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Ethical issues in Group Therapy
Abstract
Ethics refers to the moral principles that relate to human behavior and interactions within a specified context or area. In group therapy, ethical conduct and relationships between the client or patient and the therapist or clinician are critical. The advent of group therapy as an intervention to help patients overcome personal challenges has attracted debates on various ethical implications of the procedure. These ranges from the training of the therapists, the relationships with the clients and the required attributes that therapists should have in order to function optimally without prejudicing the client. Current paper focuses on the ethical issues relating to group therapy and the implications of these issues on the group therapist.
Ethical Issues in Group Therapy
Introduction
Group therapy entails a wide range of psychiatric procedures that may involve various settings, goals and time periods. The advancement and application of this intervention strategy is gaining popularity in mental health and counseling professions. This practice has also presented potentially challenging ethical scenarios, unique to group interventions. Professional practice requires that practitioners adhere to group therapy ethics. This paper focuses on the ethical issues that are involved and that should be adhered to in all therapeutic interventions where groups are involved. As such, the current paper will explore various ethical issues that should be considered and adhered to in group therapy.
Training and Education of Group Therapists
Training of competent group therapists is essential, given the heightened ethical issues surrounding group therapy. Graduate counseling programs and institutions are, therefore, ethically obliged to produce qualified and competent group leaders, capable of facilitating group therapy professionally and ethically if the rights and welfare of patients and ethical standards of this practice are to be safeguarded. Graduate training should thus focus more on ethical group therapy as a mode of enhancing patient recovery.
Training of professionally competent group therapist must be a hybrid program of theory and practical sessions. The practical training standard should be ten hours of group participation and fifteen to forty hours in practicum with groups. Besides, there should be ninety to two hundred and forty hours in internship with groups. This is because internships alone do not offer sufficient training for group therapy. The ethical implications of quality training of group therapist are founded on the fact that their competence will have implications on their effectiveness and quality of services they offer to clients. It is, therefore, unethical to have poorly trained therapists, attending to patients since such scenarios are likely to present a lot of ethical violations within the practice of group therapy.
Screening, Orientation and Informed Consent
The diversified nature of groups in terms of personality mix differs in interests and priority of group members and the therapists require screening, orientation and seeking of informed consent of all participants in group therapy. As such, screening, orientation and informed consent is one of the requirements that should be fulfilled before the onset of group therapy if the sessions are going to be ethical and beneficial to the clients.
The role of screening in group therapy is to safeguard against inclusion of people in a group where they do not fit or where they are a potential physical, emotional, health or security threats to other members. For this to be realized, there is need for an education system that trains group leaders on ethical diagnosis procedures such that the screening process is objective and effective in facilitating appropriate group therapy. For example, screening procedure will possibly enhance exclusion of people with damaged brains, paranoid individuals, hypochondriacs, active drug addicts, psychotics, and antisocial personalities from group therapy. Screening should be done to exclude such persons from group therapy due to the fact that they may be a threat to effective group sessions as they interrupt the sessions or become a threat to other group members. Such persons may be very violent and insensitive to the rights of group members and boundaries required in group therapy.
Group members deserve to be assured by the therapist that other members of the group are appropriately placed. It is unethical to recruit members of a group therapy without considering their goals and whether they will be compatible with other persons. For example, the needs or issues that the group therapy should address should be similar such that there all members of the group benefit from the session. Determination of the needs of different clients is only possible through screening before the group sessions begin.
Orientation as an ethical concern is founded on research that established the fact that it enables the therapist to inform individual clients of the fundamental elements of the group. Alonso and Swiller assert that this helps the client to be well prepared for the procedures and implications of the process before the sessions begin. Besides, all participants in group therapy should join the group with informed personal consent. Corey et al argued that maximum results or therapeutic outcomes can be achieved when there is personal commitment to the group. This is only possible when the goals of the group, its composition, procedures and costs are shared adequately to the satisfaction of individual members of the group.
