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10 Ethical and Legal Aspects of Working with Groups

Chapter Overview

From reading this chapter, you will learn about

· Major ethical issues in group work and the making of ethical decisions

· Promoting ethical principles in groups and responding to complaints of unethical behavior

· Legal issues in groups and how they affect the functioning of a group

As you read, consider

· The ethical principles and codes you abide by and why they are important in your life

· If you think ethical codes are different in working with groups than from with individuals and what unethical behaviors might be more prevalent in a group

· How your knowledge of the law and legal proceedings influences your life individually and in society

Many of the countries of the world have monarchs. They have different levels of power and prestige, but those who have authority serve as leaders in a group hierarchy. Such a position is for better or for worse. The betterment side can be seen in Catherine the Great (1762–1796) of Russia. During her 34-year reign, she worked with the nobility of Russia as a group to expand its boundaries and become recognized as one of the great powers of Europe. On the opposite end of hierarchical powers in legal and ethical matters is another Russian tsar, Paul I (1796–1801), who was the son of Catherine the Great. During his 5-year reign, Paul reversed most of his mother’s reforms, alienated the nobility with higher taxes, reintroducing corporal punishment for the nobility, and randomly sent people into exile to show off his unlimited power. He did nothing that would be considered progressive. Finally, people became so angry with him that he was assassinated. Group leaders are constantly making decisions. Much of what they decide is guided by the ethical guidelines of the professional organizations to which they belong and the legal codes of local, state, and federal governments (Remley & Herlihy, 2016). At times, practitioners are confused about whether their decision making is based on ethical guidelines, legal standards, or both. Ethics and the law are not the same. Rather, “they can probably be best conceptualized as two over-lapping circles which share a common intersection” (Kitchener, 1984a, p. 16). (See Figure 10.1.) Ethical and legal opinions complement and contradict each other. “In some cases, an ethical decision may not be legal, and in other cases, a legal obligation may not seem ethical” (Rapin, 2014, p. 71). Group leaders who make the best and wisest decisions are those who are informed by as many sources as possible. Figure 10.1The relationship between the law and ethics .Information alone, however, is not enough. Knowledge in and of itself does not guarantee proper ethical behavior (Welfel, 2016). Group leaders and members must also practice what they learn (Mangione, Forti, & Iacuzzi, 2007). “Conduct and character are correlated,” but not perfectly (Hayes, 1991, p. 24). It is only with practice that individuals who work in groups become skilled at discerning the rationale for their behaviors and the consequences of them (Foltz, Kirby, & Paradise, 1989). Therefore, ethical and legal decision-making is a dynamic activity that needs careful attention if group leaders are to stay current and act in the best interest of their group members. “It becomes every group leader’s responsibility to attempt to think ethically and behave professionally” (Gumaer & Scott, 1986, p. 149). “Ethical decision making is an ongoing process with no easy answers” (Moleski & Kiselica, 2005, p. 3).In this chapter, the nature of professional and personal ethics is examined, along with some specific ethical guidelines for group leaders. Potential problems related to ethics in group work are examined, as are issues involving the training of group leaders in ethics. In addition, the nature of law and legal codes are explored, because they affect the field of group work. Potential legal problems in groups are also discussed. Although many ethical and legal matters are fairly straightforward and clear-cut, some are not. Group work is a complex process, and individuals who are most involved in it must be multifaceted.

