Individual and Group Ethics

INDIVIDUAL AND GROUP ETHICS
ERIC FOURNIER
LIBERTY UNIVERSITY ONLINE


Abstract
    This paper explores the idea of confidentiality between counselor and client, especially in group settings where more then one client is involved.  The idea of individual counseling and group counseling were explored in the matter of confidentiality, relationships, theories and practices.  Both the ACA Code of Ethics and the ASGW Code of Ethics were examined to better understand issues that come up related to confidentiality and ethics in both the group and individual setting.  Matters relating to understanding cultural boundaries and dual relationships were discussed and ideas of how to avoid such ethical stumbling blocks were given.


Introduction
    Ethics are surrounded by controversy, often when a situation arises that ethical consideration is needed there are many circumstances which impede an easy answer.  A critique of ethics is that it is often that ethical decisions are motivated by goodwill, but they don’t answer every aspect of each situation.  When considering a matter of ethics one must take in the culture, socio-economic status, education level, along with the issue and how the issue may effect other aspects and future aspects of the relationship and situation.  A counselor facing a decision of an ethical nature must be concerned with the wellbeing of their client as well as their own wellbeing.  In America’s society where being legally sued is a real and ever present reality, counselors must be extra cautious about their decisions.  This legal tight rope between protection of self and protection of the client is a very narrow rope that must be interpreted with each situation.  Training in ethical decisions is very important for every counselor have along with a good legal counsel.  Whenever an ethical decision is about to be made, legal counsel should be sought when a clear cut answer is not evident.  Such precautions can save the counselor and client from harm.  The adage harm none is the rule at hand.  In this paper the difference between group counseling ethics and individual counseling ethics will be explored as well as a look at how well informed consent is understood by those two different groups.  Ten journal articles were looked at and compared in the writing of this essay, topics included family and marriage counseling, group verses individual counseling, APA ethical code, and ethics in counseling.  
Group Issues
    Group counseling comes with many issues, one of the most important issues for counselors to consider is how they are to care for each individual member of the group without compromising each person’s confidentiality.  This is vitally important in family group counseling where concerns of respect between child and parent are brought up through the exposure of parental failures. (Grosser, Paul; 1964)  This concurs with the ACA code of ethics which states, (2006) “counselors encourage client growth and development in ways that foster the interest and welfare of clients and promote formation of healthy relationships.  Counselors actively attempt to understand the diverse cultural backgrounds of the clients they serve.” (p 236)  In groups multiple cultures collide to form a collective, in family units culture is extremely similar in most participants; but, in family groups different cultures may be found especially in those families where interracial marriage or adoption have happened.  According to the text by Jacobs the most common ethical mistake made by counselors is, (2012) “unethical behavior on the part of leaders usually consists of leaders not being competent to lead the groups they are leading or leaders not caring properly for their members.” (p 27)  It is extremely important that group leaders only lead groups that they have been trained to lead.  Another heavy factor when discussing group therapy ethical issues is that many situations that have ethical concerns are not black and white, so counselors must think through each probability carefully.  Dual relationships, using groups for personal growth, understanding gender issues, confidentiality, informing the group of the group purpose, and making referrals are also under consideration when thinking about ethical issues.  The purpose of understanding these issues is to alleviate the danger which exists in any counseling relationship between client and therapist and with the proper understanding of ethics the therapist can safely work within his or her boundaries.  For counselors to do their work effectively, informed consent must be properly understood.

