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Legal and Ethical Considerations for Group and Family Therapy
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Post an explanation of how legal and ethical considerations for group and family therapy differ from those for individual therapy. Then, explain how these differences might impact your therapeutic approaches for clients in group and family therapy. Support your rationale with evidence -based literature.
Members of a cohesive group feel warmth and comfort in the group and a sense of belongingness; they value the group and feel in turn that they are valued, accepted, and supported by other members.
—Irvin D. Yalom, The Theory, and Practice of Group Psychotherapy. Laureate Education (Producer). (2017). Introduction to psychotherapy with groups and families [Video file]. Baltimore, MD: Author.
Group and family therapy offers a unique sense of community and support that may not be achieved through other therapeutic approaches. As you help clients effect change within themselves, they are able to in turn help others within the group change. Although many clients thrive in this environment, it is important to recognize that group and family therapy is not appropriate for everyone. Like any other therapeutic approach, group and family therapy has limitations that must be considered.
This week, as you begin exploring group and family therapy, you examine legal and ethical considerations of this therapeutic approach. You also prepare for your practicum experience by examining counseling theories and developing goals to guide your practice.
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.
· Chapter 11, “Group Therapy” (pp. 407–428)
Nichols, M. (2014). The essentials of family therapy (6th ed.). Boston, MA: Pearson.
· Chapter 1, “The Foundations of Family Therapy” (pp. 1–6)
· Chapter 2, “The Evolution of Family Therapy” (pp. 7–28)
Breeskin, J. (2011). Procedures and guidelines for group therapy. The Group Psychologist, 21(1). Retrieved from http://www.apadivisions.org/division-49/publications/newsletter/group-psychologist/2011/04/group-procedures.aspx
Khawaja, I. S., Pollock, K., & Westermeyer, J. J. (2011). The diminishing role of psychiatry in group psychotherapy: A commentary and recommendations for change. Innovations in Clinical Neuroscience, 8(11), 20–23. Retrieved from http://innovationscns.com/
Note: You will access this article from the Walden Library databases.
Koukourikos, K., & Pasmatzi, E. (2014). Group therapy in psychotic inpatients. Health Science Journal, 8(3), 400–408. Retrieved from http://www.hsj.gr/medicine/group-therapy-in-psychotic-inpatients.php?aid=2644
Note: You will access this article from the Walden Library databases.
Lego, S. (1998). The application of Peplau’s theory to group psychotherapy. Journal of Psychiatric & Mental Health Nursing, 5(3), 193–196. doi:10.1046/j.1365-2850.1998.00129.x
Note: You will access this article from the Walden Library databases.
McClanahan, K. K. (2014). Can confidentiality be maintained in group therapy? Retrieved from http://nationalpsychologist.com/2014/07/can-confidentiality-be-maintained-in-group-therapy/102566.html
U.S. Department of Health & Human Services. (2014). HIPAA privacy rule and sharing information related to mental health.
Retrieved from
http://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/special/mhguidancepdf.pdf
Document: Practicum Journal Template (Word document)
Document: Midterm Exam Study Guide (Word document)
Document: Final Exam Study Guide (Word document)
Laureate Education (Producer). (2015). Microskills: Family counseling techniques 1 [Video file]. Baltimore, MD: Author.
Laureate Education (Producer). (2015). Microskills: Family counseling techniques 2 [Video file]. Baltimore, MD: Author.
Note: The approximate length of this media piece is 32 minutes.
Laureate Education (Producer). (2015). Microskills: Family counseling techniques 3 [Video file]. Baltimore, MD: Author.
Sommers, G., Feldman, S., & Knowlton, K. (Producers). (2008a). Legal and ethical issues for mental health professionals, volume 1: Confidentiality, privilege, reporting, and duty to warn [Video file]. Mill Valley, CA: Psychotherapy.net.
Note: You will access this media from the Walden Library databases. The approximate length of this media piece is 140 minutes.
Sommers, G., Feldman, S., & Knowlton, K. (Producers). (2008b). Legal and ethical issues for mental health professionals, volume 2: Dual relationships, boundaries, standards of care and termination [Video file]. Mill Valley, CA: Psychotherapy.net.
Note: You will access this media from the Walden Library databases. The approximate length of this media piece is 191 minutes.
Considering the Health Insurance Portability and Accountability Act (HIPPA), the idea of discussing confidential information with a patient in front of an audience is probably quite foreign to you. However, in group and family therapy, this is precisely what the psychiatric mental health nurse practitioner does. In your role, learning how to provide this type of therapy within the limits of confidentiality is essential. For this Discussion, consider how limited confidentiality and other legal and ethical considerations might impact therapeutic approaches for clients in group and family therapy.
Learning Objectives
Students will:
· Compare legal and ethical considerations for group and family therapy to legal and ethical considerations for individual therapy
· Analyze the impact of legal and ethical considerations on therapeutic approaches for clients in group and family therapy
· Recommend strategies to address legal and ethical considerations for group and family therapy
To prepare for Legal and Ethical Considerations for Group and Family Therapy Paper:
· Review this week’s Learning Resources and consider the insights they provide on group and family therapy.
· View the media, Legal and Ethical Issues for Mental Health Professions, Volume I, and reflect on legal and ethical considerations for group and family therapy and individual therapy.
By Day 3
Post an explanation of how legal and ethical considerations for group and family therapy differ from those for individual therapy. Then, explain how these differences might impact your therapeutic approaches for clients in group and family therapy. Support your rationale with evidence-based literature.
The purpose of this paper is to discuss and evaluate what ethical requirements that are current “hot topics” therapists must employ when working in group and individual settings, respectively. There are subtle differences in ethical considerations but at the same time, there are many similarities. For the purpose, these ethical considerations have been narrowed down to conflict of interest (dual roles), when to refer clients to group or individual counseling or even to another more qualified therapist and when clients need to share and when they don’t. In addition, the discussion of what a therapist must share about the group; what the group is about, what rules are necessary for a successful outcome and the rational of the group – why they are there.