The Nature of Ethics and Ethical Codes

Ethics may best be defined as suggested standards of conduct based on a set of professional values (Gladding, 2016). To behave in an ethical way is to act in a professionally acceptable manner based on these values. However, although ethics address what is right and correct and are deduced from values (Welfel, 2016), ethical conduct “is a matrix relationship involving numerous variables” (Rapin, 2010, p. 61).All ethical issues involve values as grounds for decision-making. Some of the dominant values underlying the practice of ethics are based on the virtues of autonomy, beneficence, non-maleficence, justice (fairness), fidelity, and veracity (truthfulness) (Kitchener, 1984; Leach & Welfel, 2018; Meara, Schmidt, & Day, 1996).Autonomy is the promotion of self-determination, or the power to choose your own direction in life. In groups, it is important that members feel they have a right to make their own decisions. For example, if Kathy is struggling in a counseling group about whether to marry, then she needs to feel she is not being pressured by the group to decide one way or the other. Beneficence is promoting the good of others. It is assumed in groups that leaders and members will work hard for the betterment of the group as a whole. For example, in a career support group, members who find out information concerning employment opportunities will share those tips with others in the group. Non-maleficence means avoiding doing harm. To act ethically, members of groups must be sure the changes they make in themselves and the help they offer others are not going to be damaging. For instance, Yoko, a Japanese American, may not be helped if she takes a group leader’s advice and becomes more assertive with her family of origin .Justice (fairness) refers to the equal treatment of all people. This virtue implies that everyone’s welfare is promoted and that visible differences in people, such as gender or race, do not interfere with the way they are treated. Thus, Mohammed is not made to feel apart from the group because he is the only Muslim in it. Fidelity refers to loyalty and duty. It is keeping promises and honoring commitments. In group work, fidelity involves stating up front what the group will focus on and then keeping that pledge. In such situations, trust is established, and group members are able to accomplish what they set out to do. For example, a psychoeducational group deals with information. Therefore, if Mark joins such a group, he expects that the group leader will not ask him to disclose private concerns about himself that might be embarrassing, because the focus of the group is on the dissemination of facts. Veracity is truthfulness. In group work, veracity is important in all phases of the group’s development. Group members and leaders who are not truthful with themselves or others set up situations in which a good working relationship is impossible to achieve. For instance, in a therapy group, if Tosha tells the group she is not offended by a remark made by another member when she really is, then her behavior in the group may change, and the group as a whole may deteriorate because of this untruthfulness. Generally, veracity in groups has to do with both interpersonal and intrapersonal honesty.At first glance, the practice of ethics does not appear to be difficult. Indeed, individuals who are sheltered from complex interpersonal relationships may find it relatively easy to behave ethically. However, when behavior is considered in the multifaceted world of a group of diverse people, the matter of ethics and acting ethically may become complicated (Mangione et al., 2007). A uniform code of ethics is needed as a guide in such situations because a professional code of ethics “sets out norms and expectation for practitioners in order to collectively minimize the risk of harm to clients and the general public” (Francis & Duggar, 2014, p. 131).ReflectionI once had a chapter of a book I had written plagiarized. To make the matter worse, someone who was prominent and I knew quite well did it. I realized that if I turned the individual in, that individual would most likely lose a lot, including a license to practice counseling as well as a reputation. However, not to turn the individual in would be to accept the dishonesty of the act and enable the individual to be deceitful again. If that situation happened to you, how would you respond? What would be the bases for your action?A code of ethics is a set of standards and principles that organizations create to provide guidelines for their members to follow in working with the public and with one another. Codes of ethics are constantly evolving. Parts of ethical documents are aspirational in nature and not enforceable, whereas other sections require strict professional adherence. In short, ethical codes do not address all possible situations.In a field such as group work, in which practitioners come from varied backgrounds, often some question arises as to which code of ethics to follow and when (Page, Mitchell, Olson, & Vernon, 2000). The reason is that within each specialty (e.g., counseling, medicine, nursing, psychology, social work), codes of ethics have been developed. Some do not deal with aspects of group conduct, and some contradict one another (Corey, Corey, & Corey, 2019; Firmin, DeWitt, Shell, Smith, Zurlinden, 2018). In addressing the field of counseling specifically, Herlihy and Remley (1995) point out that “the existence of multiple codes of ethics creates a confusing situation both for professionals and for consumers” (p. 130). Their observation is pertinent to the field of group work.One document that specifically addresses ethical issues in group work is the Best Practice Guidelines of the Association for Specialists in Group Work (ASGW) (2007; Thomas & Pender, 2008). This document provides “structure to the planning, performing, and processing tasks required for effective and ethical practice in counseling and psychotherapy groups” (Rapin, 2014, p. 75). It should be used along with the more general codes of ethics from your professional association, such as the American Counseling Association (ACA), because together these documents give guidance for ethical interaction in groups. They are based on years of group experience and were developed in response to the need to outline proper behaviors and correct questionable practices within the group field. Two other documents, the ASGW’s Multicultural and Social Justice Competence Principles for Group Workers (ASGW, 2012) and its Professional Standards for the Training of Group Workers (ASGW, 2000), are also important sources of ethical information, as they outline ways of working with diverse groups and the qualifications of group leaders in different types of groups.It is important that group leaders be aware of these codes, standards, and guidelines as well as others like them from similar helping professions, such as social work and psychology. Although codes of ethics, best practice guidelines, and professional training standards are not entirely satisfactory because in many situations no one behavior seems entirely ethical, ethical codes, guidelines, and standards such as those just mentioned give group workers a starting place to find answers and resolutions. Therefore, these documents should be studied and discussed throughout a professional’s career. An advanced group leader is expected to operate much more ethically than one with less experience. Brief Case Sunny’s Sad Situation The principal of her school asked Sunny, a classroom teacher, to lead a counseling group for elementary children. Sunny had no background in group work, but she did not want to disappoint her principal. Therefore, she consented. Matters quickly deteriorated. Sunny invited acting-out kids to be in her group without getting their parents’ permission or even notifying them. By the second session, Sunny found that she faced both a disorganized situation in her group and a bunch of angry parents. Being clueless, she moved quickly to seek advice from the school system’s attorney.

Questions How could Sunny have avoided this situation? What would you have advised her to do had she come to you before consenting to lead the group? Afterward? What positive role could ethics have played in this scenario?

Major Ethical Issues in Group Work A number of major ethical issues are involved in most kinds of group work. For some types of groups, such as task/work groups, a few of these issues will not be as prevalent as for other types, such as psychotherapy or counseling groups. Among the most important issues are those involving training of group leaders, screening of potential group members, the rights of group members, confidentiality, personal relationships between group members and leaders, dual relationships, personal relationships among group members, uses of group techniques, leaders’ values, referrals, records, and closings and follow-up. All of these issues are discussed here. Training of Group Leaders Certain personal characteristics are vital for group leaders: self-awareness; genuineness; the ability to form warm, caring relationships; sensitivity and understanding; self-confidence; a sense of humor; flexibility of behavior; and a willingness to self-evaluate. Without these personal qualities, potential group leaders would have difficulty in their interpersonal relationships and would not be effective. Usually, individuals wishing to become group leaders will obtain specialized training in one of the four areas of group work specialization: psychoeducation, counseling, psychotherapy, or task/work. However, it is the responsibility of professional education programs, such as those accredited by CACREP, to be sure that program graduates are personally integrated and have received the experiences they need to work out biases and use strengths (Yalom & Leszcz, 2005).In addition to personal qualities, the training of group leaders involves selected course work and experience in core group skills, such as being able to identify the basic principles of group dynamics (ASGW, 2000). It is also important for potential group leaders to be involved in different types of group experiences, both as participants and as leaders or co-leaders (Corey et al., 2019; Yalom & Leszcz, 2005). Just as the ASGW has published its professional standards, so has the American Group Psychotherapy Association (AGPA) and other professional group associations. Group associations see personal-growth experiences as part of the total program for aspiring group leaders. Regardless of the standards followed, group leaders must recognize their limitations (Welfel, 2016). Those who do not possess professional credentials in an area in which they wish to practice either must not practice or must be supervised by a professionally qualified individual (ASGW, 2000). It is essential that leaders and members have a clear conception of the type of group to which they belong and the kind of goals they wish to achieve (Gumaer & Martin, 1990). One way for beginning group leaders to gain clarity and experience, in addition to the ideas mentioned previously, is to join a training group (Corey, Corey, & Corey, 2014). In such a group, beginning leaders can learn to recognize and work out major personal and professional issues that affect their ability to conduct groups—for example, criticism, anxiety, jealousy, or the need for control. Screening of Potential Group Members A second major issue in group work is screening potential members, which is more difficult than it seems. It becomes even more complicated when the group is composed of non-volunteers. Screening is actually a three-part process. It begins when group leaders formulate the type of group they would like, and are qualified, to lead. Next is the process of recruitment, in which the leader must make sure not to misrepresent the type of group that is to be conducted. In the recruiting process, potential members have a right to know the goals of the group, the basic procedures to be used, what will be expected of them as participants, what they can expect from the leader, and any major risks as well as potential values of participating in the group. Recruiting is often conducted in a number of ways, including the distribution of flyers as well as direct, personal contact with potential group members and helping professionals who may know individuals appropriate for such an experience. Finally, the leader screens applicants on a one-to-one or small-group basis to be sure they are able to benefit from and contribute to the group (Riva, Lippert, & Tackett, 2000). This type of screening is valuable because it provides an opportunity for the group leader to establish rapport, clarify norms and expectations of group behavior, and answer any questions the individual may have about the group. An important aspect of screening, besides the personal contact it provides, is finding out whether a potential group member is currently in any other kind of mental health treatment, such as individual counseling. If an individual is, then it is essential for the group leader to contact the other mental health services provider and inform him or her about the potential member’s desire to participate in the group. The potential group member ultimately must decide in collaboration with this professional whether to join the group. The potential member needs as much information as possible about the benefits and liabilities of such action. It is advisable at the end of the screening process, and before accepting a member into the group, that the leader obtain a member’s signature on an informed consent statement (Welfel, 2016) (see Figure 10.2). Such a process acknowledges that the individual is aware of the group activity in which he or she is about to participate and is doing so voluntarily. Figure 10.2An informed consent statement. Figure 10.2 Full Alternative Text Rights of Group Members Group members have rights that must be respected and protected if the group is going to work well. These rights are similar to the rights of others who are consumers of professional services. Group members need to “understand what choices they have in participating and what consequences will occur if they refuse” (Rapin, 2014, p. 76). Overt ways of conveying this understanding are important in both voluntary and involuntary groups (where members are mandated to attend, such as groups that are court ordered or conducted in an inpatient mental health facility). In some types of groups, such as counseling groups, recipients of services can be alerted to their rights through the distribution of prepackaged materials, such as those produced by Chi Sigma Iota (International Academic and Professional Counseling Honor Society) and the National Board of Certified Counselors. These materials, along with a verbal explanation of them, are crucial to fully informing individuals of their rights. In addition, specific guidelines pertaining to rights and risks in particular group situations should be covered (Remley & Herlihy, 2016). Group members should be told before the group begins that their participation in the group is voluntary or involuntary accordingly and what the consequences will be if they choose not to participate, if they are disruptive, or if they leave the group. Furthermore, group members should be informed of their rights to resist following instructions or suggestions of leaders and other members. They should expect to be treated individually and respectfully and to be protected from physical and psychological threats and intimidation. They should also be informed as clearly as possible about what the group leader can and cannot do. Group members have the right to know as realistically as possible what type of group procedures will be used, what members can and cannot do, and what the risks are in their participation.

