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Dual relationships in the training and treatment of group therapists are inherent and endemic to the profession of psychoanalytic group therapy. Independently of theoretical orientation at many training institutes, senior group leaders double as training group analysts, teachers, supervisors, administrators, friends, and sometimes even relatives of group trainees. Further, these trainees are often in the same treatment groups, supervision groups, and classes with each other and may also be friends and relatives. These complicated relationships often blur the boundaries between therapy and not therapy, and they have an incestuous quality. They may even produce iatrogenic treatment reactions when realistic negative perceptions are interpreted as transference and resistance. This can be harmful and can lead to the development of ethical dilemmas and clinical boundary violations. This brief report presents the author's experience leading an open session at AGPA's 2024 Annual Conference that addresses attendees' concerns about this troubling situation.

Our topic concerns strategies of therapeutic discourse, four relational modes of speaking and listening, adopted with and without awareness: diplomacy, integrity, sincerity, and authenticity. The four modes are offered as conceptual tools to help the therapist build therapeutic relationships, respond to challenges and impasses, and advance group process and insight. They are navigated to cement bonding, build trust, allow troubled relationships to evolve and resolve, and strengthen the abilities to think and relate. Presented in two separate articles, in Part I the topic and its relationship to truth and falsity is introduced, and the modes of diplomacy and integrity are described. The discussion continues, in Part II, where the focus is on sincerity and authenticity, and the interrelationship among the four modes and their differing functions in the totality of the clinical situation is illustrated.

Our topic concerns four relational modes of speaking and listening, and their relationship to truth and falsity. In a separate article, Part I introduced the topic and discussed the modes of diplomacy and integrity. The focus of Part II is on sincerity and authenticity, and on the interrelationship among all four modes and their differing functions in the totality of the clinical situation. Together the papers disentangle and address some of the technical issues that concern the relational group psychotherapist regarding topics of intersubjectivity, presentation of self, and self-disclosure. The four overlapping categories while nonexclusive are exhaustive; they supply conceptual references for the therapeutic stance one has adopted, allowing the therapist to be more aware of what he or she is doing and why.

Abstract Reviewing a series of articles in this special issue on combined treatment incorporating individual and group therapy, and in one instance couples therapy and a relationship group, the author provides a synoptic history of combined treatment, noting that the relational perspectives of psychoanalysis and systems theories of groups now provide conceptual frameworks for combined therapies. Taking up each article in turn, he considers that combined treatment poses particular problems while having certain advantages. He discusses the theoretical emphases and biases of each article, whether relational psychology, classical psychoanalysis, object relations theory, or self-psychology. He considers the roles of transference and countertransference, patient-therapist enactments, empathic attunement, "surrogate therapy" by the group members, and ethics in determining outcomes. In addition, the author notes how so-called difficult or regressed patients impact upon and are affected by the use of combined therapy modalities.

Abstract Combined therapy presents ethical quandaries that occur in individual psychotherapy and group psychotherapy, and dilemmas specifically associated with their integration. This paper examines two types of ethical frameworks (a classical principle-based framework and a set of context-based frameworks) for addressing the ethical hot spots of combined therapy: self-referral, transfer of information, and termination. The principle-based approach enables the practitioner to see what core values may be served or violated by different courses of action in combined therapy dilemmas. Yet, the therapist is more likely to do justice to the complexity and richness of the combined therapy situation by supplementing a principle analysis with three additional ethical frameworks. These approaches are: virtue ethics, feminist ethics, and casuistry. An analysis of three vignettes illustrates how these contrasting ethical models not only expand the range of features to which the therapist attends but also the array of solutions the therapist generates.

Endings in group psychotherapy are suffused with complexity and potential conflict, some of which entail ethical quandaries. Ethical issues attending endings in group therapy are explored through a discussion of informed consent, time and role boundaries, privacy and confidentiality, unplanned endings, therapist-initiated termination, and competence. Findings from an exploratory survey of members of the American Group Psychotherapy Association and clinical-ethical vignettes are presented to highlight these issues. Clinicians need to develop and maintain ethical fitness and awareness, including attunement to personal responses, to endings and loss.

