Module 8
Group Work
a. Introduction
Practitioners are creating a multitude of groups to fit the needs of a diverse
clientele in schools and community mental health agencies. In many agencies and
institutions, group work is the primary form of treatment, and the types of groups that
can be designed are limited only by one’s imagination. Group work is not a second-
rate modality; it is a treatment of choice for many clients (M. Corey, Corey, & Corey,
2018). Along with the increased use of group therapy has come a rising ethical
awareness. Practitioners who work with groups face a variety of ethical quandaries
that differ from those encountered in individual therapy. We are giving group work
special attention, as we did with couples and family therapy, because it raises unique
ethical concerns.
In this, the elucidation of critical ethical considerations traverses a diverse
terrain, delving into a myriad of contexts and settings. Our exploration extends
beyond the conventional boundaries, encompassing an expansive array of groups
representative of multifaceted human experiences. From the intimate dynamics of
therapy groups to the enriching environments of counseling groups, from the
transformative journeys of personal-growth groups to the enlightening spaces of
psychoeducational groups, each domain offers unique insights into the ethical fabric
that underpins human interaction and professional practice.
Within therapy groups, the ethical tapestry is intricately woven into the fabric
of healing and growth. Here, the delicate balance between confidentiality and
disclosure is paramount, as participants navigate the complexities of sharing personal
experiences within a trusted circle of support. Ethical dilemmas may arise when
addressing issues of power dynamics, transference, and countertransference, requiring
practitioners to exercise discernment and sensitivity in maintaining ethical boundaries
while fostering therapeutic progress.
Similarly, in counseling groups, ethical considerations manifest in the context
of empowerment and collaboration. The ethical imperative to uphold client autonomy
is central, as individuals engage in a shared journey towards self-discovery and
problem resolution. Practitioners must navigate the terrain of informed consent,
ensuring that participants are equipped with the knowledge and agency to make
informed decisions about their therapeutic process. Additionally, the ethical
responsibility to address cultural competence and diversity underscores the
importance of creating inclusive spaces that honor the unique perspectives and
identities of all group members.
In the realm of personal-growth groups, ethical reflections converge with the
pursuit of self-awareness and personal development. Here, the ethical landscape is
characterized by a commitment to authenticity and integrity, as individuals embark on
a journey of self-exploration and transformation. Practitioners play a pivotal role in
fostering an environment of trust and vulnerability, while also safeguarding against
potential ethical pitfalls such as boundary crossings and conflicts of interest.
Lastly, in psychoeducational groups, ethical considerations intersect with the
dissemination of knowledge and skill-building. As participants engage in structured
learning experiences aimed at enhancing their understanding and competencies,
ethical principles such as beneficence and nonmaleficence guide the facilitation
process. Practitioners must navigate the ethical dimensions of competence and
professionalism, ensuring that interventions are grounded in evidence-based practices
and delivered with cultural humility and sensitivity.
In synthesizing these diverse perspectives, we aim to provide a comprehensive
framework for understanding and navigating the ethical complexities inherent in
group work across various domains. By drawing upon a rich tapestry of experiences
and insights, we aspire to foster ethical awareness and reflexivity among practitioners,
empowering them to navigate the nuances of ethical decision-making with integrity
and compassion.
Obviously, these groups differ with respect to their member population,
purpose, focus, and procedures, as well as in the level of training required for the
facilitators of these groups. Although these distinctions are important, all groups face
some common ethical concerns: leader values, screening and orientation of group
members, informed consent, voluntary and involuntary group membership, training
group leaders, confidentiality, multiple relationships in group work, diversity and
multiculturalism, and procedures concerning termination and follow-up.
b. Ethical Issues in Training and Supervision of Group Leader
For competent group leaders to emerge, training programs must make group
work a priority. With adequate training and through participating in a group as a
member, you will have opportunities to acquire competence in facilitating a range of
groups. Group workers must remain current and increase their knowledge and skills
through activities such as continuing education, supervision, and participation in
various personal and professional development activities (ASGW, 2008). Familiarize
yourself with referral resources and refrain from working with client populations that
need special assistance beyond your level of competence. Barlow (2008) maintains
that groups can be used effectively for both prevention and education. Barlow
emphasizes the importance of adequate training for practitioners who are interested in
conducting groups so that they can effectively and ethically maximize the unique
group properties in their work.
Professional codes, legislative mandates, and institutional policies alone will
not assure competent group leadership. Group counselor trainees need to understand
and reflect on some of the typical ethical dilemmas they will face in practice. This can
best be done by including ethics in the trainees’ academic program as well as
discussing ethical issues that grow out of the students’ experiences in practicum,
internship, and fieldwork. One effective way to teach ethical decision making is by
presenting trainees with case vignettes of typical problems that occur in group
situations and encouraging discussion of the ethical issues and pertinent guidelines.
We tell both students and professionals who attend our workshops that they will not
always have the answers to dilemmas they encounter in their groups. Ethical decision
making is an ongoing process that takes on new forms and increased meaning as
practitioners gain experience. Group leaders need to be receptive to self-examination
and to questioning the professionalism of their group practice if they hope to become
competent, ethical group practitioners.
In addition to learning about ethical decision making regarding dilemmas
encountered in group work, we highly recommend four other experiences as adjuncts
to a training program for group workers: (1) personal experience in an experiential
group, (2) personal (individual) psychotherapy, (3) group supervision, and (4)
observing group therapy sessions.
s The CACREP (2016) standards require students to gain at least 10 hours of
experience in a small group as a group member. This requirement is typically met by
including an experiential group as part of a group counseling course; however, to
avoid conflicts, some programs ask students to participate in a group outside of the
program and document their hours. In an experiential group, students often have an
opportunity to be part of a group experience and at times to facilitate the process of
this group. In an experiential learning environment that involves extensive self-
disclosure and dual relationships between instructors and students, students need to
know they can trust their instructor’s skill, ethics, and professionalism.
