Is Group Psychotherapy Inherently Unethical? Robert S. Pepper1 issn 0362-4021 © 2015 Eastern Group Psychotherapy Society group, Vol. 39, No. 2, Summer 2015 159 1 Director of Training, Long Island Institute of Mental Health, Rego Park, New York. Correspondence should be addressed to Robert S. Pepper, PhD, CGP, 110-50 71st Road, #1E, Forest Hills, NY 11375. E-mail: DrRobertSPepper@aol.com. The other day, I received a call from a colleague who had just read the section of my new book (Pepper, 2014) on dual relationships in group psychotherapy. In that section , I make the argument that because dual relationships involve outside-the-group contact, they are by definition unethical; they violate confidentiality. My colleague suggested that I read an article titled “Confidentiality in Group Therapy: Empirical Findings and the Law” (Roback, Moore, Bloch, & Shelton, 1996). He said that the authors’ thesis goes well beyond my own. I must admit that I was not familiar with the article. As an expert on boundaries and ethics in group psychotherapy, I should have been. In fact, after having read the article, I wondered why every professional group psychotherapy organization doesn’t make this article required reading for all members, be they seasoned clinicians or neophyte group therapists. The implications of this obscure and overlooked little piece are mind-blowing. The authors, two of whom were lawyers, point out that, from a legal perspective, confidentiality in group therapy is not protected by law. One might infer, therefore, that group psychotherapy is inherently unethical, because not only is confidentiality in group therapy not protected, it is actually precluded by it. To quote: “Historically under law, communications are usually considered not confidential if made in the presence of third parties. . . . If the world knows about it, why not the court?” (pp. 118–119). At the time this article was written, only two jurisdictions in the United States, the District of Columbia and Illinois, had passed legislation protecting confidentiality in group therapy. That the very nature of group psychotherapy, consisting of more than two participants, excludes it from confidentiality laws may turn our professional belief 160 pepper system on its proverbial head. I cannot emphasize just how alarming and earthshaking this realization is. According to the authors, although many group leaders (but not all) ask group members to keep “everything in the room,” by far the vast majority of us do not inform members that nothing that they say in group is actually confidential. Furthermore, the authors assert that there is a discrepancy between what leaders think they tell members about confidentiality and what members report they have heard the leader say. I know some group leaders who have prospective group members sign agreement documents about the rules of group treatment. But what good are confidentiality agreements and informed consent affidavits if they hold no legal weight in the first place? How many members sign these agreements and talk about members outside the group anyway? And how many prospective group members are put off by these formalities and then decide not to join group as a consequence? We await future empirical research to fill in the facts. In my book, I write about the discrepancy between what group leaders and group members believe about confidentiality—that most members agree, in principle, to keep it, but don’t really understand the clinical reasons for it. Many members and leaders alike know that leakage occurs, despite that this matter is rarely addressed in our groups. However, the Roback et al. article goes well beyond that. It is essentially saying that the belief that confidentiality, as an ideal to strive for in group, is actually a collective delusion—it does not really exist. In light of this, what are we to do? Should we all immediately disband our therapy groups and practice only individual psychotherapy? Is that the article’s implication? I think not. There is no need to panic or dissolve our practices. If nothing else, this article reinforces the hypothesis that the modern analytic school’s concept of the contract is not only the best clinical model but, ironically, the best ethical one as well. (It is ironic because of the modern school’s notoriously apparent...