Confidentiality

Confidentiality is the right of group members to reveal personal thoughts, feelings, and information to the leader and other members of the group and expect that information to not be disclosed to others outside the group. Not keeping confidences is like gossiping and is destructive to the group process. Underlying the keeping of confidence is the matter of trust. If groups of any kind are going to be productive, then members must trust one another. Group leaders should deal with the importance and reality of confidentiality during the pre-group screening process. It should be stressed to potential group members that everyone in the group is expected to maintain confidentiality as a means of creating trust, cohesiveness, and growth (Corey et al., 2019; Cottone & Tarvydas, 2007). At the same time, the leader must acknowledge that he or she cannot guarantee confidentiality and that there may be certain cases in which ethical or legal considerations may force the leader to break confidentiality (Welfel, 2016). For example, Section B of the ACA’s (2014) Code of Ethics deals with confidentiality and privacy and spells out as clearly as possible when confidentiality must be broken, such as when clients pose a danger to themselves or others or when legal requirements demand disclosure. When group leaders find or suspect that members have broken confidentiality, they need to address the matter quickly and directly with the group as a whole. For instance, if Paul, as group leader, learns in a counseling group that Bonita has told her closest friends about Jill’s reactions to her failed marriage, then Paul needs to raise the issue before the group for discussion and suggestions. The atmosphere surrounding such an experience will be tense and should be serious. In efforts to prevent breaks in confidentiality, leaders need to reaffirm periodically to group members the importance of not discussing with others what occurs in the group (Corey et al., 2019). This approach keeps the matter of confidentiality constantly before the group and may serve a preventive function by increasing members’ awareness so that they do not unintentionally discuss material outside the group. Unfortunately, leaders and members cannot prevent breaks of confidentiality after a group ends, and this reality must also be addressed.