Students engaged in experiential training must be willing to engage in self-
disclosure, to become active participants in an interpersonal group, and to engage
themselves on an emotional as well as a cognitive level. Instructors can do a great
deal to create a sense of safety and trust among the group members by explaining to
them ways to avoid breaching confidentiality. It is important to clarify with students
throughout the course how to talk about their own work with people outside of the
group without revealing the identity or self-disclosures of other members (Corey,
Corey, Muratori, Austin, & Austin, 2017). McCarthy, Falco, and Villalba (2014) stress
the importance of structuring experiential growth groups in a manner that “supports
growth and minimizes potential ethical risks” (p. 188). Among the measures
instructors may take to minimize risk to student participants are discussions about the
depth of self-disclosure appropriate to the context, explaining students’ rights to
decline answering questions that make them particularly uncomfortable, and
providing options for continued emotional support outside of the experiential group.
Group leaders need to demonstrate the willingness to do for themselves what
they expect members in their groups to do: expand their awareness of self and the
effect that self has on others. As an adjunct to formal coursework and internship
training, participation in a therapeutic group is extremely valuable. One of the best
ways to learn how to assist group members in their struggles is to be a member of a
group yourself. Learning about group counseling through coursework and didactic
instruction alone is not considered sufficient. A survey of 82 master’s-level counseling
programs suggests that experiential group training is alive, evolving, and an accepted
form for training group leaders. Supporting this view, McCarthy and colleagues
(2014) point out that the use of experiential groups for counselor trainees is found in
the Ethics Code of the American Counseling Association (2014) and the “Best
Practice Guidelines” of the Association for Specialists in Group Work (2008). In
addition to enhancing personal growth, they note that such training provides
participants with a solid understanding of the stages of group work, group dynamics,
and group techniques that facilitate meaningful interactions.
If a self-exploration group or an experiential group is a program requirement,
it is ethically imperative that students are made aware of this requirement at an
orientation meeting during the admission process or prior to the time they enroll in a
program. When participation in an experiential group is part of a program, it is
important that safeguards are in place to manage boundaries and to reduce the risk of
harm to students. Shumaker and colleagues’ (2011) survey of experiential group
training in counseling master’s programs resulted in them recommending systematic
instructor self-reflection, informed consent of students, and selfdisclosure training as
“the most promising and critical safeguard elements dedicated to promoting a positive
experiential group experience” (p. 127).
Goodrich and Luke (2012) have written about the ethical issues in dealing
with students who exhibit problematic behavior in an experiential group. When this
situation arises, the group counselor-educator has multiple responsibilities: to@the
individual student who displays problematic behavior, to the other students in the
experiential group, and to the training program. It is important for the group member
to understand the impact his or her behavior has on others, and the group format
provides many opportunities for learning to deal with problematic behaviors. One
effective intervention is to invite other members to provide here-andnow feedback to
the member exhibiting the problematic behavior. The instructor or group facilitator is
responsible for blocking unproductive interactions while this feedback is being
delivered to prevent the group member from being scapegoated or overwhelmed with
negative feedback. As challenging as it might be in the moment, everyone in the
group can benefit from the experience of successfully working through difficult
situations. What students learn in an experiential group can be invaluable when they
lead groups in school or community settings.
Sometimes issues that surface in a group are more appropriately explored in
personal (individual) therapy. We also encourage individual therapy as a way of
enhancing trainees’ abilities to understand both themselves and others, which is
essential for ethical practice. Personal therapy enables us to identify and explore
countertransference reactions we may have toward certain group members, recognize
our blind spots and biases, and use our personal attributes effectively in our work as a
group facilitator. Psychotherapy can be a vital part of our self-care program by
helping us maintain a sense of balance in our life.
Supervision is a key component in training group leaders. Group supervision
offers unique advantages for observing group process in action; it is also an efficient
supervision model given that several group leaders can be supervised at the same
time. Some research confirms that group supervision has value with respect to
increasing the skill development of trainees (Riva, 2010, 2014). Group supervision is
of paramount importance in training group leaders as well as in monitoring the quality
of care of those who participate (Riva, 2014). Group supervision provides trainees
with many experiential opportunities to learn about the process and development of a
group and creates the foundation for future ethical practice. Workshops that provide
supervision for group trainees help them to develop the necessary skills for effective
and ethical intervention. Also, this format helps interns learn a great deal about their
response to criticism, competitiveness, need for approval, concerns over being
competent, and power struggles. Participation in a supervision group enables trainees
to learn not only from the supervisor who conducts the group but from others in the
group as questions are raised and answered.
Although reading about group counseling is useful, watching videos of group
sessions and observing groups in vivo make academic learning more meaningful.
Weiss and Rutan (2016) surveyed trainees who sat off to one side in the group room
and observed group therapy participants. The trainees consistently stated that
observing a live group and having an opportunity to process the session with the
leaders was one of their best training experiences. There are many benefits from
observing group therapy as a teaching method.
Weiss and Rutan's seminal work, which involved conducting an observed
psychodynamic therapy group over a remarkable span of five years, stands as a
testament to the profound impact of experiential learning in the realm of group
therapy. Their pioneering endeavor not only illuminated the intricate dynamics of
therapeutic interaction but also served as a catalyst for transformative learning
experiences among both trainees and seasoned practitioners alike.
Through the lens of observation, trainees were afforded a unique vantage point
from which to glean invaluable insights into the art and science of group facilitation.
Witnessing the unfolding dynamics of therapy in real-time provided trainees with a
nuanced understanding of the complexities inherent in group processes, ranging from
the subtle interplay of transference and countertransference to the delicate navigation
of therapeutic alliances and ruptures. This immersive mode of learning not only
deepened trainees' theoretical knowledge but also honed their practical skills,
equipping them with the confidence and competence to embark on their own journey
as group facilitators.
Moreover, Weiss and Rutan's findings underscore the enduring value of
ongoing learning and stimulation for senior leaders within the field of group therapy.
Far from being static repositories of knowledge, seasoned practitioners found
themselves enriched and invigorated by the dynamic exchange of ideas and
experiences that characterized their engagement with the observed therapy group. In
serving as mentors and guides to the next generation of group therapists, senior
leaders found renewed purpose and vitality in their role, drawing inspiration from the
fresh perspectives and insights offered by their trainees.
Indeed, the symbiotic relationship between observation and learning serves as
a cornerstone of professional development in the field of group therapy. By fostering a
culture of continuous learning and collaboration, Weiss and Rutan's work exemplifies
the transformative potential inherent in the experiential approach to education.
