A current and very active debate surrounding counseling, psychotherapy, and the human services professions is the hot topic of ethics in groups. This paper will explore the intriguing world of ethics by looking at how ethics is defined, including ethical theories and philosophical concerns. Ethics are designed to enforce the needs, and ethical principles of an association, organization, or business, while demonstrating the expectations of professionals obligated to particular ethic codes. This paper will seek to examine ethics in-group counseling settings by reviewing empirical based evidence and outlining information from the American Counseling Association (ACA) code of ethics.
In addition, this paper will discuss ethical practices in counseling, focusing on issues such as a competence, confidentiality, and rights while taking an in depth look at group therapy versus individual counseling. Furthermore, it will establish an understanding of why a therapist would choose one type of therapy over another. A spiritual integration will include a worldview perception of ethics in relation to God’s covenant. In conclusion, a first person analysis will discuss leadership qualities, an individual approach to group therapy, along with identifying ethical personal challenges.
Counseling is a broad term encompassing many types of counseling subfields; marriage counseling, family counseling, grief counseling, and group and individual counseling to name a few. Counseling offers a way for an individual to gain perspective on his or her behavior, emotions, relationships or personal circumstances. It acts as a means for addressing pain or working through difficult transitions in life. This is accomplished by providing methods for expressing feelings, exploring new ideas, and identifying patterns in behavior and thinking.
For many people it is a way to alleviate anxiety or depression and to find effective ways to develop their communication skills. “Counseling specialties share a common interest in facilitating human and systematic growth” (Ponton, R. F., & Duba, J. D., 2009). However, professionals in human service and mental health professions are challenged with ethical dilemmas involving their clients on a continual basis.
Ethics in Counseling
Throughout history numerous individuals have sought to maintain their psychological well being through therapeutic methods such as counseling. An important aspect of the counseling field is ethics, a system of moral principles, which attempts to differentiate between good and bad. According to Collins English Dictionary, ethics are defined as a social, religious, or civil code of behavior considered correct, especially that of a particular group, profession, or individual. Ethic codes are an integral part of both personal and professional lives that are the root of an individual’s actions on a daily basis.
There are several types of ethics that are applied to different fields, however ethics play a very pivotal role in the various forms of counseling. One of the principle concerns of ethics is an individual’s well being. For counselors, according to Gravitz (2008), “facing ethical dilemmas is a normal and expected part of our work, and ethical awareness is a continuous, active process that involves constant questioning” An individual’s conception of ethics is based on his or her own system of beliefs, values, cultural influences and life experiences.
In efforts to govern the professional application of qualified therapists, counselors, and human service professionals, a standardized code of ethics was developed by mental health associations. This code of ethics is a basic foundation that defines professional therapy and sets the standards for appropriate behavior, professional expectations, and protects the client, the counselor, and the profession as a whole. A therapist or human service professional is responsible for identifying the limit or scope of his or her practice and training in efforts to prevent crossing ethical boundaries. “The ACA Code of Ethics (American Counseling Association, 2005) is an articulation of the ever-changing relationship between counseling professionals and society” (Ponton, 2009). Mental health professionals have an obligation to themselves and their clients to be familiar with their professional code of ethics and how it applies to their particular professional service.
Among the many forms of counseling available to individuals is group counseling. In-group counseling a therapist, or therapist and co- therapist work with multiple patients in resolving specific issues. According to MacNair-Semands, R. R. (2007), “In a society marked by racism, classism, sexism, and heterosexism, we have an opportunity of transforming the group experience rather than perpetuating these dynamics”. For people who may suffer from social anxiety issues or who are not comfortable in a one on one setting with a therapist, a group setting can be very effective. Another important factor to consider is the cost involved with group counseling as opposed to individual counseling. As previously stated, group counseling is a form of counseling designed for several people at once, as opposed to individual counseling. In section B.4 of the ACA Code of Ethics (2005), it highlights the specific areas that should be taken into consideration in group therapy.
An important role as the group leader is to keep the group focused and to encourage healthy positive communication between and among group members. A group will typically focus on one specific issue due to the complexities of having different people with unique personalities and circumstances together in a group. By focusing on one issue, such as depression, sexual assault, or social anxiety, each member of the group is surrounded by others who are struggling with a similar experience or concern. This allows the group members to feel heard and understood by their peers. As time progresses in a group setting, the cohesion and trust of group members also evolves. The group members are more confident, drawing strength from one another and able to support each other, essentially beginning to heal.