Reflection

When have you had your own or a friend’s confidentiality broken? What were the results of this breach? How did you feel? What did you do? What do you think you should do if this happens in a group now? Personal Relationships Between Group Members and Leaders The degree and kind of relationship between group members and leaders will vary from group to group. In task/work groups, for instance, casual contact between group members and leaders is usually unavoidable and may even be productive. However, in therapeutic groups, such contact is likely to be inappropriate and could be destructive to the individuals involved as well as to the group as a whole. It is more likely that relationships between group members and leaders will be detrimental to the group as a whole if they are not carefully handled. Such relationships can lead to favoritism or to a failure to focus on important personal topics within the context of the group itself. Usually, outside personal contact between group leaders and members in therapeutic or counseling groups is discouraged or prohibited because this behavior may foster dependency or may lead to unhealthy dual/multiple relationships. Dual/Multiple Relationships Dual/multiple relationships occur when group leaders find themselves in two or more potentially conflicting roles with their group members, such as “professional (e.g., professor, supervisor, employer) or personal (e.g., friend, close relative, sexual partner)” (Herlihy & Remley, 2001, p. 80). Although certain dual/multiple relationships may seem unavoidable and may even seem harmless, they carry the potential for harm because of the inherent vulnerability of the client and the imbalance of power between counselor and client (Neukrug, Milliken, & Walden, 2001). In a counseling training program, for instance, a group leader might be a member’s teacher and have the responsibility of assigning grades. The fact that the group leader might come to know something about the member’s background could potentially have a detrimental effect on the member’s grade (Davenport, 2004). For example, Patricia, the group leader, might find out that Jessie, a group member, is a lesbian. If Patricia has unresolved issues or biases involving gays and lesbians, she will treat Jessie differently than before. Regardless of the exact setting, dual/multiple relationships can negatively affect the people involved in subtle and obvious ways. Therefore, they are best avoided. In academic settings, Remley and Reeves (1989) advise counselor educators to avoid dual and multiple relationships such as requiring or allowing students to participate in a group experience led by the educators as a part of a course. Most of these situations usually involve a conflict of interest. Ways of resolving these circumstances include the following: using faculty-supervised post-master’s students to lead groups for entry-level students using a blind-grading system requiring students to participate in externally supervised groups employing role-play techniques having students co-lead their own groups while the instructor observes using a “fishbowl training” technique in which students co-lead their own groups alternating between an inner and outer circle, again with the instructor observing and helping the group process what occurs (Forester-Miller & Duncan, 1990; Kane, 1995).However, how to handle potentially dual or multiple relationships in an academic or nonacademic setting is not as easy or as prescriptive as it may seem on the surface, for there is not a lot of research in this area (Goodrich, 2008).In examining dual and multiple relationships, it is important to look at the difference between a dual relationship and a relationship with dual qualities (Aponte, 1994). For instance, a group leader may know about a member’s personal issues and yet be able to treat the member fairly and appropriately. However, most relationships with dual or multiple qualities, such as conducting a group and grading participants or offering group counseling to a friend, are fraught with the potential to become contaminated. Therefore, if there is the slightest doubt about whether a group worker is about to enter into such a relationship, the leader should err on the side of caution. If a potential dual or multiple relationship cannot be avoided, such as in a rural setting where there are limited services, then all parties concerned should carefully explore the potential benefits and pitfalls in the affiliation before entering it. If possible, it is wise to have an outside neutral party strictly monitor the relationship on a regular basis. This type of an arrangement is preventive and follows the ethical principle that “the professional should, at all cost, do no harm to the client” (Sklare, Thomas, Williams, & Powers, 1996, p. 265).Personal Relationships Among Group MembersThe matter of personal relationships among group members is another ethically gray area. Context is one of the major deciding factors. In some settings, for example, work environments, schools, or mental hospitals, group members will inevitably interact with one another outside the group. In other settings, such as outpatient treatment groups or special task forces, this type of interaction is unlikely to occur naturally. Most group leaders do not make hard and fast rules about personal relationships among group members because this type of rule is impossible to enforce (Jacobs, Schimmel, Masson, & Harvill, 2016). There are some cases, such as in self-help groups, in which contact with members outside the structured group may be therapeutic. However, in most counseling and psychotherapy groups, member-to-member contact outside the group results in the formation of subgroups or hidden agendas, which can be detrimental. Therefore, discouraging socialization in these types of groups is a prudent policy (Remley & Herlihy, 2016).Overall, for most groups, the focus should be on open relationships within the group setting. There is a rich and subtle interplay between the group member and the group environment, and each member at once shapes and responds to his or her social microcosm. The more spontaneous the interaction is, the more varied will be the environment and the greater the likelihood that problematic issues will be touched on for all the members (Yalom & Leszcz, 2005).Uses of Group Techniques Group techniques or exercises are structured ways of getting members to interact with one another. They can have a powerful impact on group members and positively affect how people work together or change. However, when leaders misuse group techniques, they can also inhibit the natural ebb and flow of a group (Carroll & Krause, 2008). For instance, Meg may start each group counseling session with a structured exercise to avoid having to grapple with the hard job of focusing on group process and the difficult issues that have arisen in the group. In such a situation, Meg may accelerate the pace of the group, but at a cost. As Yalom and Leszcz (2005) state, “The group pays a price for its speed; it circumvents many group development tasks and does not develop a sense of autonomy and potency” (p. 472). Therefore, the use of group techniques as in Meg’s case is ethically questionable Corey (2016) believes that structured exercises are best used when they are focused on group goals or group members’ achievements. Group leaders face ethical problems when they lack the skill or sensitivity to use exercises properly or when they “de-skill” group members by making them overly dependent on the leader and less likely to help one another (Jacobs et al., 2016; Yalom & Leszcz, 2005). In such cases, leaders may generate more feelings or nonverbal expressions than they or the group can handle and ultimately may lead the group to a dead end (Carroll & Wiggins, 2000; Corey et al., 2019). In choosing an exercise for a group, the leader should always have a rationale and tailor the exercise to fit the particular needs of the group. Using techniques isolated from relationships and theories amounts to the employment of “gimmicks,” which is an unprofessional and unethical way to work (Patterson, 1986).Brief Case Jerry Puts Gimmicks into Gear Jerry was leading a group for the first time. Not knowing exactly what to do to get the group moving, he used a warm-up exercise initially. It worked like a charm. Group members quickly started talking to one another, and Jerry noted that the group went well. Because he was leading a psychotherapy group, Jerry believed it would be good to start each group with an exercise. He quickly learned the meaning of the term diminishing returns, as each week the activities he brought in seemed to be less powerful than the week before. Group members did not seem particularly interested in beginning the group that way, especially if they had unfinished business from the week before.

Questions

What would you tell Jerry to do at this point? What are other positive and negative aspects of beginning a group with an activity or gimmick?

Group leaders can employ at least 14 different kinds of exercises in the groups they conduct: written, movement, dyads and triads, rounds, creative props, arts and crafts, fantasy, common reading, feedback, trust, experiential, moral dilemma, touching, and group decision (Jacobs et al., 2016). Whenever an exercise is used in a group, it should be processed so that it allows group members to become better informed about themselves and the group. Therefore, at least twice as much time should be allowed for the processing of exercises as for completing them. Ways of processing include sharing in small groups, sharing in the group as a whole, sharing through writing, using rounds, or employing some combination of these methods. Leaders’ Values Group leaders have values, and for better or worse, values influence the goals, methods, and ultimately the success of group work and counseling (Corey et al., 2019; Mitchell, 1993; Patterson, 1958; Williamson, 1958). Leaders who try to hide their values may actually do more harm than good in certain situations. For instance, if Jana dislikes the patronizing way Carolyn responds to other group members but does not voice her value about members leveling with one another, then the group may either avoid interactions with Jana or scapegoat her. However, leaders must be careful not to impose their values on group members. Such action short-circuits members’ exploration, especially in counseling and psychotherapy groups, and results in confusion and chaos. Group members have the ultimate responsibility to make their own decisions. However, leaders help members explore their values more thoroughly while maintaining their own. If group leaders and members have conflicts about values, then leaders are responsible for making referrals (Corey et al., 2019). Leaders must stay attuned and be aware of the impact of values in a group of any kind.