Through the shared exploration of therapeutic processes and principles, trainees and
senior leaders alike are afforded the opportunity to cultivate empathy, wisdom, and
resilience in their practice, thereby enriching not only their own professional journeys
but also the lives of those they serve.
In reflecting upon the enduring legacy of Weiss and Rutan's observed therapy
group, we are reminded of the profound impact that experiential learning can have in
shaping the future of group therapy practice. As we continue to navigate the
complexities of human experience and interpersonal dynamics, may we remain
steadfast in our commitment to fostering a culture of curiosity, growth, and
collaboration, wherein the seeds of insight and innovation may flourish and thrive.
c. Ethical Issues in the Diversity Training of Group Workers
“Three-quarters of the world come from collectivistic group-oriented
cultures,” and Bemak and Chung (2015) assert that “as the world becomes more
globalized it is inevitable that group counseling will be a major choice of healing and
psychological intervention internationally” (p. 6). Group counseling and other kinds
of group work are alive and well in the United States, but group work is also finding a
home internationally (Hohenshil, Amundson, & Niles, 2013). An integral part of the
training of group leaders is promoting sensitivity and competence in addressing
diversity in all forms of group work. Not surprisingly, the development of
multicultural and cross-cultural competence for group psychotherapists has emerged
as an ethical imperative.
Cultural competence refers to the knowledge and skills required to work
effectively in any cross-cultural encounter (Comas-Diaz, 2014). Merely possessing
knowledge and skills, though necessary, is not sufficient for effective group work.
Becoming a diversity-competent group worker involves self-awareness and an open
stance on the leader’s part to the diversity issues that emerge in a group. To fail to
address these diversity issues is to fail the group members (Debiak, 2007). Attending
to and addressing diversity is not only an ethical mandate, but this practice is also a
route to more effective group work. It is the responsibility of training programs to
create safe opportunities for a trainee’s cultural self-explorations.
If you possess cultural tunnel vision, you are likely to misinterpret patterns of
behavior displayed by group members who are culturally different from you. Unless
you are clearly aware of your own cultural values and understand the values of other
cultures, you may misunderstand clients from diverse backgrounds. If you are in
doubt about what a group member is saying or doing, ask this person for an
explanation. One technique endorsed by leading multicultural scholars is broaching
the subjects of race, ethnicity, and culture with clients.
Day-Vines and colleagues (2007) state: “Counselors who display advanced
levels of broaching and possess heightened levels of racial identity functioning are
likely to promote trusting and open relationships with their clients that accommodate
a range of social and cultural experiences” (p. 408). If you are able to appreciate
cultural differences, you have opportunities to use this knowledge in effectively
working with the various forms of diversity in your group. Effective group
interventions are adapted to the needs of the individual member rather than attempting
to fit the member to the leader’s usual interventions. In working with culturally
diverse client populations, leaders may need to modify interventions to suit the
client’s cultural and ethnic background. Leaders can respect the cultural values of
members and at the same time encourage them to think about how these values and
their upbringing have a continuing effect on their behavior.
Social justice refers to “the fair and equitable distribution of power, resources,
and obligations in society to all people, regardless of race, gender, ability, status,
sexual orientation, and religious or spiritual background”. Multiculturalism and social
justice concepts are often intricately linked. The ASGW (2012) addresses both
concepts in their guidelines for training group workers, conducting research,
understanding how multiculturalism and social justice affect group process, and
assisting group workers in various settings to increase their knowledge and skills in
developing competence in addressing multicultural and social justice themes in group
work. The guidelines emphasize the acquisition of awareness, knowledge, and skills
that will equip group leaders to work ethically and effectively with the diversity
within their groups. Trainees and counselors need to be mindful of multicultural and
social justice themes at all times when interacting with individuals in groups.
Moreover, Bemak and Chung (2015) stress the need for counselors to redefine ethics
and boundaries when working in an international context. Adaptation, modification,
and changes to Western traditional group counseling practices may need to be
considered. For instance, it is regarded as good manners “to give and receive gifts on
auspicious holidays or at special celebrations in many societies. For a group counselor
to reject thoughtful personal gifts for a New Year’s celebration would be considered
rude and disrespectful”
Social justice practice, training, and research are interdependent. Effective
training is necessary if group workers hope to understand and address the multiple
layers of complexity involved in social justice group work. Trainees require more than
a conceptual understanding of social justice principles to develop competence; group
leaders need “concrete strategies for infusing social justice in their work” (p. 181).
Some strategies Hayes and colleagues recommend include values clarification,
empowerment of gender and ethnicity statuses, consciousness raising, self-disclosure,
social and gender-role analyses, structure to maximize group cohesion, and
bibliotherapy. Additional training in international group counseling strategies may be
needed for those interested in facilitating group work abroad. Group work, perhaps
more than any other counseling intervention, has the potential to further a social
justice agenda (Hage et al., 2010). According to Hayes and her colleagues (2010),
“the social justice movement and group work have been, and still are, a natural
marriage . . . it is difficult to see social justice becoming pervasive in society without
the sophisticated use of groups”. Experiences members have had with social injustices
will inevitably surface when people from diverse backgrounds participate in a group.
MacNair-Semands (2007) claims that group workers need to search for ways
to expand their competence in addressing social justice issues that emerge regularly in
groups, such as unfair treatment or inequities that result from racism, sexism,
socioeconomics, sexual orientation, ableism, and other forms of “isms” that affect the
quality of life. Group members can be invited to talk about their pain from the social
injustices they have encountered. Group practitioners must work toward healing
experiences within the group rather than allowing potentially harmful interactions to
occur.
Power and privilege dynamics operate in a group just as in the wider world,
and the imbalance of power can be addressed and explored in group work. In any
group, some members may come from power and others may have been denied
power; these power dynamics should be discussed as they emerge in a group. Social
inequalities often arise from an intolerance for differences that result in
discrimination, oppression, prejudice, and, at times, interpersonal violence. If these
issues are not addressed, members are deprived of an opportunity to explore cultural
values and biases, to raise their awareness of these injustices, and to learn to confront
them.
