Research Paper: Ethical Issues in Group Counseling

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Ethical Issues in Group Counseling

Any counseling scenario introduces a variety of Ethical Issues because counseling involves human beings who are frequently at their most vulnerable, seeking help and advice from human beings who are fallible. What complicates the ethical rules and norms that surrounding counseling scenarios is that the relationship between the counselor and the client is central to the efficacy of the counseling. Rules that stifle the development of an organic, helpful relationship can stifle the goal of counseling. However, there are clearly rules that must be followed to ensure that the client is protected from counselors who may act in an unethical manner. The very fact that counselors and clients enter into unique, personal relationships as part of the therapeutic process can make it difficult for even the most professional of counselors to determine, in the moment, whether a particular behavior is ethical or unethical. The result is that there are a number of ethical bright-line rules and guidelines determining behavior that is ethical and unethical in the counseling process.

The ethical considerations grow more complicated when one considers a group therapy scenario. Some of these complications are due simply to the fact that group therapy introduces more people into the relationship, and, therefore, introduces more opportunities for conflicts and misunderstandings. Group therapy can take a variety of different formats, but is essentially therapy where there are multiple client participants with one or more healthcare facilitators. The goal of group therapy is for the group members to help one another achieve therapeutic goals. However, the group environment introduces some ethical issues that do not exist in one-on-one therapy, as well as exacerbates some of the ethical problems that already plague traditional one-on-one counseling scenarios. "Ethical issues in group psychotherapy are complex and differ from individual psychotherapy with regard to the types of ethical dilemmas that are encountered. Keith Spiegel and Koocher (1985) highlighted some of these differences and concluded that in group therapy there is (a) less control over the content and direction of the therapy session, (b) greater potential for adverse experiences, (c) greater potential for stress that might result from confrontation and criticism from other group members, and (d) the possibility of a client growing dependent on the group" (Klontz 2004). These special considerations mean that a therapist has to weight the potential benefits of a the group process against the potential downfalls, including possible ethical problems, of having the client in a group therapy scenario.

Discussion

Generally, this paper will approach group work as a single process and largely from an experiential approach. However, this approach is somewhat disingenuous. "There are many types of therapy combinations that fall within what is commonly referred to as experiential therapy" (Klontz, 2004). These various types of therapies can include, but are not limited to: expressive therapy, gestalt therapy, intense feeling therapy, encounter therapy, cathartic therapy, emotional-flooding therapy, psycho-imagination therapy, symbolic-experiential family therapy, Mahrer's experiential therapy, psychodrama, process group therapy, aromatherapy, and metaphoric therapy"(Klontz, 2004). There is some overlap between all of these different group processes, and they are not exhaustive of all possible approaches to group therapy. Therefore, it is critical to keep in mind that, "although all of these psychotherapies are related in regard to their primary vehicle of change, in many cases, they differ significantly in terms of how they conceptualize therapy and how they utilize experiential techniques. As such, there may be unique ethical issues of concern that are specific to each approach" (Klontz, 2004). Therefore, general concerns about the ethical issues inherent in group therapy may be more or less applicable to each approach; some therapeutic approaches will be more vulnerable to some ethical issues, while other approaches may introduce an entirely different range of ethical considerations and concerns.

Generally, any type of social work or therapeutic approach requires the practitioner to look at any relevant guidelines or rules in order to determine ethical behavior in the therapeutic scenario. The problem is that professional ethical codes are not very informative for group practice (Gumpert & Black, 2006). Social workers are aware of this problem, and believe that the codes need to address areas of group practice that are likely to result in ethical issues (Gumpert & Black, 2006). In particular, they believe that the most frequently encountered ethical dilemmas are ones that should be addressed by the ethical codes (Gumpert & Black, 2006). Despite the fact that the current ethical codes do not adequately address potential ethical conflicts, there is some disagreement about how to change the codes in a meaningful and relevant way. The central dilemma appears to be whether to have standards that are process or outcome focused (Cohen & Olshever, 2013). Some codes may attempt to bridge those differences, but, if they do so they need to acknowledge the differential emphasis that they place on process and outcome (Cohen & Olshever, 2013). Moreover, it is crucial to keep in mind that ethical codes, guidelines, and standards will never provide a completely comprehensive outline of all of the ethical issues that can arise with group practice. Instead, they should be seen as a starting point for the resolution of ethical dilemmas, rather than the maximum that a practitioner needs to do (Cohen & Olshever, 2013).

One of the ways to help resolve potential ethical conflicts in a group work setting is to identify potential ethical conflicts. This seems like a simple process, but is actually far more difficult than one might imagine because personal bias is a huge component in creating conflict. Groups are composed of individuals, with each individual bringing his or her own individual values into the group environment. Sometimes group norms and values can come into conflict with the norms and values of individual group members or of the surrounding society (Gumpert & Black, 2006). As a result, identifying cultural differences is one way to help avoid potential ethical conflicts in a group setting. Much of the research on cultural difference has focused on the intercultural context of patients and healthcare providers. This research has uncovered four significant culture-based communication barriers: language barriers, different values regarding health and illness, differing role expectations, and potential prejudice (Suurmond & Seeleman, 2006). These same barriers can exist between group members. Therefore, looking at the individual members of the group, and the expectations that each member may bring to the group setting is critical in identifying ethical dilemmas.

One way to help counter the potential negative impact of cultural barriers is for the group facilitator to be aware of potential culture conflict and trained with how to deal with those conflicts. Group workers who are not aware that cultural differences can cause conflicts and who do not know how to mitigate the potentially negative consequences of these cultural conflicts may find themselves in a completely dysfunctional group if there is an underlying cultural conflict in the group. One of the more interesting concepts to occur in recent time is the use of simulated patients when training health care professionals. "Using simulated patients enables a health care professional to practice skills in the development of diagnostic capabilities, different communication skills, gathering and giving information, identifying the needs of different client groups and working as part of multi-professional/interagency team. Through simulation learning can be achieved in a real life setting, with none of the risks associated to the real life situation" (Holland & Ousey, 2011). In other words, the simulated scenarios allow the healthcare workers to gain experience without risking the harm that could result to group members who are placed in a group that becomes dysfunctional.

When healthcare professionals were permitted to use inclusive simulated patients, it became apparent that there were five themes where minority status had an impact on healthcare interactions. These five broad emergent themes were: "language; knowledge; power;

inequalities and inclusion" (Holland & Ousey, 2011). While working with minority communities did not resolve healthcare worker's potential cultural problems with members of that minority group, it did increase awareness in a way that seemed beneficial to those who were able to practice with minority patients in a simulated setting. "The inclusion of members of black and minority ethnic communities (BME) as simulated patients was discussed by participants and viewed to be a positive step in the facilitation of increasing social networks; reducing cultural barriers and offering an outlet by which these communities could integrate into society. The sharing of their own experiences developed a feeling of personal achievement through an understanding in others of their own community and values" (Holland & Ousey, 2011). This should be encouraged in real group therapy settings, so that all of the members of the group feel as if they are included in the group process, and that none of their experiences are being marginalized because of a minority status.

Therefore, it seems important for group facilitators to have had some experience, even if it is simulated practice experience, in dealing with members of any minority community that they are likely to encounter in group… [END OF PREVIEW]

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