Couple and family therapists arguably face more ethical challenges than individually oriented therapists, yet codes of conduct and ethics have not always been of direct assistance. Often it seems that the principles lack the specificity to really attend to the issues at hand. Further, couple and family therapy presents challenges which are often erroneously assumed to be covered under general principles about counselling and psychotherapy. A significant values difference between couple and family therapy and other mental health services is an appreciation of context, which is grounded in the foundational premise of the family as a system. This means that it is the relationship that is the focus of study, and all relationships are seen to exist within multiple other systems, including the therapeutic system (Wilcoxon et al., 2007).
Relationship issues and the values we hold about relationships are completely entwined with their social and historical context. We are constantly exposed to theories about effective relationships and relationship pathology, whether they be evidence-based or common folklore. We cannot help but be influenced by these ideas, nor by our own experience of relationships. New and emerging issues such as internet pornography, surrogacy, same-sex parenting and working with perpetrators of abuse, offer groundbreaking moments in the therapy room. Couple and family therapists have a unique view into the complexities such circumstances bring and need to be able to respond effectively … or to know when and who to report matters when it all goes belly up. Without an awareness of the potential ethical challenges in the work, psychologists can be insufficiently prepared to face them. This article provides an overview of some of the significant practice issues couple and family therapists face, and outlines some of the considerations required for ethical reflection and decision making.
Ethics are a set of moral principles or rules of conduct for an individual or group. The term ethics comes from the Greek ethos meaning custom, habit or character. Ethics determine choices made. In counselling, ethics underpin the nature and course of actions taken by the counsellor. Counsellors and others in helping professions are expected to behave in an ethical manner.
We believe it is important to become familiar with the basic ethical guidelines that therapists should follow before you begin therapy with a new therapist, and we encourage you to do so. Unfortunately, media portrayals of therapy do not always provide examples of ethical, effective therapy experiences and many myths about therapy persist.
Although all the therapists and counselors listed in GoodTherapy.org certify that the therapy they provide accords in orientation and attitude to the Elements of Good Therapy, GoodTherapy.org does not provide a specific code of ethics for therapists to follow. However, ethical codes have been developed by mental health associations for the purpose of setting professional standards for appropriate behavior, defining professional expectations, and preventing harm to people who go to therapy. Mental health professionals have an obligation to be familiar with their professional code of ethics and its application to their professional services.
We provide links to ethical codes below because we feel it is important for consumers of psychotherapy to know the difference between ethical and unethical behavior. Most therapists intend to “do no harm” and strictly follow ethical guidelines. Overall, mental health professionals are a good bunch. However, not only do good therapists make mistakes, there are some providers who, unfortunately, are careless and unaware of the importance and purpose of some ethical guidelines. We believe it is in everyone’s best interest to become familiar with basic ethical guidelines before beginning psychotherapy.
By nature of the profession, counsellors are to act in the best interest of their client, promoting client goals, protecting client rights, maximising good and minimizing harm (Stein, 1990). This expectation broadens due to the inherent power of the relationship between client and counsellor. Ethics including ethical codes and principles aim to balance the power and ensure that the counsellor operates for the good of the client and not for self.
Primarily, counsellors’ duty of care is to their clients. When making ethical choices, counsellors must consider not only themselves, but also the agency or organisation (if not self-employed), their profession and the greater community (Axten, 2002). Counselling does not occur in a vacuum therefore it is important that counsellors acknowledge all facets of their practice both internally and externally.
Ross (2002) draws on this further by asking counselors to look at ethics from a holistic perspective — body (the environment, structures, systems, policies, laws, regulations, moral codes, and societal norms), mind (ethical thinking, philosophy), heart (relationships, emotions, values) and spirit (unknowing, unconscious). A complete awareness of the ethics of a situation can occur when all are taken into consideration.Legal and Ethical Considerations for Group and Family Therapy Essay Paper
The concept of ethics relates to moral consideration. The challenge lies in what is considered moral or ethical. Each counsellor comes to the profession with their own set of values and standards. Individual principles and how they were used to interpret dilemmas would be universally different. Therefore, a Code of Ethics — a general standard that counsellors and therapists adhere to and use co jointly with legal standards to provide ethical practice and work through ethical dilemmas — is required.
Ethical codes offer counsellors an outline of what are considered acceptable and unacceptable behaviours. In a region (such as Australia) where counselling is not regulated through licensing, ethical codes provide a valuable tool for developing and maintaining ethical conduct.
Numerous professional associations have developed their own Code of Conduct and Ethics. Codes may adopt similar principles whilst also covering behaviours specific to an area of counselling. Professional counselling organisations provide Codes of Conduct and Ethics to members and the inability to stick to these Codes may result in removal of membership.
A professional may belong to more than one organisation and thus have access to additional ethical codes. When faced with an ethical dilemma, a counsellor is to consider all available and applicable codes. It is counsellors’ responsibility to familiarise themselves with relevant codes and regulations governing their area of practice.
Clarkson (2001) contends that all members of a professional association subscribe (at least in principle) to their profession’s Code of Ethics for the sake of protecting the public. The degree to which this ‘protection’ occurs is based on four factors:
A core ethical responsibility to clients is the promotion of beneficence: doing good on the client’s behalf. This is reflected in a number of professional areas, but starts with the therapist’s competence to practise. Interestingly, couple and family therapy is quite commonly practised by therapists with little or no specific training. It seems to be thought that if one is individually trained, then it is not a great stretch to see other family members (Shaw, 2001). Nothing could be further from the truth. Issues surrounding relationships (violence and abuse, family law matters, sexual concerns, infidelity and other betrayals, severe attachment disruptions) all render this work highly complex and specialised. Without core training, duty of care is potentially breached (refer to the professional standards of the Australian Association of Relationship Counsellors and the Australian Family Therapy Association). If you were seeking assistance for your own relationship, what qualifications would you seek in your therapist? We often provide less for our clients than we would require for ourselves.
The very act of asking the initial caller to gather other family members for an appointment raises questions about the forms of ‘social coercion’ that this might involve (Wilcoxon et al., 2007; Ramisch, 2010). There are different levels of power and opportunity in families. One member can decide for the group, while others can be unfairly excluded from key decision making. How the therapist is positioned within this is crucial to consider. Further, there are complexities around informed consent with people across ages and circumstances, and about how one might consider sending therapeutic letters or other communications. Are the adults always the best gatekeepers for other family members? Not uncommonly, I have had children say to me that they have ‘no idea’ about why they are in my room, despite my parental preparation.
