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Ethical Issues in Group Counseling

There are many Ethical Issues related to group counseling. In this presentation, "Legal liabilities and malpractice in group work" is explained in detail.
by

Varinder Kaur

on 21 January 2015

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Transcript of Ethical Issues in Group Counseling

IN GROUP COUNSELING
“Group leaders are not born. They are trained” (Barlow, 2004).
Untrained group leaders can be successful in leading time-limited groups to address basic skill problems, but to create an environment for change (Barlow, Burlingame, Nebeker & Anderson, 2000) and to facilitate better outcomes for consumers (Barlow, Burlingame, Hardman,& Berman, 1997), an expert leader is required
Why the group experience is vital for Trainees?
It helps in the development of leadership and self-awareness that facilitates future successful outcomes for consumers (Stockton, 1980; Yalom, 1995).
Why the group experience is vital for Educators?
• It provides educators the opportunity of doing gate keeping, in order to observe and offer constructive feedback to trainees in a pedagogy that protects the public and fellow students.

• It offers educators the opportunity to play multiple roles as group leaders, observers of trainees’ self-disclosures, and evaluators.

• It helps educators to learn through some challenging situations, e.g. balancing the trainees’ need for feedback, protecting group members from novice errors, maintaining the confidentiality of participants, and avoiding dual relationships that can occur when instructors have multiple roles (Blackwell, Strohmer, Belcas, & Burton, 2002).
A. Nature and Scope of Practice
B. Assessment of Group Members and the Social Systems in which they Live and Work
C. Planning Group Interventions
D. Implementation of Group Interventions
E. Leadership and Co-Leadership
F. Evaluation
G. Ethical Practice, Best Practice, Diversity-Competent Practice

Knowledge and Skill Objectives (Wadsworth, 2008)
What is important for an ethical group practitioner?
• Not only avoiding the breaking of laws or ethical code

But also

• Functioning at a highest level of consciousness, both personally and professionally

• Looking at their own subtle unethical behaviors, rather than focusing on gross forms of unethical behaviors such as sexual misconduct, incompetence, negligence, and malpractice (Kottler, 1994)

What are the problems that could make group counselor vulnerable to error?
• Verbal abuse in group
• Group leaders’ less control in influencing what occurs within the group and with member behavior outside the group
• Possession of power by group leader that can either empower or stifle group members
• Dependency of group members on group leader or other in group or the group itself in the absence of adequate leadership
• Confidentiality can be neither guaranteed nor enforced
• Practicing as a group counselor without adequate training, education, and supervision
• Possessing more risk for members of group than in individual therapy
• Poorly done screening and selection or members may be required to participate in a group involuntarily
• Special reentry problems that members often face once the group has ended, especially if these issues are not addressed by a group leader
Group as an Asset?
Or Group as a Hindrance?
On the path of life-changing journey of client…..
Although groups have unique therapeutic power that can change clients’ life by empowering them, but they also have the potential to cause harm to the participants.
What contribute to make a group an Asset not Hindrance?
• Group leader’s skill, style, personal characteristics, and competence in group work
• Group that is designed on ethically and legally sound principles

Group therapy poses an interesting question with regard to working alliance: With whom is the alliance made? Is it with the group leader or with the group as a whole?

To date, one study has begun to address this question, albeit indirectly, by asking whether it is the working alliance with the therapist or the factors of group cohesiveness and group climate that predict outcomes (Crowe & Grenyer, 2008). In that study, the alliance with the therapist was not predictive of outcome, but cohesiveness and climate were predictive.

Kelly & Yuan (2009) has found that clients who reported keeping a relevant secret (27.7% of the sample) rated their working alliance as being weaker than those who did self-disclose. Those who kept such secrets also showed less symptom reduction.
There is little research regarding the working alliance within the context of group counseling and psycho-therapy.

However, a few studies have been done within this setting. These include couples counseling (Knerr, Bartle-Haring, McDowell, Adkins, Delaney, Gangamma, et al., 2011), family therapy (Pereira, Lock, & Oggins, 2006), and group therapy (Taft, Murphy, King, Musser, & DeDeyn, 2003 ; Bakali, Baldwin, & Lorentzen, 2009).
The therapeutic relationship has been demonstrated to contribute about 30% of the clients' change ( Asay & Lambert, 1999 ; Duncan, 2010 ).

