is, explains its limitations (Lasky, 2006), and provides a starting point for therapists to address and expand upon confidentiality as needed for the individual client. This informed consent allows clients to be aware of potential consequences to what they say so that they can make informed decisions on what they do and do not feel comfortable sharing in a group setting.

Group Confidentiality Breach

Because therapists cannot ensure that a breach in confidentiality will not occur in a group setting, they must prepare for the eventuality of its occurrence. If groups discuss consequences for a breach in confidentiality prior to it happening, then the group, in addition to the therapist, can hold those responsible for the breach accountable in the agreed upon manner. These consequences can help with preventing future disclosures, but they do not help the group rebuild the trust impacted by the action. With group members likely feeling angry, hesitant to continue self-disclosing, and betrayed (Lasky, 2006) it would also be beneficial to have a discussion with the group where they can discuss their feelings on the matter, gain emotional support, and rebuild their trust.

Resources:

Lasky, G. B., & Riva, M. T. (2006). Confidentiality and privileged communication in group psychotherapy. International Journal of Group Psychotherapy, 56(4), 455–476.

Plummer, S.-B., Makris, S., & Brocksen, S. M. (Eds.). (2014). Social work case studies: Concentration year. Baltimore, MD: Laureate International Universities Publishing [Vital Source e-reader].

“Working With Groups: Latino Patients Living With HIV/AIDS” (pp. 39–41)