Consultation, Please
April/May 2003 

Dear Consultant:
I am a male psychologist who is in an ongoing peer supervision group in which we have always had a rule about confidentiality within the group. I recently learned from one of my most difficult patients that she is dating a psychiatrist. As she described him, I realized that he is a good friend of mine. I brought up my dilemma in the supervision group, even though I knew that there could be potential boundary crossings. I spoke of wanting to warn my friend (though I did not identify him) about my patient's destructive tendencies in relationships and also asked for help from the group in dealing with this patient. As it turned out, several members of the supervision group thought they recognized my friend, and one of them went outside the group to share this situation with him. The psychiatrist confronted me and is angry that I "talked about his personal life in a supervision group" where he also knew other therapists. I felt angry and betrayed and brought his confrontation back to group. The group now feels very unsafe to me and to others in the group, as we all feel in a dilemma. What can we do as a group to deal with our issues and to repair the boundary crossings and violations that have occurred? I know it is my issue from the past, but I just want to pull out of the group.

Sincerely,
Ambushed by Friendly Fire

Dear Ambushed:
Do you feel like shooting back real bullets? You were under fire on at least two fronts: the betrayal of confidentiality by a group member and the defensive response by your friend. It might have been helpful if someone in the group had reminded the others of the delicacy of the situation and the agreement you had regarding confidentiality in the group. Here was a group process happening within a broken container.

Issues from your past, you say? I suppose that it could be said, there are issues from our pasts in everything we do and in every emotional response we have. However, to paraphrase Tina Turner, in this case, "what's the past got to do with it?" You have more than enough cause in the present to feel unsafe in that group. In my opinion, the best way for your group to deal with the issue openly is to deal with the break in confidentiality and the damage that it has done to your trust with each other.

I think what happened in your group involved an unconscious "parallel process." What was enacted comprised the very dilemmas for which you appropriately sought consultation, advice, and collegial support. We all should seek such guidance when we find ourselves on the slippery slopes of boundary blurring, and in this case, anxiety regarding ethics and the possible loss of collegial relationships. We hope our trusted colleagues are experienced enough to maintain their own footing when we need shoring up.

The next time you need consultation when there are boundary issues, don't be so trusting just because you are with a group of therapists. Frankly, I think as mental health professionals, we have a tendency to be too trusting of them and not of our own instincts, and to be too fast to excuse others, even when we feel hurt or betrayed by them. In the same way that people sometimes "blame the victim," we therapists can sometimes hurt ourselves by falling into self-blaming introspection. We tend to believe that we should be more mature than others and that psychological insight will allow us to rise above anything and be able to repair any interpersonal problem.

Some situations are toxic, however, and your group appears to be in one of those. As you learn to trust your instincts, you may feel it is important to leave the group or you may insist that there is a need to bring in a consultant to help the group determine how to heal the damage that was done and work towards a renewal of trust.

If you decide to leave the peer supervision group, I'm sure you can find another group, perhaps at AGPA meetings or through the AGPA website (www.agpa.org), where you could find resources in your geographic area.

Saul Hopper, PhD, CGP
Fort Collins, Colorado

Dear Ambushed:
It is quite a dilemma, indeed. I wonder if what happened in your peer supervision group is parallel to something going on in your patients' group? How is the patient difficult? What did it mean to you that she was dating someone in the field? Why did you want to warn your friend? Were you concerned that he could not take care of himself?

Anne Alonso, PhD, CGP, DFAGPA, says, "Just don't do something, sit there." This sounds like the need to fix versus the need to understand. It appears that your feelings of helplessness and concern were communicated to your colleagues. It seems that the group couldn't contain this case, and the container leaked when another person thought it necessary to warn the psychiatrist.

The group needs to review its contract. What did it mean to the members of the group and the group as a whole when you discussed a case that involved someone that several people knew? Everyone needs to state his or her feelings concerning the boundaries that were crossed and the violations that occurred for them and for the group.

The group might also want to consider bringing in an outside supervisor for a few sessions. This might help to reestablish the boundaries and restore safety.

Felicia Einhorn, MSW, CGP
Delray Beach, Florida

This Consultation, Please column was published in the April/May 2003 issue of The Group Circle.