For trained human service professionals (i.e., medical doctor, counselor, social worker, etc…), there is a high standard of ethical behavior that applies to group counseling to protect the group leaders and members of the group. In an article written by Corey, G., Williams, G. T., & Moline, M. E. (1995) it notes how “we assume that the group leader’s personal life is a key determinant of how well he or she will function in the role of group facilitator”. However, in terms of ethical considerations, the focus should be on unethical behavior such as “sexual misconduct, incompetence, negligence, and malpractice”. It is essential for therapist to be knowledgeable about ethical principles and incorporate them into everyday decision-making. According to Brabender, V. (2006), “in the training of group psychotherapists, considerable attention is devoted to the mastery of theory and technique that will enable the therapist to be effective in helping members to meet their individual and group goals”.
There are many issues associated with group therapy that can provide significant implications for a group therapist or the group as a whole. In Section B.4.a of the ACA Code of Ethics (2005), it states that counselors “clearly explain the importance and parameters of confidentiality for the specific group being entered”. Unfortunately, literature on ethical issues with group therapy is not as prominent as existing literature within individual therapy settings. “One of the major clinical and ethical challenges for the group therapist is identifying and managing the difference between therapeutic and destructive pressures for members’ self disclosures” (MacNair-Semands, 2007).
A group therapist is responsible for the consideration of group members’ sensitivities and disclosures to be held confidential by other group members as well as him or her. Ellman, M., & Pezanis-Christou, P. (2010) notes how “communication can affect the ethical behavior of a group”. If confidentiality is not handled in a professional and ethical manner it can cause anxiety and shame towards the group member and the therapist may suffer extreme repercussions from state licensure boards, and the group may encounter a premature termination.
An alternative to group counseling is individual therapy that involves individuals meeting with a therapist one on one. This direct approach allows individuals to identify effective techniques to achieve their goals and cope with difficult events in their lives. Individuals seeking therapy are typically suffering from different forms of problematic behaviors, feelings, beliefs, or some form of traumatic experience. This active form of therapy may encompass many different treatment styles such as psychoanalysis that strives for personal growth and cognitive behavioral therapy, which examines the patterns of a client’s feelings and behaviors. Therapist and human service professionals will help clients focus on issues such as self-awareness, adjustment to personal circumstances, and finding understanding in their lives.
For effective individual therapy to take place it is essential that the therapist or human service professional has a good awareness of self and how his or her own morals and values could affect the relationship with the client. However, “every form of psychological intervention presents its own set of ethical and legal problems and dilemmas” (Brabender, V. M., & Fallon, A., 2009). Ethical principles stem from ethical theories, which are divided into three general subject areas; metaethics, normative ethics, and applied ethics. When human service professionals are defending particular actions, they normally appeal to these principles and not the underlying theory.
According to Fieser (2009), “Metaethics investigates where our ethical principles come from, and what they mean” this focus is on universal truths, the will of God, the role of reason, and the role of reason in ethical judgments. “Normative ethics takes on a more practical task, which is to arrive at a moral standards that regulate right and wrong conduct”. This includes the consequences of behavior along with the rules we should follow, such as the guidelines provided by the ACA Code of Ethics, 2005. “Applied ethics involves examining specific controversial issues, such as abortion, infanticide, animal rights, environmental concerns, homosexuality, capital punishment, or nuclear war.
An individual therapist can be faced with a variety of ethical concerns that branch from these ethical theories such as accepting gifts, which could cause harm to a client or breach relationship lines. Yet, in the same instance, a counselor may risk insulting a client from another culture if they refuse the gift. “The psychoanalytic psychotherapist encounters various, often conflicting guiding principles, when faced with an ethical predicament” (Bräsler, L., 2009). Confidentiality is a major problem that is often reported to state license boards across the country.
There are a number of exceptions to this rule when the decision to breach confidentiality must be made to protect the client from him or herself, or another person. Another important issue is in relation to boundaries, there are both sexual and non-sexual ethical boundaries that counselors should not cross. Counselor self-disclosure is one example of boundary counseling. According to Gutheil (2010), ethical aspects of self-disclosure identify “the most relevant principles, which are: •Beneficence (doing good for the patient)
•Nonmaleficence (doing no harm)
•The fiduciary relationship between clinician and patient, where the interests and welfare of the patient always predominate A counselor’s self-disclosure can often place an added burden on the client or take the focus off him or her and put it on the counselor. Some individuals, who are not comfortable with self-disclosure or examining their feelings in individual therapy, may choose to seek group counseling to be surrounded by others dealing with similar difficulties.
