Chapter 12 - Ethical Issues in Group Work (pg 505 - 534)
Ethical Issues in Training & Supervision of Group Leaders
Group facilitators must remain current and increase their knowledge and skills through activities such as continuing education, supervision, and participation in various personal and professional development activities
familiarize yourself with referral resources and refrain from working with client populations that need special assistance
groups can be used effectively for both prevention and education
group counselor trainees need to understand and reflect on some of the typical ethical dilemmas they will face in practice.
effective way to teach ethical decision making is by presenting trainees with case vignettes of typical problems that occur in group situations and encouraging discussion of the ethical issues and pertinent guidelines
ethical decision making is an ongoing process that takes on new forms and increased meaning as practitioners gain experience
be receptive to self-examination and to questioning the professionalism of their group practice
highly recommend four other experiences as adjuncts to a training program for group workers
(1) personal experience in an experiential group
(2) personal (individual) psychotherapy
(3) group supervision
(4) observing group therapy sessions
be proactive in seeking opportunities to gain these experiences and request to observe, or cofacilitate, groups at their practicum and internship sites
Self-Exploration & Experiential Groups
group leaders - expand awareness of self and effect that self has on others
one of the best ways to learn how to assist group members in their struggles is to be a member of a group yourself
experiential group training is alive, evolving, and is an accepted form for training group leaders, coursework & instruction is not enough
in addition to enhancing personal growth, such training through experiential groups provides participants with an understanding of the stages of group work, group dynamics, and group techniques that facilitate meaningful interactions
ethically imperative that students are made aware of this requirement (self-exploration group or experiential group) at an orientation meeting during the admission process or prior to the time they enroll in a program
safeguards must be in place to manage boundaries and to reduce the risk of harm to students - systematic instructor self-reflection, informed consent of students, and self-disclosure training
dealing with students who exhibit problematic behavior in an experiential group
group counselor-educator has multiple responsibilities:
individual student who displays problematic behavior
other students in the experiential group
the training program
important for group members to understand the impact their behavior has on others
one effective intervention is to invite other members to provide here-and-now feedback to the member exhibiting the problematic behavior, instructor or group facilitator is responsible for blocking unproductive interactions while this feedback is being delivered to prevent the group member from being scapegoated or overwhelmed with negative feedback
Personal Psychotherapy
sometimes issues that emerge in experiential group is more appropriately explored in personal therapy
encourage individual therapy as a way of enhancing trainees’ abilities to understand both themselves and others, which is essential for ethical practice
enables us to identify and explore countertransference reactions we may have toward certain group members, recognize our blind spots and biases, and use our personal attributes effectively in our work
Group Supervision
offers unique advantages for observing group processes in action
also an efficient supervision model given that several group leaders can be supervised at the same time
has value with respect to increasing the skill development of trainees
provides trainees with many experiential opportunities to learn about the process and development of a group and creates the foundation for future ethical practice
workshops help develop necessary skills for effective and ethical intervention
helps interns learn a great deal about their response to criticism, competitiveness, need for approval, concerns about being competent, and power struggles
Observation of Group Therapy Sessions
watching videos of group sessions and observing groups in action make academic learning more meaningful
lessons trainees could translate into their work
Tolerate intense emotions and learn to trust the group process
Identify and use group themes, metaphors, and group dynamics
Understand ways of working with transference and countertransference
Use techniques to highlight themes emerging in the group
Promote immediacy and the value of working in the here and now
usually difficult for students to find live groups they can observe
Teaching Group Counseling Courses Virtually
necessary to develop effective online teaching models that appropriately address counselor development
research has demonstrated that online counseling courses can teach clinical skills as effectively as face-to-face courses, some modifications may be needed
Ethical Considerations for Online Group
online groups increase access to group counseling, they also bring new ethical concerns, such as
virtual confidentiality
video recording
member identity verification
virtual informed consent
confidentiality must be assured; members need to know that others who are not in the group (such as family members and friends) will not be seeing or hearing the interactions taking place in a group session on screen
ASGW’s (Association for Specialists in Group Work) Special Initiative Committee created a document that focuses on considerations unique to virtual group work titled “Ten Tips for the Facilitation of Virtual Groups”
Social Media in Group Work: Confidentiality and Privacy Considerations
added dimensions when group members and their therapists interact with each other in online group counseling and when group members communicate via social media
a gap exists in the literature concerning the experiences of members in online counseling groups
increased risk of breaches of confidentiality when members of a counseling group engage in social media
should address the parameters of online behavior through informed consent and should establish ground rules regarding members’ commitment to avoid posting pictures, comments, or any type of confidential information about other members online
talk about their own experience, reactions, and insights without describing other members or mentioning others in the group by name or talking about themselves rather than other group members
breaches may occur when members share their own information online, especially if they struggle with poor boundaries OR may lack the technological skills and knowledge to protect information that is intended to remain private
should be cognizant of the demographics of social media users to ensure they are able to reach their targeted client population
avoid marketing groups solely on social media as this excludes client populations who are unlikely to use social media
advanced in age
live in rural areas
lower socioeconomic status - lack access to internet or social media
social media is accessed both for personal use and as a professional tool
counselors - use social media to market services
younger generations may be likely to use social media to seek mental health services
practitioners will have to translate and maintain traditional ethics when it comes to social media
recommendations to help manage your presence on social media platforms:
limit what you share online
familiarize yourself with the privacy policy and take time to maximize and customize your privacy settings
include clear and thorough social networking policies in your informed consent process
regularly update your protective settings because privacy options are constantly changing on social media platforms
prepare to get friend requests/follow/tag/direct message from current or former members of groups, reflect before responding:
What is on their Facebook or other social media platform profile?