Arranging for individual consultations within relational work raises a myriad of difficulties. While it can be important for assessing dynamics such as abuse, it also provides opportunities for disclosures that will significantly shape the work ahead. Further, issues of confidentiality and privacy are often confused, and therapists can find themselves unwittingly silenced and compromised through promises they have made in good faith. There are certain principles about moving between individual and couple or family sessions, but these are not articulated within accessible guidelines, leaving therapists to work things out on their own. It is not uncommon for well intentioned therapists to find themselves in breach of confidentiality by juggling too many agendas and finding themselves the ‘fall guy’.
Frequently couples will ask for assistance when on a covert level they want a referee or a judgment about the behaviour of the other. Individual sessions and phone calls can be invitations to take sides, and neutrality can be called into question. There are complex issues around being engaged to ‘save relationships’ and then having notes subpoenaed for divorce proceedings. Besides the feelings this can evoke for the therapist, there are invitations into conflicting roles, e.g., couple/family therapist versus advocate in court.
Working with relationships involves managing multiple alliances. It is not always possible to have everyone on side at the one time. Members of the family may have conflicting or competing needs which they want equally acknowledged. Even trying to develop a focus for the work is fraught with challenges, as you question: whose voice will prevail? Improvement for one member must not occur at the expense of another.
Commonly relationship therapists will think it might be a good idea to offer individual therapy to one family member, and may well be pursued to do so by the client. This is not considered good practice, but it can be tempting to do. Really good relational work can be brought asunder by selecting/engaging in work with one member. What might be defendable reasons (not justifications) to take on individual work in this context?
Working with systems means being able to hold the relationship in mind over and above individual contributions: the notion that the sum is more than its parts. However, one still has to attend to:Legal and Ethical Considerations for Group and Family Therapy Essay Paper
Further important issues in the field which involve specialised ethical and practice considerations include:
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Couple and family therapy has advanced different models of practice. Over time, therapeutic strategies (e.g., use of paradox, strategic manoeuvres, prescriptions, triangulation) have been critically analysed in terms of how much stress is acceptable in achieving change (Wilcoxon et al., 2007) and a post modern framework has been adopted as more respectful. In terms of our role, while we may have preferences for therapeutic intervention, we have to be prepared to also be advocates, to take positions (on abuse and violence for example) and to be strategic in our case management. We need to enhance growth and positive relationships, not act as social control agents or gatekeepers of community values not in keeping with the client’s own (notwithstanding where people are at risk).
As is evident, ethics is as much about critical and responsible reflection as it is about compliance with a professional code. Reason, intuition and experience all play a role in developing effective and justifiable responses (Shaw, in press). Finding opportunities for professional development and rigorous debate about ethical issues in practice is crucial. Ask yourself: how often do I reflect on ethical challenges in supervision?
There are some valuable decision making models for therapists (e.g., Gilligan (1982) in Newfield et al., 2000; Kitchener, 1984; Hecker, 2010). It behoves effective therapists to establish frameworks to support their practice ahead of needing them! Finally, our best work will occur when we are also in the best possible shape. Self care is foundational to good ethical practice, and something we can tend to under emphasise.
Ethics are parameters by which professionals in different fields use (Jacobs, Masson, Harvill, & Schimmel, 2012). They are, in a sense, the rules that professionals follow to be fair to their clients, their profession and to themselves. While not all ethical considerations are the same for every profession, there are similarities. This also holds true for different situations in counseling. The scope of this paper is to discuss the “hot topics” of ethical considerations for group therapy and individual therapy; and to compare them accordingly. Also, to answer why a therapist may choose individual counseling over group therapy or vice versa.Legal and Ethical Considerations for Group and Family Therapy Essay Paper
There are many ethical considerations for therapists who choose to counsel on an individual and group basis. For this context however, the focus is on the conflict of interest, when to refer clients on to other professionals or from individual counseling to group counseling and whether forcing clients to share their deepest, darkest sorrows and secrets are ethical.
A conflict of interest in counseling can range from too much therapist self-disclosure to having dual relationships, or relationships with clients outside of the therapy sessions (Jacobs, et al., 2012). These ethical dilemmas may be seemingly innocent enough and may, in some cases be unavoidable (i.e. in rural communities where there are not many therapists) (Gonyeah, Wright & Earl-Kulkosky, 2014; Gottlieb, 1993) but when the therapist and client are in a situation where knowing each others lives outside of the office setting, certain rules and ethical considerations come into play. Attending functions together may require a lot of thought on both sides to determine the safety of both the client and therapist. In a group therapy setting, the stakes for safety and protection are even higher because of the many lives and families involved (Burian & O’Connor Slimp, 2000).
Therapists must be aware and mindful of when a client needs to move on to other more qualified therapists or from an individual setting to a group session. Knowing the time to move on is the responsibility of the therapist as is knowing when they are not qualified to do their client justice with their own limitations (Jacobs, et al., 2012). This is when the therapist should refer the client to a more qualified therapist who has the experience required to further help the client. With groups, it is the therapist’s job to know when being in a group setting is more beneficial and will challenge the client to move on in their recovery. If the client within a group setting is struggling in the group and can’t seem to connect, it is the job of the therapist to refer them back to individual counseling or a group setting that is more suited to the clients issues.
Letting clients know that they are free to share whatever they’d like, as long as it is relevant to the topic of the group (i.e. substance abuse, child abuse, anger management, etc.) is important to establish early on (Corey, Schneider-Corey, & Haynes, 2014). Letting the client know that they do not have to share anything that they are uncomfortable with is also important. For some clients, it may take more time to warm up and become comfortable but most importantly, trusting of the group enough to share what they are going through or have experienced and want to work on or heal is vital.