Most of the ethics codes of the various professional organizations now give
increasing attention to applying cultural perspectives when working with diverse
client populations. The ACA (2014) Code of Ethics addresses multicultural
perspectives in every section, and the ASGW (2012) competency principles address
broad areas of race, ethnicity, socioeconomic class, age, gender, sexual orientation,
religion, and spirituality. The Association for Multicultural Counseling and
Development (2015) highlights taking action to promote social justice and emphasizes
teaching clients how to advocate for themselves. The following ethical guidelines for
acquiring diversity and multicultural competence in group practice can be found in
these codes.
If group counselors do not understand how their own cultural background
influences their thinking and behavior, there is little chance they can teach group
members much about their cultural thinking and behavior. The characteristics of the
culturally competent counselor equally relevant for practitioners who work with
groups. Although it is not realistic to assume that leaders will have knowledge about
every culture, it is important that counselors understand that each person participates
in a group from his or her own unique perspective.
Exploring the depths of social justice and advocacy competencies within the
realm of group work offers a profound opportunity for personal and professional
growth, particularly in the context of increasing sensitivity to individuals from diverse
cultural backgrounds. As we delve into the rich framework outlined in the ACA
Advocacy Competencies: A Social Justice Framework for Counselors, we are invited
to embark on a journey of self-reflection and cultural humility, wherein the seeds of
empathy and understanding may take root and flourish.
In contemplating the following case study, we are presented with a compelling
narrative that beckons us to expand our awareness and deepen our appreciation for the
nuances of cultural diversity. Through the lens of this case, we are challenged to
confront our own biases and assumptions, while also cultivating a spirit of curiosity
and openness to the lived experiences of others.
To enhance our sensitivity to individuals from cultural groups different from
our own, we may embark on a multifaceted approach that encompasses both self-
exploration and experiential learning. This journey begins with a willingness to
engage in introspection, examining our own cultural identities, values, and beliefs,
and how they may shape our perceptions of others. By embracing a stance of cultural
humility, we can foster an attitude of openness and receptivity to learning from
individuals whose experiences may differ from our own.
Additionally, we can actively seek out opportunities for cultural immersion
and cross-cultural dialogue, whether through participation in diversity training
programs, engaging with community-based organizations, or forming multicultural
study groups. By stepping outside of our comfort zones and immersing ourselves in
diverse cultural contexts, we can expand our understanding of the myriad ways in
which culture influences human behavior, communication, and worldview.
Furthermore, we can deepen our understanding of social justice and advocacy
competencies by familiarizing ourselves with relevant literature and theoretical
frameworks, such as critical race theory, intersectionality, and cultural humility. By
grounding our practice in a robust theoretical foundation, we can cultivate a nuanced
understanding of the systemic barriers and injustices that impact individuals from
marginalized cultural groups, while also developing the skills and strategies necessary
to advocate for positive change within our communities.
In essence, increasing our sensitivity to individuals from diverse cultural
backgrounds is a lifelong journey that requires a commitment to self-reflection,
cultural humility, and ongoing learning. By embracing the principles of social justice
and advocacy within the context of group work, we can create inclusive and
empowering spaces where individuals from all walks of life feel seen, heard, and
valued. Through our collective efforts, we can strive towards a more equitable and
compassionate world, where diversity is celebrated as a source of strength and
resilience.
d. Ethical Considerations in Coleadership
If you lead groups, you will probably work with a coleader at some time.
Coleader relationships can either enhance or complicate the group process and raise a
multitude of potential ethical issues. The group can benefit from the insights and
feedback of two leaders. Coleaders who complement and balance each other can
provide useful modeling for members. Furthermore, coleaders can share the
responsibilities and provide mutual support. Along with the advantages of
coleadership, there are some disadvantages that can raise ethical concerns.
Luke and Hackney's (2007) exploration into the dynamics of group leadership
sheds light on a multifaceted landscape where both advantages and disadvantages
intertwine. While the benefits of shared leadership in group settings are manifold, it is
crucial to acknowledge and navigate the potential pitfalls that may arise, particularly
in the realm of interpersonal relationships among leaders.
Central to their findings is the identification of relationship difficulties
between leaders as a primary disadvantage of shared leadership models. Within this
context, Luke and Hackney highlight the nuanced dynamics that can emerge when
leaders possess differing personality traits, communication styles, or leadership
philosophies. One notable example they underscore is the scenario wherein one leader
exhibits an exaggerated need for approval, potentially disrupting the equilibrium of
the leadership dynamic and impeding effective decision-making processes within the
group.
Expanding upon this observation, it becomes evident that relationship
difficulties among leaders can stem from a myriad of sources, ranging from
conflicting agendas and power struggles to divergent values and communication
breakdowns. Such challenges, if left unaddressed, have the potential to undermine the
cohesiveness and efficacy of the leadership team, ultimately compromising the
group's ability to achieve its objectives.
To mitigate the impact of relationship difficulties in shared leadership
contexts, practitioners and organizational leaders can employ a variety of strategies
aimed at fostering collaboration, trust, and open communication among leaders. This
may involve implementing regular team-building exercises, facilitating candid
discussions around roles and responsibilities, and cultivating a culture of transparency
and accountability within the leadership team.
Furthermore, Luke and Hackney's findings underscore the importance of self-
awareness and introspection among leaders, particularly in relation to their own
needs, biases, and interpersonal dynamics. By cultivating a deeper understanding of
their own strengths and limitations, leaders can navigate relationship challenges with
humility and empathy, while also seeking out opportunities for professional
development and mentorship to enhance their leadership competencies.
In essence, while relationship difficulties among leaders represent a notable
disadvantage of shared leadership models, they also serve as a catalyst for growth and
learning within the group context. By embracing the complexities inherent in
interpersonal relationships and adopting a proactive approach to addressing conflict
and discord, leaders can harness the transformative potential of shared leadership to
cultivate environments of collaboration, innovation, and collective success.
Other potential drawbacks to the coleadership model include ineffective
communication, competition between leaders, and overdependence on the coleader.
Group members may attempt to triangulate the coleaders by pitting one against the
other. Conflicts between the leaders can result in splitting within the group. Luke and
Hackney emphasize the necessity for group leaders to attend to their own individual
development, their development as a coleading team, and the development of the
group they are facilitating. It is challenging for group leaders to divide their time
between these multiple areas of development, yet doing so is essential for a successful
group.