Referrals

Referrals (transfers of members to another group) are made when group leaders realize they cannot help certain members achieve designated goals or when a conflict between leaders and members has proven unresolvable. The group leader is responsible for making appropriate referrals when necessary because he or she cannot be all things to all people. The process of making a referral involves assessing your own values and limitations as a group leader and listening to individual group members concerning their particular needs. Group leaders should maintain an extensive and current list of referral sources. The referral process itself involves four steps: (1) identifying the need to refer; (2) evaluating potential referral sources; (3) preparing the client for the referral; and (4) coordinating the transfer (Hackney & Bernard, 2017). For instance, if Dot realizes in her psychotherapy group that she cannot help Mahalah, then she may first arrange to meet with Mahalah after a group session and discuss the situation with her. Before the meeting, Dot should prepare a list of potential referral sources and have these ready for Mahalah to see during their session together. If Mahalah is not ready for a referral, then Dot may have to meet with her again. After Mahalah has been persuaded of the wisdom of the referral, Dot should work with her on the arrangements. Records When conducting groups for counseling or therapeutic purposes, it is important that group workers keep records. Such documentation helps the group worker concretely review what happened in the group, when it occurred, and who was involved. By reviewing past events, issues and agendas that develop in the group can be better addressed, and the group worker can document for third parties, such as courts or managed care agencies, information that may be relevant to any ethical or legal issues that arise (Bond, 2015).Written records should be kept in locked files in a secured area. The area also should be locked and have limited access. One way to keep records is to write them in a problem-oriented format. However, such a procedure “tends to transcribe clients’ experiences into the official language of diagnostic labels” and can be dehumanizing (Chen, Noosbond, & Bruce, 1998, p. 405). Another possibility is to document the experiences of group members and the group as a whole in what Yalom and Leszcz (2005) describe as a process summary. Using this method, the group worker highlights group process, “reinforcing clients’ understanding of the highly charged here-and-now experiences” of the group (Chen et al., 1998, p. 405). A third alternative is for the group worker to write a therapeutic document to the group using key phrases, responses, and descriptions of vivid nonverbal behaviors, thereby capturing the dynamics of a session (Chen et al., 1998). Group members can then discuss the document and their reactions to it at the beginning of the next session. They can also use the document as a reflective tool outside of group sessions to evaluate themselves or the group and to make appropriate changes. Closings and Follow-Up Closings and follow-up “become ethical issues more because of errors of omission rather than errors of commission” (Gazda, 1989, p. 307). Groups need to reach some form of closure before ending. By doing so, they help promote and maintain changes members have made while in the group. For long-term groups, the closing process may mean several sessions devoted to winding down and tying up loose ends, whereas for short-term groups, a few hours devoted to this activity will be all that is necessary. Issues related to attachment, loss, and meaning are primarily dealt with in ending a group (Corey et al., 2019; Hackney & Bernard, 2017; Mangione et al., 2007). The important point is that these issues involving separation and consolidation be addressed. Brief Case Lars and Loss In a psychotherapy group, Lars, who lost his parents early in life, has become particularly upset and angry that the group is ending. He has unresolved issues in dealing with loss. Although he modified his behavior and thinking in the group, he fears he will revert back to his former style of retreating inward and becoming depressed if he is not helped by the group and the leader to come to an acceptable resolution about the group ending.

Questions

What might you as the group leader do to help Lars? What do you think the group as a whole could do in assisting Lars at this time of ending?

The ethical issue in follow-up usually centers on its neglect rather than its inclusion. Group leaders should make themselves available to group members for consultation as well as follow-up meetings after a group has ended. If group leaders are negligent about this important procedure, then group members may not adequately assess the impact the group has had on them and are unlikely to continue working on their goals as specifically as they would otherwise. Besides providing for the welfare of group members, follow-up after the ending of a group has the added benefit of helping group leaders evaluate the effectiveness of what they did in the group and improve their group leadership styles. “Perhaps the most meaningful evaluation material can be gained by a group leader 30 days or more after a group ends. At that time the members are more independent of the leader and perhaps can be more honest” (George & Dustin, 1988, p. 115).Again, consider the case of Lars. If he receives follow-up, then he will most likely feel that he has not been abandoned. Furthermore, he can focus during follow-up on the improvements he has made since the group ended and be reinforced for this new behavior.

Reflection

Think of when you received follow-up from a professional (or even a nonprofessional) about a service or product you purchased. How did you feel when you received the contact? What were your impressions of the individual and the service or product? Do you think members of counseling groups might have similar thoughts and emotions?

Making Ethical Decisions

Because group leaders face such a wide variety of issues, it is crucial that they know beforehand how they will make ethical decisions. Although such decisions can be made in many ways, some approaches to ethical decision making can make the process operate more smoothly. Two are discussed here. The first is making ethical decisions according to both principle ethics and virtue ethics (Corey et al., 2019). Principle ethics are ethics based on obligations. They focus on finding “socially and historically acceptable answers to the question, ‘What shall I do?’” (p. 10). Codes of ethics are based on principle ethics (actions stemming from obligations). Virtue ethics focus on “the character traits of the counselor [or group worker] and nonobligatory ideals to which professionals aspire rather than on solving specific ethical dilemmas. Simply stated, principle ethics asks ‘Is this situation unethical?’ whereas virtue ethics asks ‘Am I doing what is best for my client?’” (p. 10). In a group, integrating principle ethics and virtue ethics becomes complex. A second way of making ethical decisions is to use specific steps as a guideline. For example, in the case of promoting beneficence and enhancing ethical decision making, a mnemonic device that reminds group leaders and members of what they should do can be helpful. One device created for these situations is the A-B-C-D-E worksheet (Sileo & Kopala, 1993). The letters stand for assessment, benefit, consequences and consultation, duty, and education. Some of the points are more applicable in certain situations than in others, but the device gives practitioners an idea of what they can use to enhance the group’s good. In addition to using this type of worksheet on a particular aspect of group ethical decision making, members can take general steps in the overall process. For example, in ethical decision making, Hill, Glaser, and Harden (1995) suggest a seven-step model to follow in a sequential fashion. This model begins with the recognition that a problem exists and ends with continuing reflection. It is one that involves client collaboration in the process, which Walden (1997) states, empowers the client—in this case, the group. Thomas (1992) recommends a less elaborate model. First, she attempts to define a situation. Then she consults ethical codes for information and guidance. A continuum of alternative actions is generated next. At either end of the spectrum will be choices ranging from “take radical action” to “take no action,” with more moderate suggestions in the middle part of the choice curve. The next part of the process is to evaluate all suggested actions in regard to others’ welfare and professional responsibilities. After the consequence of each action is examined, some tentative decision is made and finally implemented. Records are kept, at least of the final outcome. One unique psychoeducational group experience for ethics-based decision-making is conducted through the Arizona courts with the adult criminal diversion programs. These programs offer alternatives to prosecution for individuals formally charged with criminal offenses—usually first-time offenders with misdemeanors (Alexander, 1999). In this program (four sessions of two hours each), group members work to solve their own and other members’ real problems. They do so through tapping into universal values they already hold, such as goodness, thoughtfulness, tolerance, responsibility, and honesty, as well as learning how to make better decisions. In this program, ethics-based decision making “entails the following steps: (a) identify the problem, (b) research the facts, (c) identify all of the people who will be affected by this decision; and (d) list all of the solutions you can think of and evaluate each alternative” (Alexander, 1999, pp. 210–211). Homework is given, case studies are featured, and members are encouraged to think creatively, such as using brainstorming, metaphorical thinking, and generating unconventional ideas. In this way, opportunities for making choices (and making better decisions) are expanded.