Informed Consent
    Just as in individual counseling, informed consent must also be sought in group counseling.  Informed consent covers multitudes of situations.  Conditions may exist where informed consent is not understood by all parties and it is the counselors job to educate and correct those misunderstandings.  Ponton and Duba consider informed consent to be a covenant between the counselor and the client. (2009; p 119) A study was undertaken to understand how different cultures and educational levels in adults effects the understanding of informed consent, this, (Sarkar; 2010) “study was undertaken as part of a clinical trial on the effectiveness of nutritional supplementation on malnutrition in under-5 children in the Kaniyambadi block of Vellore district.” (p 2)  The most astonishing result of the study was that, (Sarkar; 2010) “Only one respondent could state the real purpose of the study, i.e. to test the efficacy of nutritional supplementation on underweight children.” (p 3)  The surprising result of their study was that,
    “There was no difference in comprehension of the key elements of informed consent         between participants who received group counseling and participants who     received         individual counseling to allow their children to participate in a trial of nutritional             supplementation for malnourished children.” (Sarkar; 2010; p 5)
This result is astonishing because the study group believed that informed consent would of been greater in those who received it in a group session because the participants would of had an opportunity to discuss the matters between themselves.  They go on to discuss how matters of education, literacy, and distraction may be significant causes in the lack of understanding of informed consent by the participants. (Sarkar; 2010; p 1)  These key cultural issues also need to be closely examined in order to fully understand true ethical counseling.
Multicultural Counseling Ethics
    Understanding cultures, gender differences, and sexuality in clients can protect both the counselor and the client from harmful mistakes.  Counselors are expected to set aside their bias in order to serve their client.  In a text on ethics by Corey the term, (2011) “cultural tunnel vision, ” means, “a perception of reality based on a very limited set of cultural experiences.” (p 117)  Turning back to family group counseling there are some noticeable differences between a white American family and a Native American family that provide the counselor with unique challenges.  The difference that is so challenging is that the Native American family is more community based, so if an individual is in distress, the entire family may show up in support. (Corey, 2011, p 118)  One significant point to the discussion topic of culture and ethics is that every organization and ethics code states in some way or form that it is wrong to discriminate based on gender, sexual identity, social status, educational level, or race, (Corey, 2011, p 121)  It is extremely difficult to not have a bias, everyone has them.  Biases range from coffee or tea to who people would rather spend time around or not spend time around.  The counseling room is not the place to practice these biases.  Everyone that steps into the counseling office is there for help and it is the job of counselors to provide those services which they are qualified too.  In the extreme case that biases will not allow for the counselor to serve someone, they should be referred to another counselor with a well thought out explanation as to the nature of the referral.  One last statement about cultural differences has to be made, the ASGW has extended a clause which promotes counselors to always continue to seek out and understand different cultures,
    Group Workers practice with broad sensitivity to client differences including but not         limited to ethnic, gender, religious, sexual, psychological maturity, economic class,         family history, physical characteristics or limitations, and geographic location. Group         Workers continuously seek information regarding the cultural issues of the diverse         population with whom they are working both by interaction with participants and from         using outside resources. (Thomas, Pender; 2007; p 116)
Understanding ethical differences is extremely important because in America counselors deal with a very diverse population.  Next this paper will explore issues that exist in group counseling that do not exist in individual counseling.
Ethics
    There are pluses to individual counseling that protect the client from harm.  Such pluses include: the client does not have to worry about other people or family members hearing the truth or about the source of their issues, the client is free to express in an individual setting that which in a group setting he or she may be uncomfortable sharing, the counselor must be aware and seek out to protect his or her client and in a group setting each member is unique and each must be protected.  What it means to protect a client in the counseling setting is that it is not okay to divulge to other members of the group the content of private sharing from another group member.  However, it would be prudent for the counselor to provide in their informed consent a clause stating that there would be no secrets kept from other members and also that private sessions without the other members of the group would be kept at a minimum.  This practice is especially prudent for family counseling.  To do this Grosser and Paul suggest in their paper that counselors are,
    “To broaden the capacity for reality testing and consensual validation as a check on                 projections and distortions by having different members review the same event from their     respective points of view.  This serves to increase the individuals ability to tolerate         differences in perception, ambiguities and uncertainties, and to appreciate, respect, and         tolerate needs of other family members as well as one’s own as they relate to differences         in perception.” (p 878)