Does the psychotherapist have a Facebook page or only a Facebook profile?
Do they use privacy controls to control access?
What can the client view on the therapist’s Facebook profile or on Instagram or TikTok accounts?
What is the context of psychotherapy?
Who is the client?
Why did the client post the request?
What is the meaning of the request?
What is the nature of the therapeutic relationship?
Where is psychotherapy taking place? What is the community like where therapy is taking place?
What does being a “Friend” with or being “followed” by this client mean for the therapist?
What is the potential effect on other potential clients (or group members)?
What are the ramifications of accepting a Friend Request from or “following” a client for confidentiality, privacy, record keeping, and HIPAA compliance?
Does accepting a Friend Request from or “following” a client constitute a dual relationship?
How will accepting the request or “following” the client affect treatment and the therapeutic relationship?
Addressing Disability Considerations in Group Work
important to recognize the potential of people with disabilities
counselors’ attitudes are a key factor in successfully intervening in the lives of people with disabilities
dispelling myths and misconceptions when helping people with disabilities achieve their goals is of primary importance
recognize their own biases and address them
a role in assisting members of their groups who have a disability to develop an understanding of the impact that societal stereotypes have on their view of themselves
Ethical Issues in the Diversity Training of Group Workers
promoting sensitivity and competence in addressing diversity in all forms of group work
Cultural competence refers to the knowledge and skills required to work effectively in any cross-cultural encounter
Becoming a diversity-competent group worker involves self-awareness and an open stance on the leader’s part to the diversity issues that emerge in a group
responsibility of training programs to create safe opportunities for a trainee’s cultural self-explorations
if you have cultural tunnel vision → likely to misinterpret patterns of behavior displayed by group members who are culturally different from you
If you are in doubt about what a group member is saying or doing, ask this person for an explanation
technique endorsed by leading multicultural scholars is broaching the subjects of race, ethnicity, and culture with clients
effective group interventions are adapted to the needs of the individual member rather than attempting to fit the member into the leader’s usual interventions
Social Justice Practice & Training in Group Work
social justice - “the fair and equitable distribution of power, resources, and obligations in society to all people, regardless of race, gender, ability, status, sexual orientation, and religious or spiritual background”
multiculturalism & social justice concepts are often intricately linked
ASCW - guidelines for training group workers, conducting research, and assisting group workers in various settings to increase their knowledge and skills in developing competence in addressing multicultural and social justice themes in group work
emphasize acquisition of awareness, knowledge, skills that equip leaders to work ethically and effectively with diversity
stress the need for counselors to redefine ethics and boundaries when working in an international context
adaptation, modification, and changes to Western traditional group counseling practices should be considered
Trainees require more than a conceptual understanding of social justice principles to develop competence; group leaders need “concrete strategies for infusing social justice in their work”
values clarification
empowerment of gender and ethnicity statuses
consciousness raising
self-disclosure
social and gender-role analyses
structure to maximize group cohesion
bibliotherapy
Experiences members have had with social injustices will inevitably surface when people from diverse backgrounds participate in a group
search for ways to expand competence in addressing social justice issues that emerge
both group leaders and group members are challenged to struggle with getting comfortable with discomfort
Power and privilege dynamics operate in a group just as in the wider world, and the imbalance of power can be addressed and explored in group work
if issues are not addressed, members deprived of opportunity to explore cultural values and biases, raise awareness of injustices, learn to confront them
discrimination
oppression
prejudice
interpersonal violence
Guidelines for Multicultural & Social Justice Competence (Association for Specialists in Group Work)
Group workers strive to increase their awareness of their own multicultural identity and how their race, ethnicity, socioeconomic class, migration status, ability, age, gender identity and expression, sexual orientation, and religion and spirituality are influenced by their life experiences and histories
Group workers consider the impact of adverse social, environmental, and political factors in assessing problems and designing interventions. They realize that an individual’s problems cannot be isolated from their societal context
Group workers address issues of status, privilege, and oppression as they arise in group work facilitation
Group workers strive to increase their awareness of their biases, values, and beliefs and how these influence their group facilitation
Group workers model relationship skills that are basic to establishing and maintaining connections between multicultural group members while planning, performing, and processing groups
Group workers establish norms that accept, value, and respect cultural differences. Leaders encourage open discussion of dynamics related to cultural issues early in the life of a group
Group workers with a social justice orientation are aware that individual change occurs through social change, and they advocate with clients and on behalf of clients both in the group and across other systems