Therapists, according to Hartman & Zimberoff (2012), should also disclose their experience and training on a honest level; to falsify information is an ethical infraction. It is also the therapist’s job to establish to their client(s) that they are trained for this type of therapy, and that they are competent to lead the group (or single individual) effectively (Scher & Kozlowska, 2012).Legal and Ethical Considerations for Group and Family Therapy Essay Paper
There are several ethical standards that apply to both group and individual therapy. In looking at the list of ethical considerations in Groups in action: Evolution and challenges (Corey et al., 2014), there were many that applied to both types of therapy in one way or another. In example, the screening of clients, to ensure that they were in the right group for the topics being discussed is important in group therapy but by the same token, screening clients to ensure that they and their issues are a good fit for the therapist and their level of expertise; and experience with those issues is important. Another similarity is that of clear roles. What the roles of the clients are in direct correlation with the roles of the therapist and what the group’s rational and purpose is.
Therapists must know their business. They must spend time keeping up their own education and constantly evolving into better therapists and including the latest information into their knowledge base. They must also learn new techniques and theories that will aid them in understanding their clients needs, the needs of the group as a whole and what will work in advancing the healing process of their clients (Brabender, 2006). They must also believe in their clients and that change is possible (Stalker, Horton & Cait, 2012). Therapists must also know the cultural and religious variables of their clients and know how those variables will affect each client within the group setting (Cornish, Wade, Tucker & Post, 2014; Henrikson, Polonyi, Bornsheuer-Boswell, Greger & Watts, 2015; Ibrahim & Dykeman, 2012). Therapists must also know how to show empathy for their clients and while not making the client feel awkward, the therapist must give emotional support throughout the group experience; this is especially true of young adolescents (Bruns & Frewer, 2011; Yamuna, 2013; Scher & Kozlowska, 2012).
A unique dynamic here is co-leadership of a group or “cotherapy” where two therapists share the job of co-leading a group. A study on this dynamic discovered that in order for co-leading to be effective and succeed, a healthy working relationship between the therapists must exist as well as the ‘sibling’ dynamic in the therapist’s personal life (Shapiro & Ginzberg, 2001).
Clients must come to a place in which they want to change for the better (Stalker, et. al., 2015). Clients must also come to a place where they become honest with themselves, their role in their issues and problems as well as the role that others played in those problems. They need to understand that therapy is hard work that can result in a painful but hopefully, a cathartic and healing journey (Jacobs, et al., 2012). The client has a responsibility to keep working toward healing or the process outcome will be limited (Corey, et al., 2014).
Establishing the group’s purpose and why the clients are there is vitally important to the success of the group. This information gives the group a clear direction and knowledge of what to expect throughout the process and what to think about bringing to the table as others talk about their own experiences and emotions. When the group knows the parameters and begins to share with one another, they often can identify with more than one person (i.e. the therapist) (Forsyth, 2014). There are more perspectives with a collective life experience to draw from.
Therapists must also have a clear plan for the group (Vinella, 2013). Corey, Corey and Haynes (2014) reiterate this need of a plan for a successful group. Knowing what is needed to be achieved on the first day to the last day (assuming there is an end) but also what events will happen from the start to the finish of the group session.
Some clients may come into the session already upset and uptight over having to ‘be there.’ This is more likely the case with court-mandated therapy where clients have no choice but to attend (i.e. drug and alcohol counseling, anger management, parenting classes, etc.). Some clients may have preconceived notions of what group therapy is all about and not want to open up out of embarrassment, fear of judgment, ridicule, bias, rejection and speaking in a group forum rather than one on one (Jacobs et al., 2012). The lack of privacy in a group setting may also scare clients into silence. This is where the therapist needs to establish from the beginning that confidentiality is vital to the group and the more others open up and share, the more likely the fearful client will also relax and begin to share and join in the conversations and dialogs (Barros-Bailey & Saunders, 2010; Hartman & Zimberoff, 2012). Clients may have had bad experiences in the past with other therapy programs so knowing about these experiences and what the client expects to gain or lose in a group session or even an individual setting is important to furthering their growth (Garzon, Worthington & Tan, 2009).Legal and Ethical Considerations for Group and Family Therapy Essay Paper
This statement, Ethics for Counselling and Psychotherapy, unifies and replaces all the earlier codes for counsellors, trainers and supervisors. It is intended to guide the practice of counselling and psychotherapy by all members of the British Association for Counselling and Psychotherapy (BACP) and inform the practice of closely related roles that are delivered in association with counselling and psychotherapy or as part of the infrastructure to deliver these services. Being ethically mindful and willing to be accountable for the ethical basis of practice are essential requirements of membership of this Association.
In this statement the term ‘practitioner’ is used generically to refer to anyone with responsibility for the provision of counselling or psychotherapy-related services. ‘Practitioner’ includes anyone undertaking the role(s) of counsellor, psychotherapist, trainers and educators for these roles, providers of coaching and mentoring in association with counselling and psychotherapy, supervisors, and practitioner researchers. Members of this Association who are providers of services using counselling skills, embedded counsellors, managers and researchers of therapeutic services, are required to be accountable in accordance with the Ethical Framework in ways appropriate to their role and to communicate appropriately the basis of their ethical accountability and expectations. The term ‘client’ is used as a generic term to refer to the recipient of any of these services. The client may be an individual, couple, family, group, organisation or other specifiable social unit. Alternative names may be substituted for ‘practitioner’ and ‘client’ in the practice setting, according to custom and context.
Group therapy is a form of counseling that involves a small group of people coming together under one trained therapist who helps them and encourages them to help one another to overcome their challenges. The group members are usually peers facing the same kind of problem for example, anxiety (Forti, et al., 2007). This therapy has been in use for over fifty years and it has produced tremendous results in the lives of the group members. The group members not only learn from personal experiences of other members, but also gain different viewpoints and ideas on the issues they are facing. Like individual therapy, group therapy very powerfully influences growth and change and helps those involved to increase their self-awareness and gain support from other group members (Northen, 2009). The various ethical issues unique to this kind of therapy will be discussed in this paper.