    Southern, Smith, and Oliver suggest that there are also different models in group counseling that therapists may or may not adhere to.  These theories and tools make up the foundation of how the therapist will approach a situation and help family members understand solutions and ideas.  These models are: the classic model, “is the medical model. In the medical model, the client is not responsible for problem or solution; then there is, “the enlightenment model holds clients responsible for their problems but assigns responsibility for solutions to a higher authority (e.g., the “Higher Power” in Alcoholics Anonymous);” also, “The compensatory model does not hold persons responsible for their problems. However, individuals, families, and communities are viewed as responsible for problem solving;” and lastly, “The moral model combines responsibilities for problems and solutions, blame and control.” (Southern, Smith, Oliver; 2005; p 460)  Each of these theories obviously has evidence of working; however, counselors must be cautious when employing them into use because of the nature of how they problem solve for the client and those involved with the issues the client faces.  Take for instance the compensatory model which holds individuals, families and communities responsible for the clients troubles.  When in a group setting, especially family and marriage counseling, such a model could trouble the other clients, also how is the counselor to juggle each client in the room when using such a model because the counselor is ultimately responsible for each individual and the group as a whole.
Confidentiality
    This paper has discussed in depth the importance of protecting individuals, but also equally important is protecting individuals confidentiality.  It is very easy to protect the confidentiality of a client in individual therapy.  When conducting individual therapy one does not have to consider the other members of the group which will also hear aspects of the clients story, nor does the counselor have to be aware of bringing up issues that may key in other members to realize what is happening with another individual in the group.  Such ideas come to mind as a counselor mentioning a name or a place which ultimately reveals to another member of the group that the individual the counselor is talking about may have been lying, in an affair, or even it may bring out secret facts about the individuals life such as the client is homosexual.  Although it is impossible to protect the client from everything, it is the counselors job to ultimately do so.  This is a big job and the task is of ultimate importance.  
    According to Bond there are two major principals that surround the idea of confidentiality.  The one adhered to mostly in this paper is the idea that all counseling is confidential; however there exists another thought about confidentiality, it is that, “the significance of confidentiality can be overstated at the cost of ignoring other ethical principles.” (Bond; 1992; P 4)  The idea is that confidentiality should be a subject which is negotiated with the client and that the client should be made to understand that complete confidentiality is not contracted.  Such a way to do this would be through informed consent.  However, as this paper explored it is imperative that the counselor know the client understands the informed consent because often informed consent is misunderstood.  It is of general good practice to keep as much information private and only between the counselor and the client.  However, there do exist matters which the counselor does have a certain liability and responsibility to share information which may concern matters of life, death, or great personal injury whether to the client or to other individuals.
Conclusion
    Ultimately the counselor is responsible for every decision that he or she makes.  Personal liability means that the counselor is concerned for the client, not that counselor is concerned with the liability of harming the client.   There are many concerns which counselors face on a daily basis and that they must be aware each action they take or do not take may be ground for ethical inquiry to their practice.  It is important for counselors to be aware of the multi-cultural world that exists, especially in America and that the counselors take an active role in learning and understanding the cultures of the clients with which they work with.  It is also important for counselors to understand the implications of forming dual relationships with clients and understand the consequences of such actions.  Although many theories exist as to how to approach therapy and understanding how to approach solutions for clients the number one thing for every counselor to remember is that it is their ultimate responsibility to protect the client from harm.  Whether that harm be from another group member or from some action that the counselor might take which causes the client direct or indirect harm.  Another matter explored here was that informed consent does not always work because it has a tendency to be misunderstood.  There existed in the study which Sarkar did a fear of power.  What this means is that the people who underwent the study feared that their children would be not given proper medical care or refused medical care in the future if they did not undergo the study.  What the people failed to comprehend was that this was not the case and that in fact they had the ability to withdraw their children at any time from the study.  Counselors need to be aware of how well their clients comprehend the informed consent.  Ultimately it always the counselors responsibility to ensure that no harm comes to their client.