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Confidentiality Issues
Confidentiality entails the right of a person or patient, in the context of group therapy, to privacy. This privacy may relate to identity, issues for which intervention and help of the therapist is sought, personal information or records. In therapeutic practice, confidentiality is one of the critical ethical issues that both individual members of the group and the therapist are required to abide by. It is, therefore, the ethical responsibility of every practitioner or therapist to ensure that confidentiality issues are highly maintained and protected before, during and after the sessions. Confidentiality is a very sensitive, yet crucial ethical issue of all therapeutic procedures, group therapy included.
It is difficult to ensure confidentiality in group therapy. This is because, unlike person to person therapy, group therapy involves group members as a third party in the relationship between the patient and the clinician. In order to safeguard against the threat to confidentiality, all group members should be implored to sign an agreement to commit to confidentiality during and after the sessions. However, there may be exceptions to confidentiality, depending on the law of the country. The American Psychological Association provides exceptions to confidentiality, especially in cases where there is child abuse, violations of the rights of the elderly, dependent adult abuse or cases where one wants to harm himself or others. In such cases, the principle of confidentiality may be inapplicable.
There have been discourses surrounding the ethical issues related to confidentiality. Some have argued against keeping patient records with the contention that such records may jeopardize the principle of confidentiality of patients personal information. However, there is consensus that clients records are important for follow-up but should be treated with the highest level of confidence. Remley and Herlihy contend that such information should only be released to the patient, another therapist, in cases of referrals and the caregiver that the client approves as legible to access such records.
In group therapy, all the participants should be required to commit that they will not disclose the issues discussed and that the issues raised and discussed within the group are kept confidential. The therapist on his or her part has the responsibility to secure the privacy of the clients information and to ensure that such disclosed personal or private information is not used to prejudice the client, but is used strictly to facilitate effective intervention and improvement of the welfare of the client.
In group therapy, confidentiality of the group members information remains one of the challenges that therapists have to address. The ethical standard requires that the group counselor makes necessary and deliberate efforts to ensure protection of members privacy by defining confidentiality, in operational terms, and the potential threats to this ethical perspective. This helps individual group members to remain conscious about the requirement and to uphold it before, during and even after the session.
Whereas it is the responsibility of the therapist to safeguard the privacy of the patient, fulfillment of this requirement often presents a great challenge to clinicians. This is because of the existence of other members of the group who act as third parties in patient-therapist relationships and interactions. Group members must, therefore, be prohibited from disclosing, outside the group, any information about each other that is accessed or obtained during the group sessions. Therefore, both the therapist and individual group members must strive and commit to uphold the rights of each member of the group to privacy and confidentiality during group therapy.
Boundary Issues
Group therapy presents a lot of challenges to the patients, as well as the therapist with regard to maintenance of appropriate professional boundary. The relationship between the patient and the therapist should be one which is premised on the need to realize the goals of the therapeutic process. Corey and California State University noted that this becomes even more complicated in the context of group therapy that is nuanced with individual group members subjective interests, goals and values.
Supervision plays a significant role in enhancing ethical practice within group therapy. It allows the therapist to learn about the role and challenges associated with group development process. It is thus imperative that all therapists are supervised and evaluated on the basis of their prospect to bring counter-transference feelings and emotions into control, recognition of blind-spots requiring improvement and overcoming personal biases that might negatively prejudice the patient. Adequate and effective structures for a therapist to consult with the supervisor is thus ethical and necessary in ensuring and enhancing ethical group psychotherapy.
Group therapy makes the clients and even the therapist vulnerable to unprofessional and unethical practices, such as sexual misconduct. Sexual relationship with the client is treated as an extreme form of unethical behavior within the practice of group therapy. The therapist, as well as individual members of the group should, therefore, endeavor to ensure that the relationship between the therapist and the group members remain professional and founded on ethical principles and standards required of the practice. Personal interests must not override the prioritized position of professional relationship between the patients and the clinician.
It is unethical for the therapist to have sexual relationships with clients. This is because it is considered that at the time of building a therapeutic relationship with the counselor, the patient often displays a help-seeking behavior that is founded on their overpowering experiences. It is thus the duty of the therapist to uphold the ethical standard required in group therapy. Alonso and Swiller noted that group therapy may involve disclosure of very personal and sensitive information, including sexual and intimate relationships, family affairs and legal issues. Such must, therefore, not be used to exploit the already vulnerable and less powerful client who is seeking help from the counselor or group members during the group sessions.