The therapist should establish clear group therapy boundaries that will enable him to maintain his professionalism. Since patients who over-step the boundaries may pose a challenge to the therapist, it is advisable for the therapist to have specific techniques to deal with such patients. Some of these techniques could be referring the patient to individual therapy. It is very difficult for a therapist to win a malpractice suit against the group. Hence, it is very important to maintain professionalism (Rochman, 2010). The biggest challenge that would face a group therapist is reporting of a sexual offence committed against a group member by a current or former therapist. It is therefore important for the therapist to know the laws that would apply in such a situation and the reporting requirements.
Confidentiality is one of the ethical issues that have to be upheld. It is the ethical duty of every therapist to practice confidentiality concerning the patient’s details (Kaminer, 2005). Confidentiality or the right to privacy is a constitution right for every citizen; some states go even further to have psychotherapist-patient privileges. Therefore, patient records confidentiality should be practiced. In the past, psychiatric records were not kept but in present times, keeping records has become part of the practice. In group therapies, confidentiality is a challenge because of the number of people involved. To overcome this, it is good for the therapist to let the members know that confidentiality is not only an ethical but also a legal requirement and reviews its importance at their first meeting and every time a new member comes in (Gonzalez, et al., 2005).
Unlike in individual therapy, members of therapy groups are prone to mistreatments by members of the group. This could be in the area of sex and money among others. The biggest challenge is the absence of legal protection for individual group members from the other members (Waldo & Grayshield, 2008). The only solution to this problem is for the therapist to apply the governing principle of competent care and exercise due diligence and clinical judgment in dealing with each member and must let them know their limits of interaction with other group members. A patient can be sent to group therapy if he ids unwilling to terminate his abusive behavior. Group therapists have to consult widely with colleagues, legal advisors and ethical committees, to overcome most of their challenges than individual therapists.
The therapist is faced with the challenge of ensuring that the needs of every member of the group are met(Abernethy& Markus, 2001). Though the members are accorded same therapy, it is possible that not all the cases are permanently identical. It is therefore essential for the therapist to guide the group effectively to discuss all issues coming up and encourage all members to open up (Dwyer, 2007). The therapist should go ahead to give the advantages of group therapy. From the above discussion, it is clear that group therapy has ethical issues unique to itself, particularly issues touching on confidentiality and professionalism especially on the issue of due diligence.
This statement marks an important development in approach to ethics within the Association. One of the characteristics of contemporary society is the coexistence of different approaches to ethics. This statement reflects this ethical diversity and supports practitioners being responsive to differences in client abilities, needs and culture and taking account of variations between settings and service specialisations by considering:
This selection of ways of expressing ethical commitments does not seek to invalidate other approaches. The presentation of different ways of approaching ethics alongside each other in this statement is intended to draw attention to the limitations of relying too heavily on any single ethical approach. Ethical principles are well suited to examining the justification for particular decisions and actions. However, reliance on principles alone may detract from the importance of the practitioner’s personal qualities and their ethical significance in the counselling or therapeutic relationship. The provision of contextually sensitive and appropriate services is also a fundamental ethical concern. Variations in client needs and cultural diversity differences are often more easily understood and responded to in terms of values. Therefore, professional values are becoming an increasingly significant way of expressing ethical commitment.
The fundamental values of counselling and psychotherapy include a commitment to:
Values inform principles. They represent an important way of expressing a general ethical commitment that becomes more precisely defined and action-orientated when expressed as a principle.
Principles direct attention to important ethical responsibilities. Each principle is described below and is followed by examples of good practice that have been developed in response to that principle.
Ethical decisions that are strongly supported by one or more of these principles without any contradiction from others may be regarded as reasonably well founded. However, practitioners will encounter circumstances in which it is impossible to reconcile all the applicable principles and choosing between principles may be required. A decision or course of action does not necessarily become unethical merely because it is contentious or other practitioners would have reached different conclusions in similar circumstances. A practitioner’s obligation is to consider all the relevant circumstances with as much care as is reasonably possible and to be appropriately accountable for decisions made.
Being trustworthy is regarded as fundamental to understanding and resolving ethical issues. Practitioners who adopt this principle: act in accordance with the trust placed in them; strive to ensure that clients’ expectations are ones that have reasonable prospects of being met; honour their agreements and promises; regard confidentiality as an obligation arising from the client’s trust; restrict any disclosure of confidential information about clients to furthering the purposes for which it was originally disclosed.
This principle emphasises the importance of developing a client’s ability to be self-directing within therapy and all aspects of life. Practitioners who respect their clients’ autonomy: ensure accuracy in any advertising or information given in advance of services offered; seek freely given and adequately informed consent; emphasise the value of voluntary participation in the services being offered; engage in explicit contracting in advance of any commitment by the client; protect privacy; protect confidentiality; normally make any disclosures of confidential information conditional on the consent of the person concerned; and inform the client in advance of foreseeable conflicts of interest or as soon as possible after such conflicts become apparent. The principle of autonomy opposes the manipulation of clients against their will, even for beneficial social ends.
The principle of beneficence means acting in the best interests of the client based on professional assessment. It directs attention to working strictly within one’s limits of competence and providing services on the basis of adequate training or experience. Ensuring that the client’s best interests are achieved requires systematic monitoring of practice and outcomes by the best available means. It is considered important that research and systematic reflection inform practice. There is an obligation to use regular and on-going supervision to enhance the quality of the services provided and to commit to updating practice by continuing professional development. An obligation to act in the best interests of a client may become paramount when working with clients whose capacity for autonomy is diminished because of immaturity, lack of understanding, extreme distress, serious disturbance or other significant personal constraints.
Non-maleficence involves: avoiding sexual, financial, emotional or any other form of client exploitation; avoiding incompetence or malpractice; not providing services when unfit to do so due to illness, personal circumstances or intoxication. The practitioner has an ethical responsibility to strive to mitigate any harm caused to a client even when the harm is unavoidable or unintended. Holding appropriate insurance may assist in restitution. Practitioners have personal and professional responsibility to challenge, where appropriate, the incompetence or malpractice of others; and to contribute to any investigation and/or adjudication concerning professional practice which falls below that of a reasonably competent practitioner and/or risks bringing discredit upon the profession.