When differences between leaders result in conflict between them, it can be a
source of anxiety for both members and leaders. Conflicts that are ineffectively
managed place an unfair burden on the members and can be harmful to the group
process and outcome. If the leaders model healthy conflict resolution for group
members, showing nondefensiveness and a willingness to challenge and be
challenged, this conflict can prove to be a valuable learning opportunity.
Navigating conflict resolution within the context of group leadership requires
a nuanced approach that balances the needs of the group with the dynamics of
interpersonal relationships among leaders. As leaders grapple with the decision of
whether to address issues in the moment with group members or in private among
themselves, it is essential to consider the potential benefits and drawbacks of each
approach, while also remaining attuned to the unique dynamics of the situation at
hand.
When conflict arises and members of the group witness the discord, there is a
compelling argument for addressing the issue directly within the group setting. Doing
so not only promotes transparency and accountability but also provides an opportunity
for collective learning and growth. By openly acknowledging and addressing conflict
in the presence of group members, leaders demonstrate a commitment to authenticity
and vulnerability, thereby fostering an environment of trust and openness within the
group.
Moreover, dealing with conflict in the moment with group members allows for
immediate resolution and clarification, minimizing the risk of misunderstandings or
lingering tensions festering beneath the surface. By engaging in constructive dialogue
and problem-solving as a collective, leaders and group members alike can
collaboratively explore potential solutions and strategies for moving forward, thereby
strengthening the cohesiveness and resilience of the group as a whole.
However, it is important to recognize that addressing conflict in the group
setting may also present challenges and limitations. In some cases, the presence of
group members during conflict resolution discussions may exacerbate feelings of
discomfort or vulnerability among leaders, potentially inhibiting their ability to
engage in open and honest dialogue. Furthermore, there is a risk that addressing
conflict publicly may inadvertently escalate tensions or trigger defensive responses,
particularly if individuals feel personally attacked or criticized in front of their peers.
Alternatively, leaders may opt to address conflict in private between
themselves, away from the scrutiny of group members. This approach affords leaders
the opportunity to engage in candid and frank discussions without the pressure of
performing for an audience, allowing for a more nuanced exploration of underlying
issues and emotions. Additionally, resolving conflict in private enables leaders to
preserve individual dignity and confidentiality, mitigating the risk of further
exacerbating tensions or causing embarrassment.
However, addressing conflict in private may also perpetuate a sense of secrecy
or lack of transparency within the group, potentially eroding trust and undermining
the integrity of the leadership team. Furthermore, the absence of group members
during conflict resolution discussions may limit opportunities for collective learning
and growth, depriving individuals of valuable insights and perspectives that could
inform their own personal and professional development.
In navigating the decision of whether to address conflict in the moment with
group members or in private among themselves, leaders must weigh the potential
benefits and drawbacks of each approach, while also remaining attuned to the unique
dynamics of the situation at hand. Ultimately, the goal of conflict resolution should be
to foster a culture of respect, communication, and collaboration within the group,
regardless of the specific approach chosen. By embracing conflict as an opportunity
for growth and learning, leaders can cultivate environments where individuals feel
empowered to navigate challenges with resilience and grace.
e. Ethical Issues in Forming and Managing Groups
How can group leaders make potential members aware of the services they are
providing? What information do clients have a right to expect before they decide to
attend a group? Informed consent is a process of presenting basic information about
group treatment to potential group members to enable them to decide whether or not
to join a group. Leaders have the responsibility of ensuring that members become
aware of their rights (as well as their responsibilities) as group participants. It is a
good policy to provide a professional disclosure statement to group members that
includes written information on a variety of topics pertaining to the nature of the
group, including the therapists’ qualifications, techniques often used in the group, the
rights and obligations of group members, and the risks and benefits of participating in
the group.
Special attention needs to be given to the nature and limitations of
confidentiality and the specific situations that would require breaching confidences.
Although informed consent is an ethical and legal mandate, group members should
not be overwhelmed with too much information at one time. It is a good practice to
tell members at the outset that informed consent is an ongoing process and that
various aspects of the consent process will likely be@revisited at different stages of a
group. When informed consent is handled effectively, it helps promote individual
autonomy, engages members in a collaborative process, and reduces the likelihood of
exploitation or harm.
Not everyone will benefit from a therapeutic group experience, and some
people may be psychologically harmed by certain group experiences. Therefore,
group leaders are faced with the difficult task of determining who should be included
in a group and who should not. Unless careful selection criteria are employed, Yalom
(2005) argues that group therapy clients may end up discouraged and may not be
helped. He maintains that it is easier to identify the people who should be excluded
from group therapy than those who should be included. Citing clinical studies, he lists
the following as poor candidates for a heterogeneous outpatient intensive therapy
group: people with traumatic brain injuries, paranoid individuals, hypochondriacs,
acutely psychotic individuals, and antisocial personalities. In terms of criteria for
inclusion, he contends that the client’s level of motivation to work is the most
important variable. From his perspective, groups are useful for people who have
problems in the interpersonal domain, such as loneliness, inability to make or
maintain intimate contacts, feelings of unlovability, fears of being assertive, and
dependency issues. Clients who lack meaning in life, who suffer from generalized
anxiety, who are searching for an identity, who fear success, and who are compulsive
workers could also profit from a group experience.
As a general ethical guideline, we think that some type of screening, involving
interviewing and evaluating potential members, should be employed to select group
members. The type of group should determine the kind of members accepted. In
addition, what is best for the group as a whole needs to be considered in selecting
members for that group. More specifically, the question can be framed thusly: Is it
appropriate for this person to become a participant in this type of group, with this
leader, at this time? Screening should not be done for the comfort of the group leader,
nor should it be done arbitrarily to unfairly discriminate against certain members (M.
Corey et al., 2018). Many group leaders do not screen participants, for various
reasons. Some practitioners are theoretically opposed to the notion of using screening
as a way of determining who is suitable for a group, and some maintain that they
simply do not have the time to carry out effective screening, or doing so is not
realistic in their work setting. Not all theoretical orientations favor or agree with the
notion of screening, nor would they view screening as an ethical mandate. For
example, some Adlerians believe screening does not fit with the democratic spirit of
their theory. Some maintain that screening is done more for the comfort of the group
leader than for the good of the client.
