Thomas F. McGee, Ph.D., ABPP

The questioner is correct in sensing a need to report the alleged perpetrator. California law indicates that retrospective reporting of potential child and /or sexual abuse should be done, when the identity and location of the alleged perpetrator is known, and most particularly, when the alleged perpetrator is known to have present access to minor children. Therefore, there is little question that this report should be made, especially given the possibility that the “two young stepdaughters” mentioned in the question may be at risk for experiencing abuse.

With respect to managing this issue in the group, one part of the question is unclear. The questioner states, “The patient at first said she wanted to report this man, but later changed her mind.” It is not clear if this report was made within the group or if it was made in a private conversation with the therapist. If this disclosure had been made within the group that would tend to simplify matters, as it seems very important that this material and related concerns be brought into the group for in-depth discussion, and hopefully, resolution. If that were to be done, the therapist might inform the group that here is a legal obligation to report the alleged retrospective abuse, but that is would be valuable to receive input from other group members prior to making the report. Obviously, making such reports, when the alleged victim is unwilling to do so can often seriously affect the viability and continuity of the therapy. This might happen even if the alleged abuse were to be discussed in the group. However, there is an equally strong possibility, that discussion within the group might be helpful to the patient and facilitate her taking the lead in making the report.

If the patient has not discussed the alleged abuse in group, and is unwilling to do so, it is suggested that the therapist work with her individually for an appropriate period, strongly encouraging her to bring this material to the group. If she continues to refuse to do so, the alleged abuse would still need to be reported. Moreover, if the individual is not willing to bring this material to the group, and does not give the therapist explicit, written permission to discuss this material in the group, the therapist would run a serious risk of violating patient confidentiality, were she to disclose this material to the group.

The question underscores the importance of working with group members, both in preparatory processes and during psychotherapy to consistently work toward the development of an increasing sense of trust in the group and its processes. From a personal perspective, I have not encountered this particular problem, but I have been in group sessions where first-time disclosures about retrospective incidents of molest were made. This resulted in particularly powerful group discussions, which often extended over a number of sessions, and which in general, appeared to be highly therapeutic for the entire group. Such disclosures and discussions also tended to enhance group growth and trust.

There is great potential therapeutic value in using a “group contract.” Such a contract has no legal basis, however, and I much prefer the term used by Rutan and Stone, i.e. group agreement, which seems more egalitarian in spirit. In addition, it seems important that the group therapist not attempt to “play God” regarding extra-group contact, and recognize that in spite of having a group agreement, the possibility almost always exists that there will be various types of extra-group contact among group members. It is also important to remember that the group therapist must consistently stress that the group is primarily for therapeutic rather than social purposes. In addition, it is important for the group therapist to stress consistently that any planned or actual extra-group contact among members as well as the group therapist should be brought into the group for group discussion. While we may expect such actions to occur explicitly, they often occur indirectly, e.g. a group member quietly saying, “thanks for the ride to the group.” When a group therapist has even a hint that extra-group contact is about to occur or may have occurred, s/he needs to assiduously discuss this part of the “group agreement” and inquire explicitly in the group about this issue. All extra-group contact may not necessarily be ant-therapeutic by itself, however, the failure on the part of both group therapist and group members to openly bring such matters to the group for examination can be quite anti-therapeutic, and when serving as a form of resistance, can have significant potential to damage the psychotherapy group.

With respect to the last part of this question, about the therapist being held responsible for the client’s “injury,” as a result of some of the interactions that occurred outside the group, it is within the realm of possibility that the therapist might be held at least partly responsible for such a sense of injury. The standard of care and legal actions with respect to group psychotherapy continues to evolve, and there is little questions that the group therapist is perceived as the individual most centrally responsible not only for what happens in the group, but also among group members. Perhaps this represents another way of stating that issues of safety and trust are paramount in developing and maintaining a psychotherapy group, and that the group therapist plays a most critical role in developing and maintaining a group climate of safety and trust.

Dr. Tom McGee is Professor Emeritus at CSPP/Alliant University, a fellow of the American Group Psychotherapy Society and a member of the ethics committee of the San Diego Psychological Association