The working alliance is the “strength of the collaborative relationship between client and therapist in therapy” (Luborsky, Barber, Siqueland, & Johnson, 1996 ; Horvath & Bedi, 2002).
Some ethical issues related to Group Counseling
• The rights of group members: screening, orientation, informed consent and confidentiality of group members

• The psychological risks of groups

• Personal relationships with clients

• The impact of the group leader’s values

• Working sensitively and ethically with diverse client populations

• The uses and misuses of group techniques

• Guidelines for termination and follow-up

• Legal liability and malpractice in group work
NOTE: "Legal liabilities and malpractice in group work" will be discussed in detail in upcoming slides.
Legal Liability and Malpractice
• It’s a legal liability of group leaders to practice within the code of ethics and to abide by legal standards.

• Practitioners are subject to civil penalties, if they fail to do right or if they actively do wrong another.
When the group leader is open to malpractice suit?
• If group members can prove that personal injury or psychological harm was caused by a leader’s failure to render proper service, either through negligence or ignorance.

• Negligence consists of departing from the standard of care. i.e. the therapist breached his or her duty in not providing what is determined as commonly accepted practices of others in the profession and that an injury was sustained by the client.

• For example, clients might claim increased presenting symptoms; new symptoms; misuse or abuse of therapy overextending him- or herself, leading to failure; reliance on directives leading to divorce, job loss, emotional harm, suicide or death of third party, or self-inflicted injuries; deprivation of constitutional rights; and/or loss of liberty or privacy. (Austin, Moline, & Williams, 1990).
What is expected from practitioners in court who are involved in a malpractice?
• Practitioners are expected to justify the techniques they use. If their therapeutic interventions are consistent with those of other members of their profession in their community, they are on much firmer ground than if they employ non-traditional techniques.

• If practitioners are charged with negligence, they will be expected to furnish copies of their records for working with the group.

What precautions should leaders take in order to avoid malpractice?
• Leaders should keep themselves up to date with the laws of their state as they affect their professional practices.

• Leaders who work with group of children and adolescents must have knowledge of laws related to confidentiality, parental consent, the right to treatment or to refuse treatment, informed consent, and other legal rights of clients.

• Leaders should be aware of the fact that there might be instances in which the law conflicts with the profession’s code of ethics.

• Leaders should function at a higher level of moral reasoning (i.e. aspirational ethics) than simply complying with the law and the profession’s code of ethics.

• Leaders should not practice outside the boundaries of their competence so that they can maintain reasonable, ordinary, and prudent practices.
In a group setting, counselors are expected to take reasonable precautions to protect clients from physical, emotional, or psychological trauma (A.9.b. ACA Code of Ethics, 2014).
What are the guidelines for professional standards of practice?
• Give the potential members of your groups enough information to make informed choices about group participation and do not bewilder the group process. Professional honesty and openness with group members is very important to create a trusting environment.

• Be willing to devote the time to adequately screen, select, and prepare the members of your group. According to ACA Code of Ethics, counselors are expected to screen prospective group counseling/therapy participants and select members whose needs and goals are compatible with the goals of the group, who will not impede the group process, and whose well-being will not be jeopardized by the group experience (A.9.a. Code of Ethics, 2014).

• Develop a diagnostic profile and keep specific treatment notes for each group member (Gumaer & Forrest, 1995)

• Emphasize the importance of maintaining confidentiality before the group begins and at various stages of group counseling. Also, inform group members that confidentiality in group therapy may not be protected under the state laws of privileged communication and that it cannot be guaranteed.
• Be aware of your state laws and professional organization ethical guidelines that limit your practice, as well as the policies of the agency for which you work. Inform members about these policies and about legal and ethical limitations (such as exceptions to confidentiality, mandatory reporting etc.). Court may refer to a group leader’s professional organization’s code of ethics to determine liability.

• If confidentiality must be violated, discuss it with the group member and obtain a written release (Gumaer & Forrest, 1995).

• Adhere to billing regulations and paperwork requirements as prescribed.

• Use written group contracts to ensure that members give their informed consent to comply with group rules about physical and psychological harm to other group members. Group leaders need to ensure that members’ rights and safety, both physical and psychological, are protected.
• Restrict your scope of practice to client populations for which you are prepared by virtue of your education, training, and experience.

• Be alert for symptoms of psychological debilitation in group members, which may indicate that their participation should be discontinued. Be able to put such clients in contact with appropriate referral resources.

• Don’t promise the members of your group anything that your cannot deliver. Help them realize that their degree of effort and commitment will be key factors in determining the outcomes of the group experience.

• In working with minors, secure written permission of their custodial parents or legal guardians, even if this is not required by state law.
• Always consult with colleagues or clinical supervisors whenever there is a potential ethical or legal dilemma. The willingness to cunsult and to seek supervision implies a high level of professionalism. Find sources of ongiong supervision.