The healing power of psychodynamically oriented therapy and training groups rests, to a large degree, upon the quality of the here and now interactions. For the work to be effective, the basic principles of analytic group work need to be followed, including the observance of no extra-group contact. Simply said, nothing leaves the room. This principle has both ethical and clinical implications. It is my premise that while some forms of outside contact between members are relatively benign, other types are not. Outside contact that is built into the fabric and context of the group may pose a risk, as may be the case where dual relationships exist between members. The impact of dual relationships between group members in the particular instance of analytic training institutes is the focus of this article. What happens to the transference in this context when members reveal too much of their personal lives to each other through dual relationships is explored. It is suggested that extra-group contact can disrupt the balance between reality and transference distortion in group interactions in at least three ways: (a) "The Emperor's New Clothes" effect, (b) looping, and (c) gaslighting. Vignettes are presented to illustrate these phenomena and suggestions for reform are offered.

This concluding article of a two-part special section on the ethical group psychotherapist are highlighted: (1) the importance of the cultivation of the skill and knowledge base of the group psychotherapist in terms of pertinent legal statutes and ethical guidelines; (2) the criticalness of certain personality features related to the concept of virtue; (3) a therapist's self-awareness contributes to the capacities to think and respond ethically; (4) ethical decision making is most likely to occur when the group psychotherapist attends comprehensively to all dimensions that define the setting in which a dilemma emerges; and (5) that in the service of positive ethics, attention to the ethical dimensions of group psychotherapy practice should be continuously present. In agreement with other contributions to this section, I conclude that the commitment to the ethical practice of group psychotherapy must be made not only by the individual practitioner but also by educational and training programs and professional organizations.

Ethical issues can arise in dealing with diversity when practicing group psychotherapy. In this paper, a case is presented of a therapist-in-training who is attempting to determine whether a particular psychotherapy group composed exclusively of heterosexual males would be an appropriate and effective treatment venue for a gay male; the clinical vignette is designed to illustrate a process of ethical and culturally competent decision making. The discussion of this vignette articulates the multiple steps through which the group psychotherapist must proceed to successfully resolve ethical dilemmas that are related to diversity.

Endorsed as part of ethical practice in group psychotherapy by professional organizations, informed consent is a process of communicating essential information about group treatment to patients so that they can make rational decisions about treatment-whether to enter and how to participate. Its benefits as well as necessary precautions are discussed. The design and implementation of the informed consent process for group is discussed in terms of who should obtain it, when it should occur, how it should be communicated, and what information should be considered for inclusion. Specific suggestions are included as well as a discussion of some potential ethical dilemmas.

This article discusses numerous ethical issues regarding the keeping of records in group psychotherapy, those activities that have to do with the creating, retaining, storing, releasing, and disposing of them. A central dilemma for the group therapist is whether to keep records separately for each individual group member or to keep one record for the group as a whole. Confidentiality of records, patient access, and release of information tend to be more complex issues for group psychotherapists than for individual psychotherapists. Although notes written about the entire group may capture important themes, such notes can compromise the privacy and confidentiality of individual group members. An individual record for each patient is recommended.

Group psychotherapists in their everyday practice confront a series of ethical problems, some of which rise to the level of ethical dilemmas. This two-part special series will address how the group psychotherapist can address these problems and dilemmas in a way that leads to an ethical course of conduct. This article introduces the series by examining ethical principles and decision-making processes that are relevant to the wide range of issues that confront the group psychotherapist. The article also considers the person of the group psychotherapist him or herself and notes that certain personal qualities might create a foundation for ethical thinking and behavior.

Exploring money in the context of group therapy highlights the powerful way that groups can magnify the most intimate and charged aspects of our patients as well as ourselves.A thorough self-examination that includes an ethical framework for decision-making about money matters can safeguard against problems resulting from therapists' and patients' unconscious relationship to money. This paper addresses the setting and raising of fees, pre-group evaluations, third-party payers, handling of payments and statements, as well as combined treatment. Special attention is paid to countertransference with an exploration of the particular difficulties inherent in reconciling one's identity as a healer with the business of clinical practice.