Refrences

ACA code of ethics. (2006). Journal of Counseling and Development : JCD, 84(2), 235-254. Retrieved from http://search.proquest.com/docview/218970374?accountid=12085

Amato, L., Blase, C., & Paley, S. (2000). Ethics. American Journal of Art Therapy, 39(1), 12. Retrieved from http://search.proquest.com/docview/199340778?accountid=12085

Bond, T. (1992). Confidentiality: counseling, ethics and the law. Employee Counseling Today, 4(4), 4. Retrieved from http://search.proquest.com/docview/198444103?accountid=12085

Corey, G. E. (1995). Ethical and legal issues in group counseling. Ethics & Behavior, 5(2), 161.

Corey, G.; Schneider-Corey, M; Callanan, P. (2011) Issues and ethics in the helping professions. 8th Ed.     
    (pp 117, 118, 121) Belmont, CA: Brooks/Cole CENGAGE Learning

Daniels, J. A. (2001). Managed care, ethics, and counseling. Journal of Counseling and Development : JCD, 79(1), 119-122. Retrieved from http://search.proquest.com/docview/219025309?accountid=12085

Grosser, G. H.; Paul, N. L. (1964) Ethical issues in family group therapy. The American Journal of Orthopsychiatry. 875-884, Retrieved from http:rx9vh3hy4r.search.serialssolutions.com/?ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info:sid/summon.serialssolutions.com&rft_val_fmt=info:ofifmt:kev:mtx:journal&rft.genre=article&rft.atitle=Ethical+issues+in+family+group+therapy&rft.jtitle=American+Journal+of+Orthopsychiatry&rft.au=Grosser%2C+George+H&rft.au=Paul%2C+Norman+L&rft.date=1964&rft.issn=0002-9432&rft.eissn=1939-0025&rft.volume=34&rft.issue=5&rft.spage=875&rft.epage=884&rft_id=info:doi/10.1111%2Fj 1939-0025.1964.tb02243.x&rft.externalDBI%2Fa&rft.externalDocID=10_1111_j_1939 _0025_1964_tb02243_x&paramdict=en-US

Jacobs, E. E,; Masson, R. L.; Harvill, R. L.; Schimmel, C. J. 7th Ed. (2012) Group counseling strategies and skills. (p 27) Belmont, CA: Brooks/Cole CENGAGE Learning

Pedersen, P. B. (1997). The cultural context of the american counseling association code of ethics. Journal of Counseling and Development : JCD, 76(1), 23-28. Retrieved from http://search.proquest.com/docview/219038282?accountid=12085

Ponton, R. F., & Duba, J. D. (2009). The ACA code of ethics: articulating counseling's professional covenant. Journal of Counseling and Development : JCD, 87(1), 117-121. Retrieved from http://search.proquest.com/docview/219041088?accountid=12085

Sarkar, R.; Sowmyanarayanan, T. V.; Samuel, P.; Singh, A. S.; Bose, A.; Muliyil, J.; & Kang, G. (2010) Comparison of group counseling with individual counseling in the comprehension of informed consent: a randomized controlled trial. BMC Medical Ethics 2010, 11:8  doi:10.1186/1472-6939 -11-8. Retrieved from http://www.biomedcentral.com.ezproxy.liberty.edu:2048/1472-6939/11/8

Southern, S.; Smith, R. L.; & Oliver, M. (2005) Marriage and family counseling: ethics in context. The Family Journal 2005 13: 459 DOI: 10.1177/1066480705278688. Retrieved from http://tfj.sagepub.com/content/13/4/459
Stevens, P. (2000) The ethics of being ethical.The Family Journal April 2000 8: 177-178, doi:10.1177/10 66480700082011 Retrieved from http://tfj.sagepub.com.ezproxy.liberty.edu:2048/content/8/2/177