The unique ethical and legal requirements
Fundamental ethical issues related to conducting therapy take on increased complexity when applied to settings with multiple clients. Group therapy represents even further complications as the group is typically not a bonded entity in itself outside of the therapy session. Group therapy represents a context in which unrelated clients meet in order to address similar psychological, emotional or behavioral problems in a focused and supportive context.
Members come to the sessions with disconnected and individual issues of their own which are related to those of the other members by nothing more than a similarity in theme or subject. Thus, group therapy can be viewed as a series of individual therapies occurring simultaneously within a group context. As such, ethical issues of confidentiality, multiple roles and relationships, informed consent and the wide variety of related concerns are more difficult for the therapist to regulate and predict.
In essence, the therapy group represents a relatively public treatment environment where disclosures are made not only to a trained professional therapist, but also to other clients seeking treatment and support within the group context. This represents a significant risk for any client revealing personal information, as well as an increased obligation for group therapists. As Tribbensee and Claibborn (2003) indicate, “In group therapy, the therapist not only has the usual obligation of maintaining the confidentiality of each client’s information within the legal limitations, the therapist must also confront the possibility that clients could disclose information about other clients to members outside the group.
The fact that clients do not have the mandated professional obligation to maintain the confidentiality of other clients constitutes a risk of group therapy, and the therapist should inform potential clients of this risk as a part of informed consent prior to the beginning of therapy” (p. 296). A thorough understanding of the potential risks and benefits of this type of therapy can help clients make informed choices about their course of treatment.
Risk management, in general, constitutes one of the primary ethical responsibilities of the group therapist. As Corey, Corey and Callanan (2002) point out, “The fact that groups can be powerful catalysts for personal change means that they are also risky” (p. 430). As such, therapists have ethical obligations to both warn prospective members of the potential psychological risks related to group participation and within the context of the group setting, to “take reasonable precautions to protect clients from physical or psychological trauma” (ACA, 1995, A.9.b).
While the specifics vary with each group, common risks inherent in group therapy participation can include, but are not limited to, invasion of privacy, group pressure or coercion (i.e., to reveal personal information, explore a charged emotional issue or participate in a group exercise), aggressive confrontation, inappropriate scapegoating, projection, transference or displaced aggression, and a disruption in the ability to function normally in one’s life.
Because of the many variables involved, including differing personalities, group dynamics, specific issues being addressed and the natural unpredictability of human interaction, control of the therapeutic environment and the course of therapy represents a significant challenge for therapists. Therapists utilize tools such as teambuilding techniques, modeling, and therapeutic contracts in order to develop group norms and goals, manage psychological risk and clearly delineate the rights and responsibilities of group members.
Within each group they must strike the appropriate balance between directive regulation of the process and group autonomy. Controlling for every eventuality within this context of group interaction is not possible. However, skilled management and redirection of the group as potentially harmful situations arise is the responsibility of the therapists and is an essential aspect of their professional training.
REFERENCES
American Counseling Association. (1995). Code of ethics and standards of practice. Alexandria, VA: ACA.
Corey, G., Corey, M. and Callahan, P. (2002). Issues and ethics in the helping professions (6th ed.). Pacific Grove, CA: Brooks/Cole Publishing Company.
Tribbensee, N. E. & Claiborn, C. D. (2003). Confidentiality in psychotherapy and related contexts. In W. O’Donohue & K. Ferguson (Eds.). Handbook of professional ethics for psychologists: Issues, questions and controversies. Thousand Oaks, CA: Sage Publications.