Group workers discuss why social justice and advocacy issues are important in a group and how these issues influence the practice and outcomes of group work
Group workers address underlying cultural conflicts in a group when appropriate and model ways of successfully dealing with conflict
Group workers are aware of different connecting and communication styles
Group workers expand the concept of being a client to include systems and communities when they are examining change
Group workers strive to develop competence in both multiculturalism and social justice advocacy throughout their professional practice
Group workers assume various roles such as mentor, teacher, ally, or advocate to assist members in navigating personal and systemic change
**If group counselors do not understand how their own cultural background influences their thinking and behavior, there is little chance they can teach group members much about their cultural thinking and behavior.
Ethical Considerations in Coleadership
can either enhance or complicate the group process or raise a multitude of potential ethical issues
The ASGW (2021) Guiding Principles for Group Work provides this guideline on coleadership:
relational skill
foundational for addressing complexities in groups
coleaders engage in intentional planning together
make use of supervision
training mechanism for more novice group workers with experienced leaders to develop competencies
group can benefit from the insights and feedback of two leaders
advantages
Coleaders who complement and balance each other can provide useful modeling for members
coleaders can share the responsibilities and provide mutual support
disadvantages
One of the main disadvantages involves relationship difficulties between the leaders
ineffective communication
competition between leaders
overdependence on the coleader
group members may try to pit one coleader against the other
conflicts
place an unfair burden on the members and can be harmful to the group process and outcome if unmanaged
can be a valuable learning opportunity - model healthy conflict resolution, no defensiveness, willingness to challenge/be challenged
up to leaders to determine - address it in moment with group members or in private between leaders (if members witnessed conflict, prefer to deal with it in group)
Ethical Issues in Forming and Managing Groups
Informed consent - process of presenting basic information about group treatment to potential group members to enable them to decide whether or not to join a group
Leaders have the responsibility of ensuring that members become aware of their rights (as well as their responsibilities) as group participants
good policy to provide disclosure statement to group - written info on things like therapists’ qualifications, techniques often used, rights and obligation of group members, risks/benefits of participating in the group
special attention needs to be paid to limitations of confidentiality
good practice to tell members at the outset that informed consent is an ongoing process and that various aspects of the consent process will likely be revisited at different stages of a group
Screening & Selection of Group Members
not everyone will benefit from a therapeutic group experience
leaders determine who should/should not be included in a group
easier to identify the people who should be excluded from group therapy than those who should be included
list the following as poor candidates for a heterogeneous outpatient intensive therapy group:
people with traumatic brain injuries
paranoid individuals
hypochondriacs
acutely psychotic individuals
antisocial personalities
criteria for inclusion - he contends that the client’s level of motivation to work is the most important variable
groups are useful for people who have problems in the interpersonal domain (loneliness, inability to make or maintain intimate contacts, feelings of unlovability, fears of being assertive, dependency issues)
also, clients who lack meaning in life, who suffer from generalized anxiety, who are searching for an identity, who fear success, and who are compulsive workers could also profit from a group experience
ethical guideline - some type of screening (interviewing and evaluating) should be employed
type of group should determine type of members accepted
many group leaders do not screen participants
theoretically oppose to notion of using screening to determine who is suitable for group
simply do not have the time
not realistic in work setting
failure to evaluate suitability of group member could lead to harm of other members
Preparing Group Participants
many practitioners do little to prepare group members, opposed to preparation on grounds that it could inhibit a group’s spontaneity and autonomy
others assert that members need to be provided with some structure to derive maximum gains
explore group members’ misconceptions and expectations, predicting early problems, providing a conceptual framework that includes guidelines for effective group behavior
reinforces the therapist’s respect for the client
demonstrates that therapy is a collaborative venture
shows that the therapist is willing to share knowledge with the client
providing members with basic information about the group process tends to eliminate some of the difficulties typically encountered in the early stages of a group
both the screening session and the initial group meeting, we explore the members’ expectations, clarify goals and objectives, discuss procedural details, explore the possible risks and values of group participation, and discuss guidelines for getting the most from a group experience
include a discussion of the values and limitations of groups, the psychological risks involved in group participation, and ways of minimizing these risks. We also allow time for dealing with misconceptions that people have about groups and for exploring the fears or reservations the members may have.
