Communications In Group Or Family Therapy

When therapy includes more than one individual, as in group and family therapy, clients have a right to know in advance, as part of the informed consent process, any limitations of privacy, confidentiality, or privilege affected by the presence of more than one client. For example, if a clinician is providing family therapy, will he or she keep confidential from other family members information conveyed in a telephone call from a minor son that he is using drugs, from a minor daughter that she is pregnant, from the father that he is engaging in an extramarital affair and plans to leave his wife, or from the mother that she has secretly withdrawn the family's savings and is using it to gamble?

Therapy involving more than one client emphasizes a major theme of this book: trust. The therapist and members of a therapy group may assume that everyone involved is trustworthy. But what if that is wrong? What if, for example, one of the group members is a newspaper or magazine reporter gathering information for an exposé of what the reporter considers bogus therapy groups, or of the therapist, or of what the reporter considers a "culture of dependency"? Or what if one of the group members later decides to write a memoir to be published in a magazine or book about what the experience of group therapy was like? Or what if some of the group members simply pass along what they learn about other group members to their family and friends and that information ripples outward to those who recognize and know members of the group? Group and family therapists must struggle with these difficult issues in a way that respects the clients' legitimate rights to privacy, confidentiality, and privilege and their right to know the limits—both legal and practical—of their privacy, confidentiality, and privilege.

Therapy involving more than one person also presents challenges to documentation. If, for example, the therapist keeps one set of therapy records for "the family" or "the group," what happens if one member of the family or group requests or subpoenas a copy of those records? How can a therapy record that mentions more than one patient by name be turned over without the informed consent or legal waiver of each patient? One of the approaches that some therapists and counselors use is to maintain a separate chart for each client in a family or group.

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