The principle of justice requires being just and fair to all clients and respecting their human rights and dignity. It directs attention to considering conscientiously any legal requirements and obligations, and remaining alert to potential conflicts between legal and ethical obligations. Justice in the distribution of services requires the ability to determine impartially the provision of services for clients and the allocation of services between clients. A commitment to fairness requires the ability to appreciate differences between people and to be committed to equality of opportunity, and avoiding discrimination against people or groups contrary to their legitimate personal or social characteristics. Practitioners have a duty to strive to ensure a fair provision of counselling and psychotherapy services, accessible and appropriate to the needs of potential clients.
This chapter focuses on ethical issues in group therapy. The author begins by discussing the wide range of groups being offered as well as the differing levels of training and background of group leaders. He contrasts individual and group therapy to point out that the group leader is faced with some unique ethical challenges not likely to be encountered by the individual therapist.
The author discusses the problem of defining the standards of training for group therapists, the pressure by employers to provide services beyond the scope of one’s training, and he presents guidelines to assist the practitioner in determining his or her strengths and weaknesses and strategies for overcoming deficiencies. The topic of multiple relationships is amply examined, as the author explores the complex ethical issues involved in social relationships with group members, educators functioning as therapists and evaluators, and concurrent individual and group therapy. Finally, the author tackles the complicated issue of maintaining confidentiality in group settings, the ethics of involuntary group participation, physical contact in groups, and the necessity for developing a multicultural perspective to work effectively with ethnical and culturally diverse populations. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
The challenge of working ethically means that practitioners will inevitably encounter situations where there are competing obligations. In such situations it is tempting to retreat from all ethical analysis in order to escape a sense of what may appear to be unresolvable ethical tension. These ethics are intended to be of assistance in such circumstances by directing attention to the variety of ethical factors that may need to be taken into consideration and to alternative ways of approaching ethics that may prove more useful. No statement of ethics can totally alleviate the difficulty of making professional judgements in circumstances that may be constantly changing and full of uncertainties. By accepting this statement of ethics, members of the British Association for Counselling and Psychotherapy are committing themselves to engaging with the challenge of striving to be ethical, even when doing so involves making difficult decisions or acting courageously.
The British Association for Counselling and Psychotherapy is committed to sustaining and advancing good practice. This guidance on the essential elements of good practice has been written to take into account the changing circumstances in which counselling and psychotherapy are now being delivered, in particular:
Variations in client needs and the diversity of settings within which counselling and psychotherapy services are delivered have also been carefully considered. Clients vary in their requirements in order to communicate effectively and to gain access to services. Ethically aware services strive to meet these needs and to avoid excluding someone from receiving a service or lowering the quality of that service solely on the grounds of a client’s learning difficulty or physical disability. Services may be provided by the independent practitioner working alone, one or more practitioners working to provide a service within an agency or large organisation, specialists working in multidisciplinary teams, and by specialist teams of counsellors and psychotherapists. Most work is undertaken face to face but there are also a growing number of telephone and online services. Some practitioners are moving between these different settings and modes of delivery during the course of their work and are therefore required to consider what constitutes good practice in different settings. All practitioners encounter the challenge of responding to the diversity of their clients and finding ways of working effectively with them. This statement therefore responds to the complexity of delivering counselling and psychotherapy services in contemporary society by directing attention to significant issues that practitioners ought to consider and resolve in the specific circumstances of their work.
The terms ‘practitioner’ and ‘client’ are used in the same way as defined in Ethics for counselling and psychotherapy (see page 2). Practitioners’ behaviour may vary from these guidelines provided the variation is ethically justifiable; the client is supportive of the variation; it is demonstrably to the benefit of the client; and that practitioners are willing to be appropriately accountable to people affected, and this Association for their practice and the reputation of therapy in general.
All clients are entitled to good standards of practice and care from their practitioners in counselling and psychotherapy. Good standards of practice and care require professional competence; good relationships with clients and colleagues; and commitment to being ethically mindful through observance of professional ethics.
Ethical Issues Unique to Group Therapy and Individual Counseling Clients and therapists now have the options between individual and group counseling as methods to help to work through life changes and cope with issues in relationships, addictions, feelings, grief, stress and many others. One method is not better than the other since each person’s circumstance and expectation of therapy is different. Jacobs et al. highlights how a combination of both methods is also beneficial (2012). An effective leader determines if the client will not only benefit from group counseling, but assess the ability to participate in group counseling based upon their personal, mental and emotional state. In addition to having a keen awareness of the individual, the group, protection of each group member and ethical standards, the leader must be aware of their personal issues, boundaries and role as a leader when group therapy is incorporated. Jacobs et al. states “most members expect and want a leader to lead” (2012), so being aware of all aspects and resolving personal issues related to counseling topics improves the dynamic in both methods oppose to hindering it. A leader may exhibit the characteristics of an effective leader such as caring, openness, patience, honesty and trustworthiness, but being aware of ethical considerations is vital.Much like a church confessional, a counselor’s office is considered sacrosanct. Counselors adhere to a very strict, comprehensive code of ethics that governs the nature of the counselor/client relationship, requires informed consent and mandates confidentiality. But one-on-one counseling sessions are only one treatment setting. When counselors are facilitators in group therapy, the code of confidentiality is tested.
Put simply, non-maleficence is to “do no harm.” Beneficence is to work toward the benefit of others, such as by eliminating harms, preventing them or improving another person’s situation. Both of these are cornerstone concepts in the counseling profession, and at first glance, they seem simple enough. Beneficence and non-maleficence, as pertaining to patient confidentiality, allow clients to develop a trusting relationship with the counselor because they know that their information is kept confidential. While ethical counselors will never violate confidentiality except when required to do so by law, the same cannot necessarily be assumed of group participants. Furthermore, clients may walk into a group therapy session without having a clear understanding of how it will alter the code of confidentiality.
The challenges posed by group therapy to the ideals of beneficence and non-maleficence underscore the critical importance of informed consent. It can be helpful for the referring therapist to have a one-on-one discussion with each client before he or she joins a group. Some people are more likely to voice concerns or ask for clarification during one-on-one conversations, compared to group conversations. A more personal discussion also allows the counselor to closely evaluate the client’s comprehension of confidentiality issues in a group setting. A client should walk away from this discussion with the firm understanding that:
Additionally, depending on state law, there is a possible lack of privileged communication in a group setting. Many states have a “third-party rule.” This rule states that any information disclosed where a third party is privy to it cannot be considered privileged or private information. Each group participant should understand that, if called to testify against another group participant, an individual can be legally compelled to disclose information.