ask members to spend time before they come to the group identifying what they most want to achieve and formulating personal goals that will guide their participation
Involuntary Participation
Members will make significant changes only to the extent that they actively seek something for themselves
negative attitudes of some members can contaminate the entire group experience
Skilled leaders often are able to change negative attitudes of some involuntary members by showing them how they might benefit from a group experience
Group leaders should strive to help involuntary members understand their choices and the consequences of lack of compliance with the treatment program
need to be certain that group members understand their rights and their responsibilities
Freedom to Withdraw From a Group
Procedures for leaving a group should be explained to all members during the initial session
members have an obligation to attend all sessions and to inform us if they decide to withdraw.
leader and the member cooperate to determine whether a group experience is proving to be productive or counterproductive
clients have a responsibility to the leader and to other members to explain why they want to leave.
it can be psychologically damaging to members to leave without having been able to discuss what they considered threatening or negative in the experience
unfortunate if members leave a group because of a misunderstanding about some feedback they have received
can be harmful to group cohesion
Psychological Risks
Ethical practice demands that group practitioners inform prospective participants of the potential risks involved in the group experience
goal is to create a safe environment where members can take risks and explore their discomfort
leaders have an ethical responsibility to take precautionary measures to reduce unnecessary psychological risks
group leaders have a great deal of power, prestige, and status within their groups and caution that “many leaders are not able to responsibly manage, or even recognize, their power and influence”
a variety of factors or events that result in members having a negative group experience:
lack of leader support
an aggressive and harshly confrontational leadership style
premature pressure to disclose
a passive leadership style
misuse of a leader’s power and influence
lack of acceptance for diverse points of view
lack of clarity about group norms
negative norms that coerce participation or encourage excessive confrontation
Group members are often more willing to be challenged when they know they will be supported in the group
some of the risks that participants should know about (M. Corey et al., 2018):
Members may experience some disruptions in their lives as a result of their work in the group.
Group participants are often encouraged to be completely open. In this quest for self-revelation, privacy is sometimes inappropriately surrendered.
A related risk is group pressure. The participant’s right not to explore certain issues or to stop at a certain point should be respected. Also, members should not be coerced into participating in an exercise.
Scapegoating is another potential hazard in groups. Unchallenged projection and blaming can have dire effects on the target person and can have a negative impact on the progress of a group.
Confrontation can be used or misused in groups. Harmful attacks on others should not be permitted.
If safety is lacking in a group, members who have been subjected to social injustices may be revictimized if they are subjected to a similar kind of injustice when they explore their experiences in the group.
Even though a counselor may continue to stress the necessity not to discuss with outsiders what goes on in the group, there is no guarantee that all members will respect the confidential nature of their exchanges
can minimize psychological risks in groups by using a contract or training for leader to have clear grasp of boundaries of competence
Leaders can reduce the chances of creating a toxic climate within a group by:
assuming a nonjudgmental stance toward the members
avoiding responding to sarcastic remarks with sarcasm
being honest with members rather than harboring hidden agendas
avoiding judgments and labeling of members, and instead describing the behavior of members
stating observations and hunches in a tentative way rather than dogmatically
letting members who are difficult know how they are affecting them in a nonblaming way;
detecting their own countertransference and managing these reactions
avoiding misuse of their power
providing both support and caring confrontations
avoiding meeting their own needs at the expense of the members
Confidentiality in Groups
Protecting the confidentiality of group members is an ethical mandate, and it is the responsibility of the counselor to address this at the outset of a group
group therapist expected to safeguard members’ right to privacy
protecting identity of members
protecting info of confidential nature
informing members of limits of confidentiality & responsibilities to other members
confidentiality in a group cannot be guaranteed - group leaders are responsible for educating members: how easy it is to unintentionally breach confidentiality, importance and advantages of keeping information private that pertains to the group
leaders need to periodically reaffirm to group members the importance of not discussing with outsiders what has occurred in the group
Exceptions to Confidentiality in Groups
if members pose a danger to themselves or to others, the group therapist has an ethical and legal obligation to take appropriate steps to protect the group member and society in general
therapists must become familiar with the state laws that have an impact on their practice
all states have had mandatory child abuse reporting laws since 1967
legally required to report members’ threats to harm themselves or others. This requirement also covers cases of child abuse or neglect, incest, child molestation, older adult abuse, and dependent-adult abuse
Confidentiality With Minors
Encouraging confidentiality is a special challenge for counselors who offer groups for children and adolescents in school settings.