Others believe that ethical practice demands careful screening and preparation
of all candidates. We are concerned that failing to evaluate the suitability of a group
member could lead to harm for other group members. Even minimal screening can
lessen the potential harm to group members. The need for screening members depends
in part on the type of group you are forming. A person who can work well in a
psychoeducational group designed to teach social skills might not be ready for an
intensive therapy group. Individuals with severe emotional trauma would probably be
excluded from an interpersonal process group, but they might benefit from a weekly
group for outpatients at a mental health center. Screening is less important for a
psychoeducational group, but potential members should be clearly informed of the
purposes of this kind of group and what will be expected of them.
To what extent are group counselors ethically responsible for helping
participants to benefit from their group experience? Many practitioners do very little
to prepare members for a group and are opposed to preparation on the grounds that it
could inhibit a group’s spontaneity and autonomy. Others take the position that
members need to be provided with some structure to derive maximum gains (M.
Corey et al., 2018). Yalom (2005) advocates exploring group members’
misconceptions and expectations, predicting early problems, and providing a
conceptual framework that includes guidelines for effective group behavior. He views
this preparatory process as more than the dissemination of information. He contends
that it reinforces the therapist’s respect for the client, demonstrates that therapy is a
collaborative venture, and shows that the therapist is willing to share his or her
knowledge with the client. This cognitive approach to preparation has the goals of
providing a rational explanation of the group process, clarifying how members can
best participate, and raising expectations about what the group can accomplish.
In our experience in working with groups, we have found that providing
members with basic information about group process tends to eliminate some of the
difficulties typically encountered in the early stages of a group. Our preparation
procedures apply to most types of groups, with some modifications. At both the
screening session and the initial group meeting, we explore the members’
expectations, clarify goals and objectives, discuss procedural details, explore the
possible risks and values of group participation, and discuss guidelines for getting the
most from a group experience. As part of member preparation, we include a
discussion of the values and limitations of groups, the psychological risks involved in
group participation, and ways of minimizing these risks. We also allow time for
dealing with misconceptions that people have about groups and for exploring the fears
or reservations the members may have. In most of our groups, members do have
certain fears about what they will experience. Acknowledging these fears and talking
about them provides a foundation for productive group work. We also ask members to
spend time before they come to the group defining what they most want to achieve
and formulating personal goals that will guide their participation.
Voluntary participation is an important beginning point for a successful group
experience. Members will make significant changes only to the extent that they
actively seek something for themselves. Unfortunately, not all groups are composed
of clients who have chosen to be there. Are there situations in which it is ethical to
require or mandate people to participate in a group? How is informed consent
especially critical in groups where attendance is mandatory? Can involuntary groups
be successful? Mandatory participation in a group raises a different set of ethical
issues. The negative attitudes of some members can contaminate the entire group
experience. Skilled leaders often are able to change negative attitudes of some
involuntary members by showing them how they might benefit from a group
experience (M.@ Corey et al., 2018). With involuntary members, greater effort needs to
be directed toward fully informing members of the nature and goals of the group,
procedures to be used, the rights of members to decline certain activities, the limits of
confidentiality, and what effect their level of participation in the group will have on
critical decisions about them outside of the group. Group leaders should strive to help
involuntary members understand their choices and the consequences of lack of
compliance with the treatment program (Rapin, 2014). When attendance at group
sessions is required, group leaders need to be certain that group members understand
their rights and their responsibilities, and counselors must at all times show their
respect for these mandated members.
Once members make a commitment to be a part of a group, do they have the
right to leave at any time they choose? Procedures for leaving a group should be
explained to all members during the initial session. We tell our members that they
have an obligation to attend all sessions and to inform us if they decide to withdraw.
Ideally, the leader and the member cooperate to determine whether a group experience
is proving to be productive or counterproductive. We take the position that clients
have a responsibility to the leader and to other members to explain why they want to
leave. There are several reasons for this policy. It can be psychologically damaging to
members to leave without having been able to discuss what they considered
threatening or negative in the experience. Further, it is unfortunate if members leave a
group because of a misunderstanding about some feedback they have received. Such a
termination can be harmful to group cohesion, for the members who remain may think
that they caused a particular member’s departure. Although members have a right to
withdraw from a group, we ask them to talk about it out of respect for the needs of the
remaining members as well as for their own safety and well-being. However, we do
not think it is ethical to use undue pressure to keep these members, and we are alert to
other members’ pressuring a person to stay.
The fact that groups can be powerful catalysts for personal change means that
they can also be risky. Ethical practice demands that group practitioners inform
prospective participants of the potential risks involved in the group experience. Our
goal is to create a safe environment where members can take risks and explore their
discomfort. Group leaders have an ethical responsibility to take precautionary
measures to reduce unnecessary psychological risks. AMHCA’s (2015) guideline
reinforces this responsibility: “In a group setting, mental health counselors take
reasonable precautions to protect clients from physical, emotional, and psychological
harm or trauma”
Group leaders have a significant role in preventing damaging group
experiences. Smokowski, Rose, and Bacallao (2001) remind us that group leaders
have a great deal of power, prestige, and status within their groups and caution that
“many leaders are not able to responsibly manage, or even recognize, their power and
influence” (p. 228). The outcomes of a group are very much related to what leaders
bring to a group and to their actions. Smokowski and colleagues studied damaging
experiences in therapeutic groups and identified a variety of factors or events that
result in members having a negative group experience, some of which include lack of
leader support; an aggressive and harshly confrontational leadership style; premature
pressure to disclose; passive leadership style; misuse of a leader’s power and
influence; lack of acceptance for diverse points of view; lack of clarity about group
norms; and negative norms that coerce participation or encourage excessive
confrontation. Group members are often more willing to be challenged when they
know they will be supported in the group.
f. Confidentiality in Groups
The ethical, legal, and professional aspects of confidentiality have a different
application in group situations. Are members of a group under the same ethical and
legal obligations as the group leader not to disclose the identities of other members or
the content of what was shared in the group? The legal concept of privileged
communication is generally not recognized in a group setting, unless there is a
statutory exception. However, protecting the confidentiality of group members is an
ethical mandate, and it is the responsibility of the counselor to address this at the
outset of a group. The group therapist is expected to safeguard the members’ right to
privacy by judiciously protecting the identity of the members and protecting
information of a confidential nature. Group leaders also have the ethical responsibility
of informing members of the limits of confidentiality within the group setting, their
responsibilities to other group members, and the absence of legal privilege concerning
what is shared in a group.
