When confidentiality mandates a secret be kept: a case report.

The success of group psychotherapy is impeded when group members maintain secrets and fail to self-disclose to other group members. However, revealing secrets sometimes conflicts with the legal and ethical constraints of confidentiality, thus placing a greater burden on the group. The case reported here illustrates how complex the dynamics of group therapy become when one group member maintains a secret. In this case, one member maintained a secret about another to preserve that individual's right to privacy and confidentiality. This case also details the group member's deliberations and confusion about the effect his secret had on the group's success, as well as the burden he experienced by choosing to preserve confidentiality at the expense of successful therapy for himself.