Promoting Ethical Principles in GroupsThe promotion and implementation of ethical conduct in groups occur on two levels: training and practice. There is an opportunity in educational settings to instill in prospective group leaders’ knowledge of and a feel for ethics (ASGW, 2000; Hayes, 1991; Paradise & Siegelwaks, 1982). Indeed, such a procedure is crucial to the welfare of group leaders and other helping professionals in general. For individuals already in practice, training in the ethics of working with groups can best be achieved through continuing educational opportunities and peer supervision.Training Group LeadersTraining group leaders to address ethical issues is a multidimensional process (Brabender, 2007). On one level, group leaders must become familiar with ethical codes and standards. For instance, group leaders should know the relevant standards from the ACA Code of Ethics (Stolsmark, 2015). On another level, they must get to know their own ethics and values. On a third level, prospective group leaders must practice recognizing ethical dilemmas and making ethical decisions. Finally, individuals must become aware of the development of ethical decision making over time so they can assess their own development as practitioners. Rapin (2010) actually puts ethical behavior in a group in the following formula: “(moral and ethical development + core knowledge and skills + specialty/best-practice guidelines + legal parameters) * decision-making model(s)” (p. 61).Regardless of how conceptual it may be, the different aspects of ethical behavior require integrating. Indeed, as Kitchener (1986) points out, the training of potential group leaders requires sensitizing them to ethical standards and issues, helping them learn to reason about ethical situations, developing within them a sense of being morally responsible in their actions, and teaching them tolerance of ambiguity in ethical decision making. To become familiar with ethical codes, best practices, and standards in group work is initially as simple as reading pertinent documents and articles. This type of approach has often been used. Although it may expose individuals to the basics of what are commonly accepted guidelines in the practice of group work at a particular time, it does not teach them that ethics are normative rather than factual (Wilcoxon, Remley, & Gladding, 2013). Ethics “inevitably change both as new scientific evidence dictates new approaches and as our culture changes” (Gazda, 1989, pp. 297–298). A prime example of the rapid change in ethics is the revision of the ASGW’s Ethical Guidelines for Group Counselors (1991 and the decision by the ASGW not to use these guidelines after the mid-1990s and instead to use the ACA’s code of ethics (ACA, 2014) and the ASGW’s own best practices document (Thomas & Pender, 2008) as standards for ethical conduct. Training group leaders in ethical decision making today thus involves the dynamic process of examining particular codes of ethics, guidelines, and standards while simultaneously exposing prospective group leaders to vignettes related directly to ethical cases. Casebooks and videos on ethics are helpful in this procedure (e.g., Corey, Corey, & Haynes, 2014; Herlihy & Corey, 2014), but they are never enough by themselves. Reflection Do you learn better from casebooks or videos? How does the learning differ for you? Which medium do you think would work best in teaching ethics? How could you make each more dynamic? On a second level, ethical training requires individuals to examine and understand their own personal codes of ethics (Van Hoose & Kottler, 1985; Van Hoose & Paradise, 1979). Group discussion related to general dilemmas can increase ethical awareness and help individuals gain more self-understanding (Paradise & Siegelwaks, 1982). For example, in a classroom situation, a teacher may use a values scale, like those generated by Milton Rokeach (2001), to help class members assess the values they hold most closely. The teacher may present controversial group case histories to the class and ask members to focus on ways they would handle these situations. A third way to emphasize ethics is on an integrated level. Prospective group leaders can gain a greater exposure to dealing with ethical dilemmas from a practical viewpoint through role-plays in simulated groups and direct participation in practitioner training groups (Conyne, Wilson, & Ward, 1997). Using these methods, leaders-to-be get a feel for decision-making and group dynamics. This type of knowledge is crucial for potential group leaders who do not have a good understanding of making decisions within the dynamics of a group. It can help them learn to reason and risk as well as prevent them from becoming ineffective, harmful, and unethical. Finally, as a last part of training, individuals who aspire to be group leaders should be exposed to developmental theories of ethical reasoning so they can gauge their own professional growth (Welfel, 2016). Models, such as those developed by Van Hoose and Paradise (1979), hold promise for helping individuals in training to gain a clearer understanding of their own level of functioning. Continuing Education and Peer Supervision For practitioners already in the field of group work, the matter of keeping up with ethical codes and growing as an ethically based professional can be met by taking continuing education courses and by undergoing peer supervision. Almost all professional associations offer programs on ethics at their national, regional, and state conventions. Continuing education for participating in professional programs helps group workers stay attuned to the latest developments in areas related to group work. For example, programs on group dynamics, group leadership, and group standards are frequently offered at conferences of the ACA and ASGW. Many professional associations require that their members participate in such activities. Continuing education can be supplemented with peer supervision, in which practitioners meet regularly to consult with one another about particularly difficult group situations (Borders et al., 2014). Through this type of experience, practitioners, especially those in private practice, become more informed, establish support, avoid burnout, and stay more aware of the ethical dimension of working with clients in particular cases. It is interesting to note that peer supervision is conducted in a group environment, which can also provide information on dealing with, among other topics, issues in running groups (Greenburg, Lewis, & Johnson, 1985).Both continuing education and peer supervision can be helpful in subtle as well as obvious ways to professionals who practice group work. In addition to giving them more knowledge and procedures to use in groups, these educational methods can create new awareness of even minor misconduct in the group leader or in the group. Through this awareness, such behavior can be eliminated. For example, in some groups, a promise is made that no pressure will be put on a participant, but then non active members are encouraged in subtle ways to be involved in the group (Kottler, 1994). In helping themselves and their groups make ethical decisions about incidents like this one, group workers increase the safety and efficiency of their groups as well as their own self-knowledge.