In individual psychotherapy, the therapist can ensure the client’s
confidentiality, yet in group therapy leaders cannot prevent other members from
disclosing personal information about members in the group. Group leaders are
themselves ethically and legally bound to maintain confidentiality, yet a group
member who violates another member’s confidences faces no legal consequences
(Lasky & Riva, 2006). Although confidentiality in a group cannot be guaranteed,
group leaders are responsible for educating members regarding how easy it is to
unintentionally breach confidentiality, as well as the importance and advantages of
keeping information private that pertains to the group.
Although group leaders are expected to stress the importance of confidentiality
and set a norm, they also are expected to inform members about its limits. For
example, if members pose a danger to themselves or to others, the group therapist has
an ethical and legal obligation to take appropriate steps to protect the group member
and society in general (AGPA, 2006). Therapists who lead groups must become
familiar with the state laws that have an impact on their practice. For instance, all
states have had mandatory child abuse reporting laws since 1967. Most states also
have mandatory elder abuse and dependent adult abuse reporting laws. The great
majority of states currently have laws requiring counselors to report clients’ threats to
harm themselves or others. If you lead a group at a correctional institution or an
inpatient facility, you may have to record in a member’s chart certain behaviors or
verbalizations that he or she exhibits in the group. At the same time, your
responsibility to your clients requires you to inform them that you are documenting
their verbalizations and behaviors and that this information is accessible to other staff.
Do parents or legal guardians have a right to information that is disclosed by
their children in a group? The answer to that question depends on whether we are
looking at it from a legal, ethical, or professional viewpoint. State laws differ
regarding counseling minors. It is important for group leaders to be aware of the laws
related to working with minors in the state in which they are practicing.
Circumstances in which a minor may seek professional help without parental consent,
defining an emancipated minor, or the rights of parents (or legal guardians) to have
access to the records regarding the professional help received by their minor child
vary according to state statutes. Before any minor enters a group, it is a good practice
to obtain written permission from the parents. Such a statement should include a brief
description of the purpose of the group, the importance of confidentiality as a
prerequisite to accomplishing these purposes, and your intention not to violate any
confidences. Although it may be useful to give parents information about their child,
this can be done without violating confidences.
Beginning a counseling relationship with minors involves a delicate balance of
establishing trust and ensuring confidentiality while also addressing any concerns or
questions they may have. Indeed, one of the fundamental pillars of effective
counseling with minors is the establishment of a safe and confidential space where
they feel comfortable expressing themselves and exploring their thoughts and
feelings.
At the outset of the first session, it is not only helpful but essential to inform
minors about the importance of confidentiality and how it will be maintained
throughout the counseling process. By proactively addressing this topic, counselors
can help alleviate any anxieties or uncertainties that minors may have about sharing
personal information. Moreover, discussing confidentiality from the outset can
empower minors by providing them with a clear understanding of their rights and the
boundaries of confidentiality within the counseling relationship.
In discussing confidentiality with minors, counselors may choose to explain
the limitations and exceptions to confidentiality in a developmentally appropriate
manner. For example, counselors can clarify that while most information shared in
counseling will remain confidential, there are certain circumstances where
confidentiality may need to be breached in order to ensure the minor's safety or the
safety of others. By providing concrete examples and scenarios, counselors can help
minors grasp the nuances of confidentiality and understand the importance of
prioritizing their well-being.
Furthermore, counselors can use the discussion of confidentiality as an
opportunity to establish clear guidelines and expectations for the counseling process.
This may include outlining the roles and responsibilities of both the counselor and the
minor, as well as discussing the parameters of informed consent and the minor's right
to participate actively in their own counseling journey. By fostering a sense of
partnership and collaboration from the outset, counselors can lay the foundation for a
strong and trusting therapeutic relationship.
Moreover, counselors can explore with minors their concerns and preferences
regarding confidentiality, inviting them to share any hesitations or reservations they
may have about disclosing sensitive information. By validating minors' concerns and
actively listening to their perspectives, counselors can demonstrate empathy and
respect for their autonomy, thereby strengthening the therapeutic alliance.
In sum, discussing confidentiality at the first session with minors serves as a
vital step in building trust and rapport within the counseling relationship. By
addressing this topic openly and transparently, counselors can empower minors to
engage more fully in the counseling process, while also laying the groundwork for a
collaborative and effective therapeutic journey.
g. Social Media in Group Work: Confidentiality and Privacy Considerations
Confidentiality and issues of privacy take on added dimensions when group
members and their therapists interact with each other in online group counseling and
when group members communicate via social media. Online platforms such as
Facebook, Twitter, and Instagram have become widely used and are increasing in
popularity. Kozlowski and Holmes (2014) state that “the vast majority of what the
field understands about group counseling has been learned from groups that take place
in face-to-face group environments@.@.@. a gap exists in the literature concerning the
experiences of members in online counseling groups” (p. 276). The implications of
using online social networking sites for group counseling and group psychotherapy
warrant greater attention by scholars and researchers.
Wheeler and Bertram (2015) note that there is an increased risk of breach of
confidentiality when members of a counseling group engage in social media. Group
counselors should address the parameters of online behavior through informed
consent and should establish ground rules regarding members’ commitment to avoid
posting pictures, comments, or any type of confidential information about other
members online. Developing these rules needs to be part of the discussion about
norms governing the group. One way for members to share their experience with
others outside the group is for them to talk about their own experience, reactions, and
insights without describing other members or mentioning others in the group by
name. Members can be educated to talk about themselves rather than telling stories
about other group members.
Breaches of confidentiality or privacy may occur when members share their
own information online, especially if they struggle with poor boundaries. Others may
lack the technological skills and knowledge to protect information that is intended to
remain private. Zur and Zur (2011) point out that some therapists who have Facebook
profiles use privacy settings to protect their personal information, but others do not.