important to work cooperatively with parents and legal guardians, as well as to enlist the trust of the young members
useful to teach minors, using a vocabulary they understand, about the nature, purposes, and limitations of confidentiality
leaders to encourage members to initiate discussions on confidentiality whenever this becomes an issue for them
Circumstances in which a minor may seek professional help without parental consent, defining an emancipated minor, or the rights of parents (or legal guardians) to have access to the records regarding the professional help received by their minor child vary according to state statutes
good practice to obtain written permission from the parents
include a brief description of the purpose of the group, the importance of confidentiality as a prerequisite to accomplishing these purposes, and your intention not to violate any confidences
Ethical Issues Concerning Termination
final phase in life of group - critical, consolidate learning, members need to be able to express what experience has meant to them & state where they intend to go from there
neglecting - can leave members with unfinished work & limits opportunities for them to conceptualize what they learned from the group experience
endings can be difficult - realize that time is limited in their group; often triggers other losses that members have experienced, so termination of a group may involve a grieving process
Termination Phase in a Closed Group
closed groups - time limitations, predetermined number of sessions
members expected to remain in group until it ends, new members not added
help members review their individual work and the evolving patterns from the first to the final session.
termination phase of a group provides an opportunity for members to clarify the meaning of their experience, to consolidate the gains they have made, and to make decisions about the new behaviors they want to carry away
Termination of Members in an Open Group
members leave the group and new members are incorporated into the group at various times
tasks to accomplish with person leaving group:
teach members in an open group to give adequate notice when they decide it is time to terminate, ensure that members have time to address any unfinished business with themselves or others in the group
ideally - mutually agreed upon by member and leader, sufficient time to work through process of loss and separation
remaining group members have opportunity to express thoughts and feelings about loss of member
good policy to ask those members who are leaving to review what they have learned in the group and, specifically, what they intend to do with this learning
Follow-Up and Evaluation
can provide you with helpful feedback on the value of a group experience from the perspective of members and can be done in a variety of ways
evaluation is an ongoing process whereby members are taught how to determine whether the group is helping them attain their personal goals
group counselors also must assess both the process and the outcomes of their groups.
How to Determine What Works in a Group
Group practitioners operate from diverse theoretical models and possess unique individual characteristics and therapeutic styles
Evidence-Based Practice in Group Work
the similarities rather than the differences among models account for the effectiveness of psychotherapy
Clinical practice should be based on the best available research integrated with a practitioner’s expertise within the context of a particular client
rely exclusively on an evidence-based practice (EBP) approach to evaluation, which considers the best research evidence in light of therapist and client factors
three pillars: best available evidence, clinician expertise, and client characteristics
can be difficult b/c involvement of active and informed group members is crucial to the success of a therapy group
to base their practices exclusively on interventions that have been empirically validated may seem to be the ethical and competent path to take, yet some view this model as mechanistic and failing to take into full consideration the relational dimensions
Alternative: The Practice-Based Approach to Group Work
Many group practitioners do not think matching techniques that have been empirically tested with specific problems is a meaningful way of working with the problems presented by group members
the approach of practice-based evidence (PBE), which uses data generated from clients during treatment to inform the process and outcome of treatment
collecting data directly from members about their group experience is a significant part of developing an evidence-based group therapy practice
can help therapists assess the value of a group for its members throughout the life of the group as well as provide a tool to aid evaluation of the group experience during the termination phase
relationship-oriented approach (such as person-centered therapy and existential therapy) emphasize understanding the world of the group members and healing through the therapeutic relationship
many aspects of treatment—the therapy relationship, the therapist’s personality and therapeutic style, the client, and environmental factors— contribute to the success of psychotherapy and must be taken into account in any evaluation
importance of enlisting the client’s active participation in the therapeutic venture
Feedback-informed treatment (FIT) is an evidence-based practice that monitors client change and identifies modifications needed to enhance the therapeutic endeavor.
involves consistently obtaining feedback from clients regarding the therapeutic relationship and their clinical progress → used to tailor therapy to their unique needs
If group leaders learn to listen to members’ feedback at all phases of a group, members can become full and equal participants in all aspects of their therapy