Responding to Complaints of Unethical Behavior It is unusual for a group member to file an ethics complaint against a group leader. However, such incidents occasionally happen, especially in counseling and psychotherapy groups. When they do, the group leader, as a helping professional, needs to take appropriate actions. Two essential actions are to notify his or her professional liability insurance carrier and “ensure that an attorney is promptly retained” (Chauvin & Remley, 1996, p. 564). The reason is that allegations in an ethical complaint can be used as the basis for a lawsuit. Therefore, ethical complaints must be treated seriously. If an ethics complaint is lodged against a group worker, it will usually be made with a group with which the worker has an affiliation, such as a professional association’s ethics committee or a state licensing board. The group worker will have an opportunity to respond to the charges, and the committee or board will then act as a jury. Charges may be dismissed or upheld. If they are upheld, then the group worker may be disciplined through a reprimand, suspension, probation, or revocation of membership or licensure. Regardless, it is in the group worker’s best interest to be discreet. If an emotional outlet is needed to handle the stress associated with such a process, then the group worker should seek professional counseling services. As with all matters pertaining to adversity, prevention is the first and best practice when dealing with ethical matters. Overall, “ethical conduct results from a combination of didactic knowledge, an understanding of problem-solving approaches, a clear conception of philosophical principles . . . that underlie a formal code of ethics, and a basically sound character that leads one to respond with maturity, judgment, discretion, wisdom, and prudence” (Bersoff, 1996, p. 90).Brief Case Hostile Henry Strikes Again Although they were both in the same profession, Henry hated Fielding. He thought Fielding was a little too good and was too kind. Therefore, when Henry heard rumors that Fielding had said something outrageous as the leader of a psychotherapy group, he immediately filed an ethics charge against him with his national professional group and the state licensure board. The information Henry received was wrong, and he later retracted his charge. Fielding had been hurt professionally and personally by then.

Questions

What would you advise Fielding to do? What would you do in regard to Henry if you were the national group or the state licensure board?

Legal Issues in Groups Ethics and the law are separate but sometimes overlap (Rapin, 2010). By their nature, ethical codes and laws tend to be reactive, emerging from what has occurred rather than anticipating what may occur (Corey et al., 2019). Law refers to a body of “agreed-upon rules of a society that set forth the basic principles for living together as a group. Laws can be general or specific regarding both what is required and what is allowed of individuals who form a governmental entity” (Remley & Herlihy, 2016, p. 4). Some ethical issues, such as telling the truth, have legal ramifications when violated. There are also situations regarding issues such as confidentiality and advertising in which conflicts may emerge between legal and ethical systems. Therefore, group leaders are well advised to have knowledge of both ethical codes and legal precedents. Often, when individuals feel wronged by professional helpers, the helpers’ actions will be judged according to the standards of the group with which their services are most identified (Woody, Hansen, & Rossberg, 1989). The conduct of group leaders, for example, would likely be compared with the type of behavior considered appropriate in the ASGW’s (2007) “Best Practice Guidelines” or a similar definitive document. Thus, group workers must keep up with professional and legal developments on a regular basis. This means staying abreast primarily of community, state, and national standards and knowing what to do in the case of legal action (Hartsell & Bernstein, 2013).Community, State, and National Standards Group leaders who function successfully are aware of “community standards, legal limitations to work, and state laws” governing the practice of groups, especially those that directly affect counseling or psychotherapy (Ohlsen, Horne, & Lawe, 1988, p. 391). This type of information may be best obtained from these sources: Civic, religious, and business leaders of the community in which the group worker resides Professional state counseling boards State departments of education Individuals involved in the state or national divisions of major professional counseling associations Liaison personnel in national professional associations Local attorneys Members of the state attorney general’s office It is not unusual for helping professionals, such as group workers, to fail in their practices because they have not paid enough attention to community, state, and national standards (Woody, 1988). Knowing theories and techniques of group work is not enough to make practitioners successful, especially those who operate in diversified settings or who wish to operate as private practitioners (Paradise & Kirby, 1990).The best procedure to employ in preventing legal difficulties is to do your professional “homework” beforehand. This means reading and studying major references on legal decisions that have an impact on conducting groups. For example, major sources explaining the relationship between the law and mental health practices include those by Wheeler and Bertrum (2015); Hartsell and Bernstein (2013); Hummel, Talbutt, and Alexander (1985); Sidley (1985); and Swenson (1997). The ACA’s legal series, edited by Theodore P. Remley Jr. (1996), is also excellent in this regard. Primary sources for researching legal opinions include the United States Supreme Court Report (for Supreme Court decisions), the Federal Reporter (for U.S. Courts of Appeals decisions), and the Federal Supplement and Federal Rules (for U.S. District Court decisions). An official state reporter, such as Connecticut Reports or Alabama Reports, usually disseminates state court decisions. A frequently used legal research source is Shepard’s Case Citations, which follows “the judicial history of a targeted case” (Woody & Mitchell, 1984, p. 32).Bibliographies on group work are a rich source of information on all professional aspects of groups. With the use of the Internet and computer technology, specialized bibliographies can be put together quickly and cost-efficiently. Reading journal articles, books, and monographs and attending workshops on trends and issues in human services all should be included in group workers’ schedules. Consultation with professional peers on landmark legal decisions, such as Taras off v. Board of Regents of the University of California (1969), is also vital. Legal Action Legal action is most likely to be taken against a group worker, especially in a psychotherapy or counseling group, if members think they have sustained physical harm, emotional trauma, or psychological or financial damage because of participating in a group experience. Such legal action usually is in the form of a malpractice suit that implies the group leader has failed to render proper service because of either negligence or ignorance. “The word ‘malpractice’ means bad practice,” and “the claim against the professional is made by a ‘plaintiff’ who seeks a monetary award based on a specific amount of damages: physical, financial, and/or emotional” (Gazda, 1989, p. 299). Practitioners can best avoid these suits by maintaining reasonable, ordinary, and prudent practices (Crawford, 1994). For example, keeping written records of groups under lock and key and securing electronically stored records are necessary (Bond, 2015; Mitchell, 2007).Specific practices that are most likely to prevent lawsuits include these: Screening to reject inappropriate potential group members Spending extra time at the beginning of the first group session to discuss group rules and group members’ responsibilities Following the ethical codes of professional organizations to which you belong Practicing only those theories and techniques in which you have actual expertise Obtaining consent or contracts in writing from members (or, in the case of minors, their parents)Warning members about the importance of confidentiality and the exceptions in which member confidentiality will have to be broken Staying abreast of recent research, theory, and practice techniques within your specialty Empowering members to evaluate their own progress and be in charge of their own progress Obtaining regular peer supervision of your work Following billing regulations and record-keeping practices to the letter of the law (Corey et al., 2019; Paradise & Kirby, 1990; Wheeler & Bertrum, 2015)If a malpractice suit is filed, especially as a result of counseling or psychotherapeutic experiences, plaintiffs must show that: A therapist–client relationship was established, The therapist’s conduct fell below the minimal acceptable standard for the case, The conduct of the therapist was the cause of injury to the client, and An actual injury was sustained by the client (Schultz, 1982).Although the therapist–client relationship may be established easily (e.g., through producing a bill or receipt for services), other criteria in malpractice suits are more difficult to prove. In suits charging that the group leader’s conduct fell below minimum standards, the measure usually used in such cases is what other practitioners in the same geographical area would do under similar circumstances (Wilcoxon et al., 2013). Group workers who are in contact with and in line with other practitioners in their area are less likely to be affected by this criterion, although local standards are increasingly being replaced with those on a national level. The question of whether the group leader’s conduct caused injury to an individual is easiest to prove if the acts and injury are closely related in time (Wilcoxon et al., 2013). Finally, in deciding whether a group member sustained an actual injury, one or more of the following effects must be shown: Exacerbation of a previous symptom Appearance of a new symptom Client misuse or abuse of therapy (e.g., increased intellectualization or dependency)Client overextension of self (e.g., taking on inappropriate tasks)Disillusionment with therapy (e.g., feelings of hopelessness and depression) (Strupp, Hadley, & Gomes-Schwartz, 1977).Brief CasePhyllis Becomes a Plaintiff Phyllis joined her therapist’s psychotherapy group because she had issues revolving around unresolved grief from her childhood. About halfway through the group, the leader became demanding. He insisted that if group members were going to get better, they needed to “spill their guts” and “get on with life.” Feeling pressured, Phyllis complied with the leader’s demands. She later came to regret her actions, especially when she found out that information she had disclosed in the group was out in the public domain. In response, Phyllis quit the group and sued the leader. She was visibly upset. The case was settled out of court, with the leader apologizing to Phyllis and returning the money he had charged her. Phyllis wanted to press the case further, but she could not prove she had been harmed in an irreparable way. Furthermore, the leader had kept careful records, which documented that Phyllis had asked him to “push her” to talk before the group.

