Psychotherapeutic Group Case

Within the mental health profession, psychotherapeutic group processes have become increasingly popular. In this age of managed care, therapeutic group have proven to be a timely a cost-effective alternative to individualized treatment. Furthermore, group therapy has been shown to be, "as effective as individual therapy in treating a range of psychological and psychiatric problems" (Markus & King, 2003, p. 203). However, just as group treatment can provide powerful therapeutic change and growth when properly facilitated, if poorly planned, it can have the opposite effect. Furthermore, in addition to the conventional ethical dilemmas and concerns posed by individual therapy, group work presents its own unique challenges, which must be taken into consideration (Kottler, 1994). Given the recent rise in group therapy utilization, it has become increasingly imperative for mental health professionals to make themselves aware of these potential challenges, as well as maintain a solid grasp of the ethical standards that guide therapeutic group work.

Establishment of Guidelines

The American Counseling Association (ACA, 2005) and the American Psychological Association (APA, 2002) established the basic codes of conduct, or ethical guidelines, that are followed by mental health professionals who provide therapy. In 1989, however, the Association for Specialists in Group Work (ASGW, 1989), a division of the ACA, published a comprehensive set of Ethical Guidelines specifically put forth, "to promote quality group training, practice, and research through enhancing the awareness of ethical issues associated with groups" (Durr, n.d., p. 2). And as a therapeutic group leader, one must be conversant with the contents of these rules and procedures.

Coming to be an ethical group practitioner encompasses more than simply avoiding violations of laws or ethical codes. It implies conducting oneself in a mindful manner, doing whatever it takes to perform at the highest level, both professionally and personally (Corey, Williams, Moline, 1995). As a group therapist, one is faced with a multitude of both legal and ethical obligations that influence nearly every aspect of group work, from planning and participation to confidentiality and termination. Collectively considered, this myriad of concerns reveals the intricacies and uncertainties that encompass the therapeutic group process, and that which a competent therapist must be adequately prepared to handle. This paper will focus on the examination of particular ethical issues associated with group therapy, as well as how best to manage them. It will also concisely evaluate the benefits of group work as opposed to individual treatment, as well as touch on some of the personal qualities that aid therapists in being effective group leaders.

Ethics of Group Therapy

The primary ethical concerns and principles of group therapy can be broken down into two broad themes; those concerning the rights of the group members, which include screening, orientation, informed consent, participation, and confidentiality, and those dealing with the responsibilities of the group leader, such as professional competence, equitable treatment, cultural competence, dual relationships, treatment modality, to name a few (Corey et al., 1995; Glass 1998).

Group Members' Rights Screening.

It has been suggested that most individuals who consider or enter into group treatment setting are not aware of their fundamental rights and responsibilities as members of the group (Corey et al., 1995). These rights are present before one even enters into therapy. For instance, according to section A.8 of the ACA Code of Ethics, group membership warrants the surety that other members' basic needs and goals are compatible with their own. Otherwise the process itself would be impeded and progress would be thwarted (2005). Thus, careful screening of prospective members is imperative. Moreover, the National Board of Certified Counselors' (NBCC, 1998) ethics code stresses the importance of the screening process, due to the fact that such an emphasis is placed on self-understanding and growth through self-disclosure, and compatibility, or the lack thereof, can seriously hinder progress in such a vulnerable environment.

Orientation and Informed Consent.

Orientation and informed consent are the other important aspects of the pre-group process. Corey et al. (1995) indicated that group members who are provided with basic fundamentals of the group processes during the screening and intake tend to exhibit increased cooperation and participation. The attainment of informed consent is another vital step when orienting new individuals to the group process, for if individuals do not obtain the necessary particulars concerning their basic entitlements and obligations as members, and they and they enter ill prepared, complications in group progress are sure to arise (Corey et al., 1995). Thus, members should be informed specifically as to the group's goals, norms, rules and possible risks, as well as the group facilitator's credentials and the limits of confidentiality. Additionally, the APA Ethics Code directs that the mental health professional, "describe at the onset the roles and responsibilities of all parties" (p. 15). In fact, according to the ASGW Ethical Guidelines for Group Counselors (1989), the therapist should ready potential participants by offering as much group information as possible.

Participation.

Ethical issues involving participation are also a concern for a number of reasons, namely, instances of involuntary participation and group coercion. In the case of mandatory participation, every effort should be made to enlist cooperation, and as previously stated, this is best done by providing the individual with as much information as to the group's goals and procedures, their rights as a member, and limits of confidentiality. Professionals are being increasingly confronted with instances of mandatory memberships, and hence, an unwillingness to contribute to group growth (Glass, 1998). As such, leaders should make every attempt to gain the informed consent of those persons in order to ensure the continued progress of the group (ASGW, 2000).

Corey et al. (1995) suggests that the reluctance and concerns of the involuntary member, "be explored in the same way as the fears and expectations of individuals who are voluntarily in a group" (p. 165).

Within a group setting, a certain amount of group pressure is unavoidable, and can, at times, be somewhat therapeutic. For instance, individuals within a group can be forced to explore some of their maladaptive philosophies and actions,