Adoption of Multicultural Perspectives
Group therapy often involves group leaders, facilitating the sessions and making sure individual members of the group benefit from the group sessions. The ability of the leader to develop a multicultural perspective during group therapy is one of the most critical ethical issues in this form of therapy. Social transformations have reproduced a society with diverse population whose psychotherapeutic needs are also diverse. Group therapy may, therefore, not be very effective to address the needs of all the patients within the group set up if the multicultural background issues of individual participants are not considered and integrated within the group therapy sessions. The failure of a group leader to adopt and integrate the multicultural perspective into group session will thus be equivalent to insensitivity against the diverse needs of clients constituting the group.
Corey and California State University argue that in group therapy, the diversity of the group makes it ethically binding for the group leader to be very sensitive, culturally competent, aware and ready to accommodate diversified opinion of all participants. The failure to address the diversified nature of the issues that arise in group therapy is thus professionally and morally unethical on the part of a leader. Group development in group therapy must, therefore, be founded on identification and effective intervention to address such needs.
Ethical practice in group therapy requires effective training of a group leader who is able to transfer his personal sensitivity and respect for diverse opinions and cultures to the group members. Therefore, group interaction should be helpful and not harmful to the clients. Here, the emphasis should be on the need to appreciate, respect, accept and accommodate diversity of the cultural or racial backgrounds and identity of all group members. Corey and California State University maintained that this way, group therapy would remain an effective tool in empowering clients to understand where their difficulties are arising from and how to address them.
Ethical Issues Involved in the Termination Process
Termination of any therapeutic process is a very critical point that is surrounded with a lot of ethical issues. Good group leadership skills will enable the group leader to assist members in transferring the lessons learned in the group to their personal challenges outside the group. The leader should inform the members that they are coming closer to the end of the sessions. This gives them opportunity to express their fears of having to face personal challenges alone and evaluate the effectiveness of the sessions already held. During this time, clients may express feelings of attachment to the group and unwillingness to dissociate or disengage. The ethical concern is the ability of the leader to terminate these relationships and bonds without hurting the patient or attracting him or her unnecessarily.
One way of helping the patient is encouraging him or her to build social support systems in his new environment outside the group and build trust with people outside the group. At the termination stage, the therapist and group leader should avoid situations where patients give gifts to appreciate their support. However, he should help them overcome the grief of having to face personal challenges outside the group and away from the therapist. One way to do this is to encourage clients to apply the lessons they have learned in the session to share their challenges and seek support to overcome the challenges. It is, therefore, unethical for the group leader to suddenly inform the members that the meetings have been terminated without prior adequate preparation for termination of the counseling relationship.
Effective Group Therapist
Group therapist must ensure that he or she is not imposing personal values on the group. It is unethical for a group therapist to use the group to champion their own personal goals at the expense of the group members. Instead, group counselors should be very conscious and well aware of their personal values and the potential impact of such values on the clients. When such values are imposed on the members, the therapist is likely to show disrespect for the clients integrity. Instead of imposing personal values on the clients, group leaders should build a platform on which values are discussed objectively, while respecting the diverse values of individual members of the group. Therefore, awareness of the self is essential since it influences the relationship between the patient and the clinician.
Group leaders must be very receptive and possess a balanced combination of legal, professional and ethical aptitude and knowledge. There are certain critical values that a therapist should have in order to function professionally and ethically. These include ability to help members find solutions to their issues within the confines of their own values. The therapist should be very honest, demonstrating acceptance, being non-judgmental and with a strong sense of unconditional positive regard for all patients, able to minimize imposition of personal values on clients, able to relate well and control difficult group members. Group therapist lacking some of these attributes is likely to infringe the rights of group members and introduce a relationship that is unethical and exploitative to the patients who are very vulnerable.
Conclusion
Group therapy is surrounded with numerous underlying ethical issues. It is, therefore, essential that group therapists are effectively trained to safeguard against ethical, professional and legal challenges that this intervention presents. This requires a strong balance in knowledge on the professional standards, legal issues and ethical implications involved in group therapy. Therapists are, therefore, bound to do no harm to patients and instead employ morally and ethically acceptable practices that enhance optimum healing and enlightenment of the patients.