Questions Even though Phyllis was limited in what she could do legally, do you think she had some ethical recourses? If so, what would they have been?

Most malpractice suits in group work will center on unintentional civil liability (a lack of intent to cause injury). For example, Lilly may claim that a group leader caused her harm by not letting her fully express herself when he blocked her from verbally attacking another group member with whom she disagreed. However, in some cases, “intentional” harm becomes the issue in question. Intentional civil liability cases include situations in which there are issues regarding: battery (the unconsented touching of an individual),defamation (injury to an individual’s character or reputation either through verbal [slander] or written [libel] means),invasion of privacy (violation of the right to be left alone), or infliction of mental distress (outrageous behavior on the part of the therapist) (Wilcoxon et al., 2013).These types of cases are usually more clear-cut than those involving unintentional actions. In all cases, group specialists, especially those who work in psychotherapeutic or counseling groups, are advised to study their professional standards and codes of ethics carefully before, during, and after group sessions. In all cases, professionals who work with groups should carry professional liability insurance (insurance designed specifically to protect a group worker from financial loss in case of a civil suit). Any court litigation can be costly, and even the most careful group leader may be the subject of legal action. Thus, purchasing liability insurance (usually available through professional associations) and carefully keeping up to date on ethical and legal matters may be two of the best practices that group leaders can employ in helping themselves operate on the highest possible level. Reflection Who have you known who has been in a civil court case? What did they have to pay their attorney? How much do you think malpractice insurance would cost? Check it out.

Summary and Conclusion This chapter has covered various aspects of ethical and legal issues regarding group work. Many of the topics focus on group leaders’ responsibilities to their members and themselves. However, some material in this chapter is specifically targeted toward the rights and responsibilities of group members. It is assumed by most individuals who join a group that their leaders will be ethical and professional. However, that is not always the case, and some group members become casualties of their experience. To ensure against this, most professional associations, particularly the Association for Specialists in Group Work and the American Group Psychotherapy Association, have constructed best practice guidelines, ethical codes, and professional standards by which group leaders and groups should abide. These documents are probably more relevant to leaders of psychotherapy and counseling groups, but they also apply to those who work in psychoeducational settings and with task/work groups. By adhering to such guidelines, codes, and standards, group leaders tend to maximize the benefits and minimize the harm that a group can do to individuals. Nevertheless, group leaders must pay attention to specific ethical issues, including the following: Their training and competence Screening potential members Informing members about the group and the rights they have Ensuring confidentiality to the greatest extent possible Establishing appropriate relationships among group members and between the leader and members Owning but not imposing their own values Using group exercises properly Making appropriate referrals Transcribing and keeping appropriate records Employing termination and follow-up procedures correctly Group leaders and members must also scrutinize how they make ethical decisions. None of these are simple tasks that are easily accomplished on a one-time basis. Therefore, group leaders must constantly monitor their behavior and keep current on ethical matters. “A combination of good personal character and virtue with sound thinking and good decision-making skill . . . ensures the best solution to an ethical dilemma” (Sileo & Kopala, 1993, p. 90). Prospective group leaders may receive cognitive and experiential training in ethics while they are still in training, whereas more experienced leaders (who are supposed to be more knowledgeable about ethics) must rely more on continuing education experiences and peer supervision. Legal aspects of group work are similar to those involving ethics in some ways, but there are differences. It is important for group specialists to do their homework in researching legal cases that affect human services professionals and consult with others about ways to behave within the limits and spirit of the law. Getting to know community, state, and national standards for the practice of their profession is a major way to do this. If practitioners encounter legal difficulties, then they need to know the difference between unintentional and intentional malpractice suits and what they need to do in such cases. It is crucial that all group leaders carry professional liability insurance.