Group Therapy vs. Individual Therapy
The traditional form of therapy is a one on one interaction with a client and therapist, or human service professional. People seek individual or group counseling to address many issues such as depression, anxiety, low self esteem, mental disorders, or sexual assault to name a few. However, as previously stated, group therapy is a form of treatment that involves more than two or more clients at once and can sometimes involve more than one therapist. While group therapy encompasses many of the same techniques that are utilized in individual therapy, it does this on a larger scale and with a variety of complex ethical implications. According to MacNair-Semands (2007), “another potential conflict for group members is maintaining the confidentiality of other group members when they feel the need to discuss their group experiences with significant others”. Nonetheless, group therapy can be used as an alternative, or in conjunction with, individual therapy, “ The complexity of combined therapy necessitates the therapist’s firm grounding in ethical theories and a thorough understanding of the fundamentals of the ethical codes of the human service professions” (Brabender, V. M., & Fallon, A., 2009).
Depending on the situation, a therapist providing individual counseling can opt for group therapy to best serve the needs of his or her client. “In principle ethics, when principles conflict, the practitioner must carefully weigh, balance, sift, and winnow competing principles to determine which principle has precedence” (Urofsky, R. I., Engels, D. W., & Engebretson, K., 2008). A therapist must consider these principles when in a group setting, because people often feel a sense of connection with other members of the group that could lead to potential conflict or jealousy. They are surrounded by people suffering from a similar experience and typically will grow a sense of mutual support with one another. Individuals are accustomed to being in groups in one form or another, through family, work, or school for example. Counselors may choose group therapy for their clients to bring them into a situation in which they may be more comfortable. Members are able to learn and grow from one another. Others prefer to have the one on one attention that is provided in individual counseling.
Like many counselors in the human services profession, the leadership qualities I possess have developed from my life experiences, personal ethics, morals and values. I have a strong, determined, willful personality that feeds into my skills as a leader. I am an active, empathetic listener and I will approach any counseling setting with the confidence and skill necessary to help others. I am flexible, considerate, and willing to adapt to any given situation, especially when my client requires change. It is my belief that we grow from our own difficulties. My life experience has helped me to communicate in an efficient manner, listen and hear more effectively, and maintain a non-judgmental, non-dismissive stance on the complexities in life.
Therapy is about helping someone examine themselves in an honest and open manner so they may learn and grow from the experience. I am a sincere, genuine, and trusting individual with a passion for helping others; I have a clear understanding of my competence level and will competently provide the best care possible within my limits. I understand that what works well for one person may not work for another, therefore keeping in mind that every person is unique and finding what works best for each client at that specific time is invaluable.
In a group setting, preparation is a very important factor, I would first make a commitment to providing an ample amount of time to organize and plan for my group. I will make sure all group members are aware of all the rules and expectations in a group setting. My primary focus would be to encourage the group members to be open and honest with themselves, and to the group. I will tactfully handle any conflict that occurs, and provide substantial questions for the group to open discussion.
By knowing my own strengths and weakness I am aware of my abilities and knowledge that I will bring to a group setting. For instance, if I am working with a group of abused women, I understand that trust and security are a very important factor in their lives. It is imperative that I be viewed as a trustworthy person. Therapy in any setting is a very personal and private relationship, it is important for clients to be able to trust and depend on their therapist or group leader.
Corey (1995) indicates that:
“Groups have unique therapeutic power that can be used to empower clients in their life changing journey, groups also have the potential to produce harm to their participants. Thus, the group leader’s skill, style, personal characteristics, and competence in group work are crucial dimensions that contribute to the quality of the outcomes of a group”. In a group setting, I will treat all group members with respect, set limits when necessary and include self-disclosure to maintain trust and cohesion. “For completeness, note also that the therapist’s comfort level, personal needs, and wishes for privacy also enter into the decision of whether and what to disclose” (Gutheil, G. T., 2010).
I am most confident in a leader directed approach to group settings however, I am also comfortable with maintaining the group’s focus when turning the group over to group members in a group directed approach to determine the direction and content. In a group setting I will focus on the strengths of group members and help each to utilize their strengths when facing areas of weakness. I will also be cautious to make referrals when an issue has reached a scope beyond my capability.
When faced with an ethical challenge, I will handle it according to principle and ethical guidelines. There are a number of ethical concerns, which I may encounter, such as end of life care for terminally ill patients. I tend to be very emotional about this subject matter and may find myself in a situation in which I am unable to separate my personal beliefs from my professional responsibilities. Another area of concern is my roles and relationships with clients. In section A.5.c of the ACA Code of Ethics (2005), it outlines that a “ counselor-client nonprofessional relationships with clients, former clients, their romantic partners, or their family members should be avoided, except when the interaction is potentially beneficial to the client”.
I have a tendency to become attached to people and form close relationships, which will be unethical in a counseling setting. Because of my personal nature a main ethical concern of mine is boundaries in relation to self-disclosure. While a certain amount of self-disclosure can establish trust in a therapeutic relationship, “both disclosure and nondisclosure may foster or impair the therapeutic alliance” (Gutheil, G. T., 2010)”. A key factor when encountering any ethical dilemmas will be maintaining my professionalism and handling the issue in the most responsible, effective manner.