In addition to hosting one-on-one discussions with each group participant, the counselor should discuss group policies when the participants come together for the first time. Group participants can be more willing to uphold an ethical code if they take ownership of it, such as by signing a contract that promises confidentiality. Ideally, group members should agree not to disclose each other’s names, life circumstances, identifying details or any other information discussed during the group. They should also be aware of the potential problems that may arise if group members happen to encounter each other outside of group. If, for example, the group is for women coping with domestic violence, the acknowledgement of one member by another may cause a third party, like an abusive spouse, to ask unwanted questions about the nature of this relationship.
All in all, counselors should be aware of the ethical changes that take place in group sessions and be sure to make these concepts clear to their clients before starting a group counseling session.
Individual and group behavior is governed in part by ethics, the moral principles or values on which judgments are made as to whether actions are right or wrong, good or bad. The minimum ethical standards in a society are codified in law, but ethical behavior requires going beyond mere adherence to the letter of the law. The ability to engage in commercial and other types of relationships is dependent on trust and general acceptance that standards or codes of behavior will be upheld. Community agreement regarding acceptable and unacceptable behavior enables transactions to take place with some sense of order and predictability.
This article first examines the organizational context in which choices about ethical behavior take place and then discusses sources and career effects of ethical values. The stages in development of moral reasoning are then examined and also the types of ethical issues associated with specific career stages. The special case of organizational whistle-blowers is considered. Finally, the bases for making ethical decisions and opportunities for careers in the field of ethics are discussed.
In the late twentieth and early twenty-first centuries, a number of highly publicized events concentrated negative attention on ethics in public life and in private and public organizations, such as WorldCom, Enron, Tyco, HealthSouth, and Arthur Andersen. Consequences for individuals held responsible for these legal and ethical failings were career ending in many cases.
A plethora of potential ethical issues faces individuals at all organizational levels: discrimination, sexual harassment, falsifying financial information, insider trading, confidentiality and privacy violations, lying (to managers, colleagues, or customers), stealing, bribery, undercutting coworkers, claiming credit for work done by others, misrepresenting credentials, covering up unsafe working conditions and products—to name just a few types of ethical violations that occur in organizations. Most individuals can expect to face and handle many ethical issues throughout their careers.
As organizational changes accelerate, new situations with uncertain ethical overtones require action: downsizing, outsourcing, employability replacing career ladders, use of contingent workers, technological changes, and the increasingly global nature of competition. These changes impact careers at all organizational levels and present new challenges to those trying to balance their own career development and the needs of the organizations that employ them. The changing nature of workers’ psychological contracts introduces new tensions between individual career considerations and obligations to employers. As job security fades and individuals recognize a lack of commitment from their organizations, they reciprocate with less commitment to their employers. The accepted exchange relationship between employer and employee has eroded, and individuals must now take responsibility for maintaining and updating their skills and managing their careers.
Individuals develop ethical standards as a result of socialization in their families, community, religious institutions, and professions. When they join organizations, the contexts in which they work become a powerful determinant of ethical choices. In fact, organizational context is a stronger determinant of ethical behavior than individual moral reasoning ability or espoused ethical standards. Individuals have been shown to use lower levels of ethical reasoning when making decisions in business settings than they do in non-business contexts. Organizational culture, the presence and strength of a code of behavior, role-modeling by managers, the reward system of the organization, and personal career consequences of ethical choices may override the individual’s code of behavior or ability to reason ethically.
Ethics impacts careers in a number of ways. Personal beliefs about work that is valuable to society and consistent with the individuals’ values influence the choice of a career. Decisions to join, stay with, or leave a particular career or organization may be made on the basis of congruence between the individual’s moral beliefs and those enacted by and required of members of the profession or organization.
One criterion for determining whether a profession exists is the presence of a generally accepted code of ethics for those working in the area. Professions thus socialize their members into the behaviors regarded as ethical by their practitioners; however, these professional ethical standards may come into conflict with expectations for employees of particular organizations. For example, certified public accountants must pass an examination on the ethics of accountancy. If their employers request that they falsify accounting records or violate generally accepted accounting practices, the ethics of their profession will be in conflict with the expectations of their employers—and possibly with their own ethical standards.
Movement through stages of ethical reasoning occurs as individuals mature. At the lowest levels of moral reasoning, preconventional, individuals make choices based on hedonistic consequences for themselves: They do what gives them pleasure or what allows them to avoid punishment or pain. At this level of cognitive moral reasoning, individuals are concerned about the consequences of their actions for themselves. As people mature, their ethical choices are influenced by the standards of the groups to which they belong. Conformity to rules and laws of peer groups govern ethical choices at the conventional level. At the highest level of moral reasoning, postconventional or principled, individuals’ ethical choices are made by reference to principles they have accepted or developed for themselves. Here, the concern is for consequences to society at large, not just to individuals and their reference groups.
Different types of ethical dilemmas are faced by individuals at different career stages. Using Donald Super’s career development framework, researchers have found different types of ethical issues faced by those in the exploration, establishment, maintenance, and disengagement stages of their careers.
In the aptly named exploration career stage, individuals focus on acceptance from peers and also may be most vulnerable to pressure from superiors. If achieving performance norms is critical to peer acceptance, this need for acceptance by peers can lead to ethical shortcuts. If the organization rewards goal achievement, the individual in this early career stage may feel pressured to achieve those goals using any means, ethical or unethical. The potential for ethical shortcuts is increased if superiors themselves do not model ethical behavior.
When individuals enter the establishment stage, they have made some commitment to a particular profession or career and are increasingly concerned with career advancement. High levels of competition may result in individual ethical compromises to achieve promotion. In individuals with high success drives, this temptation may be intensified. In the establishment stage, the pressure to take ethical shortcuts may be mostly internal, in contrast to the exploration stage, in which pressure comes from peers and superiors.
