Confidentiality vs Secret Keeping in Group Therapy

Without guidance it’s easy for members of group therapy to do old patterns of secret keeping when trying to maintain confidentiality. Clients, especially those with parents that experienced trauma and/or addiction, may have been instructed as a child to not speak about what goes on at home. Without a clear explanation of what is okay to speak about in regards to group therapy, it’s easy to repeat historic patterns. When asked about a group, and a client says “I’m not allowed to talk about it”, that’s actually not true. So what can clients speak about while maintaining confidentiality of other group members?

General Topic

It’s important for clients to be able to speak about the topics covered in group therapy. Speaking about general topics, such as childhood trauma and the long term impacts, can support the client in educating their support network about what they are working on and ways others can offer them support.

Their Experiences

Clients may speak about their personal experience in group therapy. It’s important for clients to be able to speak about their insights, challenges, hopes, and practices to others in their life.

The Therapist

While the therapist must maintain confidentiality of all group members, and group members must maintain confidentiality of all other group members. Anything the therapist says or does may be talked about to others. Clients are encouraged to bring up concerns or disagreements to the therapist and practice direct communication. The clients may relate lessons or stories shared by the therapist to others. 

Finally, it’s also important to speak to and have a written agreement about the consequence of not maintaining confidentiality.

Who goes first?

There’s many ways to choose which person to lead with in a group session, and I will cover some other options on how to choose llater on. The choice I repeatedly make is by choosing a group member who has been vulnerable in check-ins and warm ups. This member can role model to others in the group and in turn support the releasing of overly protective parts in other group members so deeper work may be done.

Parts of a Group Therapy Session, Part 2 – The Warm Up

After your clients have mentally arrived through the grounding exercises, it’s time to begin the warm-up. The warm up is a time for clients to start thinking about what’s most important for them to work on, while fostering internal and external connections. It can be a time to awaken both sides of the brain through metaphorical thinking. I was taught by an amazing facilitator at Onsite, that there’s no such thing as resistance, only not enough warm-up. The following are some possible warm-up exercises, with an emphasis on metaphors:

The Keys

Ask the clients, “Think about the most meaningful thing you could unlock for yourself today. What is it that you want to unlock? What key unlocks this for you and why?” Inspired from workshop on Onsite.

Stature or Movement

Guide participants to think about what they want to achieve or work on today, and how that would translate into a feeling in their body, and how this feeling would lead into either their stature or in their movement. Each participant will have a turn expressing what they would like to work on today, and how working on that would be evident in their body through their stature or movement.

Yeses and Nos

Have all group members pair up, while one person only says yes, one person only says no for 30 seconds to a minute, then have participants switch roles. Ask each member what they were saying “Yes” to. Then ask each member what they were saying “No” to. Lastly, ask if anything else came up for them around their reactions to the exercise. Group member with specific explanation of who or what they were saying Yes or No to are warmed up and ready to do work. Inspired from workshop on Onsite.  

The participants answers will guide the experiential work done in session. With practice, as you listen to their responses, you will be be able to pair meaningful exercises with each response. These are just a few of the hundreds of possibilities. You will be able to determine what warm-up best suites the group’s needs. The group could be very low energy, so a movement grounding and warm-up can support them in energizing while connecting with their bodies.

Group Therapy Session Parts, #1 – The Grounding

Your clients have just arrived for their group therapy session, and, likely, they have dozens of topics on their mind and very few of these thoughts might actually be about where they are now. I find it beneficial to open each group and individual session, with a grounding, resourcing, or mindfulness exercises. This supports clients in practicing these tools, while supporting them in landing in the here and now. The following are some suggestions:

Breathing Exercises

I like using a Hoberman Sphere when demonstrating breathing techniques, to represent inhales, holds, and exhales. You can pass the sphere in a circle allowing each client to be able to guide the group in breathing.

Senses Exercises

  • 5 Senses Mindfulness Exercise
    • An augment I made to the 5 sense, is in explaining the exercise I will either que the group to focus on sensations far away and then bring it closer or even internally, or to start close and then allow the awareness to expand further and further away. The way I choose depends on what the group needs more, are they scattered and need help focusing inwards or are they too internally focused and need support in expanding their focus.
  • Safe Place Exercise
  • Silly LIttle Questions
    • This helps increase activation of the pre-frontal cortex for clients that may be more stressed upon arrival to group. Examples of Silly Little questions include:
      • How many yellow items can you see?
      • How many different scents can you notice?
      • How many shades of green can you currently see?
      • How many textures can you feel?
  • Taking in the Good

Movement Exercises

Take your time introducing and explaining exercises. Let the clients know about the physiological and neurological benefits. After you have lead clients through the exercises a couple times, empower them to co-lead the exercise with you, then to lead the exercise on their own. Encourage clients to practice these exercises every day. If they are able to repeat these exercises for 20-30 seconds 8-10 times a day, it can support increasingly being able to access calm states when under stress. Ways to incorporate regular practice could include setting a phone alarm or through marking, such as every time one walks through a door or washes their hands.