One of the most widely used scriptural references used worldwide is found in John 3:16 (English Standard Version), “ For God so loved the world, that he gave his only son, that whoever believes in him should not perish but have eternal life”. This scripture declares God’s response to our sin, his covenant. The bible speaks of God’s covenant with his people in numerous places, explaining how our relationship with God is made by provision and exists by his terms alone. As humans through our covenant with God we enjoy a relationship with Him, which includes material provision in this life as well as the life to come.
As counselors we enter into a covenant agreement with our clients, and the human services profession. According to Ponton (2009), when he speaks of the ACA Code of Ethics, 2005 he states that it “provides clear parameters of behaviors to meet the challenging needs of the people counselors are called to serve”. He includes that it acts as both a statement of counselor identity and an ethical covenant with society. In our covenant with God we are called to serve Him. One way this is done is by serving others through the human services professions, using the gifts in which God has given us to help others.
Throughout the old and new testaments we read stories of ethical and moral concerns, such as in 1 Corinthians 6:9-11 (English Standard Version) where it reads “ Or do you not know that the unrighteous will not inherit the kingdom of God? Do not be deceived: neither the sexually immoral, nor idolaters, nor adulterers, nor men who practice homosexuality, nor thieves, nor the greedy, nor drunkards, nor revilers, nor swindlers will inherit the kingdom of God. And such were some of you. But you were washed, you were sanctified, you were justified in the name of the Lord Jesus Christ and by the Spirit of our God”.
In our covenant with God there is no bargaining, no bartering, or contract negotiations regarding the terms of His covenant. It makes an extreme difference how we think of our covenant with God, especially with regard to the motives of the heart. Our covenant with God is a unique relationship of intimate fellowship in mutual love. We have an ethical and moral responsibility to our God and ourselves in keeping the covenant. If human services viewed their professional covenant outside of the realm of cold, business like, rules and guidelines then it would make a world of difference in how clients are treated.
Having been on both sides of the counseling spectrum as a client and group leader, I am a firm believer in the therapeutic process and the power of groups. If a counselor is of sound mind and body, and has a full understanding of his or her ethical obligation then they will be fully aware of how to handle the ethical dilemmas that they may encounter. The American Counseling Association (2005), and other mental health associations provide distinctive outlines of things that should be considered when entering the field of counseling. The aforementioned sections of this paper are only a mere sample of what is indicated in ethical concentrations.
American Counseling Association. (2005). ACA Code of Ethics. Alexandria, VA Retrieved from http://www.counseling.org/Resources/CodeOfEthics/TP/Home/CT2.aspx Brabender, V. (2006). The ethical group psychotherapist. International Journal of Group Psychotherapy, 56(4), 395-414. doi:10.1521/ijgp.2006.56.4.395 Brabender, V. M., & Fallon, A. (2009). Ethical hot spots of combined individual and group
therapy: Applying four ethical systems. International Journal of Group Psychotherapy, 59(1), 127-147. doi:10.1521/ijgp.2009.59.1.127 Bräsler, L. (2009). The ethical container: Different dimensions informing ethical action. Psychoanalytic Psychotherapy in South Africa, 17(2), 53. Collins English Dictionary – Complete & Unabridged 10th Edition. Retrieved from http://dictionary.reference.com/browse/ethics Corey, G., Williams, G. T., & Moline, M. E. (1995). Ethical and legal issues in group counseling. Ethics & Behavior, 5(2), 161-183. doi: 10.1207/s15327019eb0502_4 Ellman, M., & Pezanis-Christou, P. (2010). Organizational structure, communication, and group ethics. (author abstract). American Economic Review, 100(5), 2478. doi:10.1257/aer.100.5.2478 Fieser, J., (2009). Ethics. Internet Encyclopedia of Philosophy. Retrieved from http://www.iep.utm.edu/ethics/ Gravitz, M. A. (2008). Ethics in psychotherapy and counseling: A practical guide, 3rd ed. American Journal of Clinical Hypnosis, 51(1), 79. Gutheil, G. T. (2010). Ethical aspects of self-disclosure in psychotherapy. Psychiatric Times, 27(5), 39. MacNair-Semands, R. R. (2007). Attending to the spirit of social justice as an ethical approach in group therapy. International Journal of Group Psychotherapy, 57(1), 61-66. doi:10.1521/ijgp.2007.57.1.61 Ponton, R. F., & Duba, J. D. (2009). The “ACA code of ethics”: Articulating counseling’s professional covenant. Journal of Counseling & Development, 87(1), 117-121. Urofsky, R. I., Engels, D. W., & Engebretson, K. (2008). Kitchener’s principle ethics: Implications for counseling practice and research. Counseling and Values, 53(1), 67.