During the maintenance and disengagement stages, both external and internal pressures to violate personal ethical standards in pursuit of organizational goals can be expected to lessen. With established track records, decreased competition, and more personal acceptance of one’s achievement levels, both internal and external pressures for unethical behavior can be expected to decrease. In addition, as individuals become more focused on their work legacies, they may gain more incentive to help others achieve their life and career potential and also further integrate their own careers into their whole life systems. On the other hand, individuals in the maintenance stage are expected to be at the top of their careers, often in positions that may lead to temptations to encourage subordinates to use ethically questionable means to achieve organizational goals. Furthermore, individuals who have reached upper-management positions may face external pressure from stockholders as well as from their boards of directors to do whatever it takes to increase share price.
Thus, the nature of the pressure to behave unethically, the types of ethical issues faced, and the motivation for ethical/unethical behavior can be expected to vary over the course of a career, but no career stage immunizes individuals from the necessity of handling ethical issues.
In extreme cases, individuals may choose to become whistle-blowers, even though the consequences of such actions are almost always detrimental to the individual’s career. Whistle-blowers speak out about illegal or unethical behavior in organizations. They may blow the whistle internally or, after exhausting internal reporting systems, publicly report organizational wrongdoing. At the other extreme, individuals who remain in positions or organizations that require some violation of their personal ethical standards may disconnect their emotions from the work situation and therefore reduce commitment to the organization and fail to engage in organizational citizenship behaviors. Perceptions of ethical culture are strongly related to both job satisfaction and organizational commitment and thus to organizational citizenship behaviors.
Issues differ in their levels of moral intensity. Moral intensity is higher—and whistle-blowing is more appropriate—when consequences are greater, when there is general social consensus that an action is wrong, when it is highly likely that the harmful consequence will actually occur, when the event is imminent and proximate to the individual, and when the effect is concentrated rather than diffuse. Enron whistle-blowers Sherron Watkins and Maureen Castaneda felt the legal and ethical violations at Enron justified their going public with the company’s lapses. In another case, the Challenger disaster might have been avoided had the engineer, Alan McDonald, who disagreed with the judgment regarding the safety of the O-rings, taken his concerns outside NASA.
Being a whistle-blower frequently carries heavy career consequences. Most whistle-blowers lose their jobs as a result of their reporting legal or ethical violations. They may also be unable to find employment in their professions after the event. Most suffer financial and/or personal reverses as they pursue cases, which frequently drag on over a number of years. Nonetheless, whistle-blowers feel a moral imperative to expose organizational actions that endanger others, even at the cost of their own careers.
Integrity, honesty, and a strong work ethic are high on employers’ lists of traits and skills they seek in employees. However, many employees fail to see a positive relationship between ethical behavior and career advancement. In fact, they believe they must choose between adhering to their personal ethical standards and their own career progressions. Concerns for organizational profit and/or survival often trump individual concerns about honorable behavior. Ethicists thus recommend that early in their careers, individuals make decisions about the lines they will not cross. If these decisions are not consciously taken when there is time for thoughtful consideration, individuals may find themselves unwittingly compromising their integrity as they respond to the organizational pressures of the moment.
Philosophers have suggested prescriptive approaches to ethical thinking. The utilitarian approach judges whether an action is ethical by examining its likely consequences. Among the alternatives available, the ethical choice is the one that creates the greatest good or the least harm for the greatest number of people. This approach, with its roots in economics, is embraced by the majority of businesspeople and by many in other fields. Using utilitarian reasoning, for example, management fires some workers in an attempt to improve profits, attract investors, and retain other jobs, or they close a plant in one town because its inefficiencies have a negative impact on profits of more efficient plants in the same organization. Utilitarianism works well for those in the majority, but minorities do not fare well under this philosophical approach to making ethical decisions. That many others benefited from the decision may offer small comfort to those who lost their jobs or to the town whose economy was decimated when the plant closed. In addition, the likely consequences of all alternatives cannot be known with certainty. Information about some consequences or even about some groups or individuals who will be affected by the decision may be unavailable.
A second approach to ethical decision making is the rights approach. A decision is considered ethical if it avoids violating the basic human rights of any stakeholders affected by the decision. Difficulties with this approach include the impossibility of getting universal agreement on what basic human rights are. To some, these rights include the right to a livable wage or health care; others recognize fundamental rights to life and freedom, but to little else. Furthermore, rights can conflict, and there are no clear rules for determining which rights take precedence in a particular case.
In the justice approach to making ethical choices, decisions are considered ethical if the same procedures apply to all who are affected by the decision (procedural justice) or if those who are similarly placed receive similar outcomes (distributive justice). Thus, those with similar professional qualifications, workloads, and performance levels should receive similar compensation; those with lesser credentials, workloads, and performance levels should be compensated less than those in the first group, but all members of the same performance class should receive similar outcomes.
The virtue approach focuses on the integrity of the decision maker or moral actor. Intentions and motives as well as actions themselves are considered in judging whether or not an action is ethical. This approach relies on community standards of behavior. In professions, these standards are encapsulated in codes of behavior accepted by practitioners in the field.
Career opportunities in the field of ethics are increasing. Growth in the demand for ethics officers in corporations is partially a response to changes adopted in 1991 by the U.S. Sentencing Commission. The sentencing guidelines reduce penalties for corporations found guilty of violations if they can demonstrate that they have comprehensive ethics programs in place. Having a high-level executive with direct responsibility for ethical behavior in the organization is a strong signal that companies take ethics seriously. More recently, the passage of the Sarbanes-Oxley Act of 2002 has reinforced the pressure for compliance officers who are held responsible not only for ensuring compliance to ethics laws but also for the development of an organizational climate and culture that support ethical behavior.
The responsibility for compliance with employment laws, ensuring nondiscrimination in hiring and treatment of employees, and setting programs in place to prevent sexual harassment is generally housed in human resource management departments. Thus, careers in human resource management also require a thorough grounding in law and ethics.
Ultimate responsibility for ethical behavior in organizations, however, still rests with individual employees. Company titles that include the word ethics may be limited, but the necessity of considering the ethical implications of organizational decisions permeates the entire organization and affects careers at all levels.