They add, “those who do not use the privacy settings do not because they either do
not know about these options, do not know how, or do not understand what other
people can see or not see on their profiles” (p. 12). The same is true for group
members. In a small study, master’s-level counseling students who were part of an
online (videoconferencing) process group reported experiencing a lack of trust in the
other members, which was compounded by a lack of trust in the technology
(Kozlowski & Holmes, 2014). According to the investigators, “members’ sense of
safety in the group appeared to be inversely proportional to their awareness of the
capabilities of technology. The seemingly technology-savvy members were more
mistrusting of how technology could be used to break confidentiality” (Kozlowski &
Holmes, 2014, p. 292). Some members reported being hyperaware of the ability of
other members to take screen shots and videos.
Wilson, Gosling, and Graham (2012) discovered that there is “a disparity
between reported privacy concerns and observed privacy behaviors [on Facebook]”
(p. 212) but that “the sheer online ubiquity of Facebook is astounding. As of February
2012, Facebook had over 845 million users (more than the population of Europe) who
spent more than 9.7 billion minutes per day on the site” (p. 203). By December 2016,
Facebook reported 1.23 billion daily active users and 1.86 billion monthly active users
(Facebook Newsroom, 2017). It seems inevitable that mental health professionals and
clients will be among those users, and they will grapple with the same concerns other
users of social media encounter. Spotts-De Lazzer (2012) comments that practitioners
will have to translate and maintain traditional ethics when it comes to social media.
For example, “in California, there are currently no explicit ethics or regulations
regarding therapists’ use of social networking sites” (p. 19). Spotts-De Lazzer believes
therapists must address ethical issues dealing with boundary concerns, assessing dual
relationships, maintaining impartiality and judgment as a therapist, and using
Facebook to announce or market one’s professional practice.
h. Ethical Issues Concerning Termination
The final phase in the life of a group is critical, for this is when members have
the task of consolidating their learning. At this time members need to be able to
express what the group experience has meant to them and to state where they intend
to go from there. Neglecting the process of termination can easily leave the members
with unfinished work and will limit opportunities for them to conceptualize what they
learned from a group experience. For many group members endings are difficult
because they realize that time is limited in their group. The ending of a group often
triggers other losses that members have experienced. Thus, the termination of a group
may involve a grieving process. It is important for leaders to help members identify
and explore these feelings of loss, even though they may not be completely alleviated.
Preparing group members for the process of termination is a crucial aspect of
group therapy that can greatly impact their overall therapeutic experience and future
growth. As the end of the group journey approaches, members must confront the
reality of termination and navigate the complex emotions that arise, including feelings
of sadness, loss, and apprehension about the future. However, if the group has been
truly therapeutic, the termination process can serve as a powerful opportunity for
reflection, integration, and closure, paving the way for continued growth and learning
outside the group setting.
One of the key tasks in preparing group members for termination is helping
them to understand and normalize the range of emotions they may experience as the
group comes to an end. By acknowledging the natural feelings of sadness and loss
that often accompany termination, counselors can create a safe and supportive space
for members to process their emotions and express their thoughts and concerns
openly. This validation of their experiences can help members feel understood and
validated, reducing feelings of isolation and anxiety about the impending goodbye.
In addition to acknowledging the emotional impact of termination, counselors
can also work with group members to explore the valuable lessons and insights they
have gained throughout their time in the group. By facilitating reflection and
discussion about their growth, progress, and accomplishments, counselors can help
members recognize the positive changes they have made and the skills they have
developed, empowering them to carry these newfound strengths with them as they
transition out of the group.
Furthermore, counselors can support group members in developing coping
strategies and resources to help them navigate the challenges of termination and adjust
to life outside the group. This may include exploring healthy ways to cope with
feelings of sadness and loss, identifying supportive individuals or resources in their
social network, and setting goals for continued personal growth and self-care. By
equipping members with the tools and support they need to navigate the transition
effectively, counselors can help empower them to extend their learning and apply the
insights gained from the group experience to their everyday lives.
Finally, counselors can facilitate a meaningful and intentional goodbye ritual
or ceremony to honor the shared journey of the group and provide closure for
members. This may involve reflecting on meaningful moments and experiences
shared within the group, expressing gratitude and appreciation for fellow members
and the counselor, and setting intentions for the future. By creating a structured and
supportive space for saying goodbye, counselors can help members process their
emotions and experiences in a constructive and meaningful way, fostering a sense of
closure and resolution as the group comes to an end.
In conclusion, the process of termination in group therapy is a complex and
multifaceted journey that requires careful preparation, support, and reflection. By
acknowledging and validating the range of emotions experienced by members,
celebrating their growth and accomplishments, providing practical tools and resources
for coping with the transition, and facilitating a meaningful goodbye ritual, counselors
can help empower members to extend their learning outside the group and continue
their journey of personal growth and self-discovery.
Generally, closed groups have time limitations, with the group meeting for a
predetermined number of sessions. Members are typically expected to remain in the
group until it ends, and new members are not added. In a closed group the task of
leaders is to help members review their individual work and the evolving patterns
from the first to the final session. Informed consent involves talking with group
members from the beginning of a group experience about the ending and how to
terminate productively.
The final phase of group work may be the one that leaders handle most
ineptly, possibly owing to their lack of training or partly because of their own
resistance to termination. Avoiding acknowledgment of a group’s termination may
reflect discomfort on the leader’s part in dealing with endings and separations. A
group facilitator who does not have a clear picture of his or her own vulnerabilities
pertaining to loss or endings will likely find it difficult to facilitate members’
expressions of their feelings about endings. When termination is not dealt with, the
group misses an opportunity to explore concerns that may affect many members, and
the members’ therapy is jeopardized. When learning is not conceptualized, the ability
to bring the meaning of the experience to real life is diminished. Thus, a discussion of
endings is crucial to adequate closure.
This phase of group work can provide you with helpful feedback on the value
of a group experience from the perspective of members and can be done in a variety
of ways. Throughout the life of a group, group leaders assist members in assessing
their progress and monitor their style of modeling. In this sense, evaluation is an
ongoing process whereby members are taught how to determine whether the group is
helping them attain their personal goals. But group counselors also must assess both
the process and the outcomes of their groups. Once a group has ended, follow-up
group sessions provide an opportunity to do this. In our opinion, follow-up activities
are useful for members as well as for the group counselor and can be invaluable
measures of accountability