• Learn how to assess and intervene in cases in which group participants pose a threat to themselves or others and be sure to document by writing in your group record.

• Avoid mixing professional relationships with social ones.

• Avoid engaging in sexual relationships with either current or former group members.

• Promote an atmosphere of respect for diversity within the group context.
• Remain alert to ways in which your personal reactions might inhibit the group process, and monitor your countertransference. Be careful of meeting your own needs at the expense of the members of your group. Avoid using the group as a place where you work through your personal problems.

• Keep yourself informed about research findings and be abel to apply this information to increase the effectiveness of your groups.

• Be able to explain the technique that you regularly use in your groups. Have a rationale that is tied to some theoretical perspective.

• Carry professional malpractice insurance.

• For a more extensive discussion of specific issues pertatining to malpractice. (Austin et al., 1990)
Asay, T. P., & Lambert, M. J. (1999). The empirical case for the common factors in therapy: quantitative findings. In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change: what works in therapy. Washington, DC: American Psychological Association. 23-55.
Austin, K.M., Moline, M. E., & Williams, G. T. (1990). Confronting malpractice: Legal and ethical dilemmas in psychotherapy. Newbury Park, CA: Sage.
Bakali, J.V., Baldwin, S.A., & Lorentzen , S. (2009). Modeling group process constructs at three stages in group psychotherapy. Psychotherapy Research, 19 (3), 332-343.
Barlow, S., Burlingame, G., Hardman, J., & Berman, J. (1997). Therapeutic focusing in time-limited group psychotherapy. Journal of Group Dynamics, 1, 254 - 266.
Barlow, S., Burlingame, G., Nebeker, R.,&Anderson, E. (2000). Meta-analysis of medical self-help groups. International Journal of Group Psychotherapy, 50, 53-70.
Barlow, S. H. (2004). A strategic three year plan to teach beginning, intermediate, and advanced group skills. The Journal for Specialists in Group Work, 29, 113-126.
Blackwell, T. L., Strohmer, D. C., Belcas, E. M., & Burton, K. A. (2002). Ethics in rehabilitation counselor supervision. Rehabilitation Counseling Bulletin, 45, 240-247.


Luborsky, L., Barber, J. P., Siqueland, L., & Johnson, S. (1996). The revised Helping Alliance questionnaire (HAq–II): psychometric properties. Journal of Psychotherapy Practice & Research, 5(3), 260-271.
Pereira, T., Lock, J., & Oggins, J. (2006). Role of therapeutic alliance in family therapy for adolescent anorexia nervosa. International Journal of Eating Disorders, 39(8), 677-684.
Stockton, R. (1980). The education of group leaders: A review of the literature with suggestions for the future. The Journal for Specialists in Group Work, 5, 55–62.
Taft, C.T., Murphy, C. M., King, D. W., Musser, P. H., & Dedeyn, J. M. (2003). Process and treatment adherence factors in group cognitive-behavioral therapy for partner violent men. Journal of Consulting and Clinical Psychology, 71(4), 812-820.
Wadsworth, J. (2008). The group experience. Rehabilitation Education, 22(3 & 4), 257-266.
Yalom, I. D. (1995). The theory and practice of group psychotherapy (4th ed.). New York: Basic Books.
References
Corey, G., Williams, G. T., & Moline, M. E. (1995). Ethical and legal issues in group counseling. Ethics & Behavior, 5 (2), 161-183.
Crowe, T.P., & Grenyer, B. F. S. (2008). Is therapist alliance or whole group cohesion more influential in group psychotherapy outcomes? Clinical Psychology & Psychotherapy, 15 (4), 239-246.
Gumaer, J., & Forrest, A. (1995). Avoiding conflict in group therapy: Ethical and legal issues in group training and practice. Directions in Mental Health Counseling, 5(Lesson 5).
Kelly, A. E., & Yuan , K-H. (2009). Clients' secret keeping and the working alliance in adult outpatient therapy. Psychotherapy: Theory, Research, Practice, Training, 46 (2),193-202 .
Knerr , M., Bartle-haring, S., Mcdowell, T., Adkins, K., Delaney, R. O., Gangamma, R., Glebova, T., Grafsky, E., & Meyer, K. (2011). The impact of initial factors on therapeutic alliance in individual and couples therapy. Journal of Marital and Family Therapy, 37(2), 182-199.
Kottler, J. A. (1994). Advanced group leadership. Pacific Grove, CA: Brooks/Cole.
Lambert , M. J. (1992). Psychotherapy outcome research: implications for integrative and eclectical therapists . In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration. New York : Basic Books. 94-129.
Presenter: Varinder Kaur
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