Introduction
Counseling can help people resolve issues in their lives in various ways. However, not all therapies or techniques of counseling will work for every individual. Therefore, it is essential for counselors to understand client needs in order to determine what technique will result in the most effective outcomes. Individual counseling and group counseling are the most popular and commonly used counseling techniques (Jacobs, Masson, Harvill & Schimmel, 2012). Individual counseling is a one-on-one therapy session in which a personalized approach is utilized in guiding and treating an individual. On the other hand, group counseling happens when a counselor works with two or more people who share similar problems and issues. There might be no relationship between individuals in counseling groups, except for the problems for which they are seeking treatment. During group therapy, members confront their individual problems as a group (Stalker, Horton & Cait, 2012). This paper seeks to identify ethical issues in group counseling and explain benefits that group counseling offers compared to individual counseling.
Ethical Issues in Group Counseling
There are many ethical considerations for therapists who choose to counsel groups. One of these issues is breach of confidentiality. According to Garzon, Worthington and Tan (2009), confidentiality is a legal right for patients in many countries, and therefore it is the duty of the counselor to uphold high levels of confidentiality regarding private information revealed by clients. In group counseling, ensuring confidentiality can be a great challenge because of the large number of people involved.
Another ethical issue in group counseling is conflict of interest. This issue can arise from too much self-disclosure on the part of the therapist to having relationships with the client outside the counseling forum (Yamuna, 2013). Although such relationships may seemingly appear inconsequential and unavoidable, ethical challenges are bound to occur if the client and the therapist know each other’s lives outside the context of counseling. For example, if the client and the therapist come from the same neighborhood and know about each other, this may affect the client’s willingness to disclose issues. Generally, stakes for individual safety and protection are high in group contexts because of the many families and lives involved (Jacobs, Masson, Harvill & Schimmel, 2012).
Another ethical issue in group counseling is involuntary tendencies by members. Members may be unwilling to disclose critical information to the group. They may be too shy to speak in a group or too ashamed to disclose embarrassing personal accounts. On ethical grounds, the counselor should not compel clients to reveal any information against their wishes. At best, the counselor can only advise the clients of their duties and privileges, and inform them of any concerns that may arise if a particular course of action is followed. Where the clients are too reluctant to disclose pertinent information, the counselor becomes compromised because the clients’ behaviors influence the direction of the session for the rest of the group. This can be counterproductive and lead to suboptimal results (Garzon, Worthington & Tan, 2009).
Referring of clients is another important ethical issue in group counseling. According to Stalker, Horton and Cait (2012), therapists must be aware of when to refer a client from a group session to an individual setting. Knowing the appropriate stage and time when to let members seek individual counseling can be challenging to therapists, especially when they have a limited understand of the complexity of the client’s problems. The same difficulty is encountered when the therapist has to refer clients to a more qualified therapist. Ideally, it is the responsibility of the counselor to know when group counseling is more beneficial and when referral is necessary. If a client in a group setting is struggling to connect with the rest, it is the duty of the counselor to refer such a client to an individual counselor (Jacobs, Masson, Harvill & Schimmel, 2012).
Unlike in individual counseling, members of counseling groups are prone to mistreatment by other members. This could be in the form of inappropriate sexual advances, gossiping, blackmailing and money issues. As Garzon, Worthington and Tan (2009) found, the worst forms of mistreatment happen in the absence of legal protection for individual members in the group. The best solution for this problem is for the therapist to invoke the principle of competent care by exercising due diligence in dealing with each member.
Can the Ethical Principle of Confidentiality be upheld in Group Counseling?
The ethical principle of confidentiality is the cornerstone of health counseling relationships and is based on the the values of fidelity, autonomy, non-maleficence and beneficence. Autonomy means that the client retains the right to decide what information they reveal to the group and the therapist. Respect for the client’s right to decide what to disclose is the basis of confidentiality in counseling. Fidelity means the counselor’s loyalty and faithfulness including not disclosing information revealed by the client to third parties (Hartman & Zimberoff, 2012). Counselors are expected to be clear about the limits of confidentiality so that clients can make informed choices regarding disclosure of personal information. Non-maleficence and beneficence refer to the imperative of not using information revealed by the client to cause harm. In counseling, trusting relationships are achieved and clients benefit when the information they reveal is kept confidential. Disclosure of the client’s private information without due consent can harm the counseling relationship even when doing so is mandated by law (Cornish, Wade, Tucker & Post, 2014).
The issue of confidentiality is very complex and often difficult to resolve. Garzon, Worthington and Tan (2009) report that the challenge of confidentiality becomes more pronounced when providing group counseling. When dealing with either individual or group therapy, psychologists have an ethical obligation to recognize the extent of confidentiality as may be regulated by moral considerations or the law. In order to achieve this, the psychologist must discuss with the client all confidentiality issues related to the case at the onset of the counseling relationship. Discussion of confidentiality can also occur at later stages of the counseling relationship as the situation may warrant (Yamuna, 2013).
When providing counseling services in a group setting, the individual and collective roles and responsibilities of all parties should be described clearly at the outset (Stalker, Horton & Cait, 2012). This means that the group counselor must inform the group of the need for confidentiality, the legal privileges which apply to group counseling and the consequences of breaching confidentiality. The counselor must also take into consideration the fact that while group counseling is a powerful method for psychological counseling, the issue of confidentiality gets magnified as many times as the size of the group. Therefore, the confidentiality needs of each member in the group must be addressed properly (Bruns&Frewer, 2011).
During group therapy, not only is confidential information revealed to the counselor, it is also revealed to the rest of the group and there is no guarantee that the information will be kept confidential by other group members (Scher & Koziowska, 2012). However, research studies have shown that individual members in a group counseling session expect absolute confidentiality as a prerequisite for participating in such sessions. Informed consent describes the process through which members learn and understand the potential consequences of confidentiality. When group therapy is being considered for several clients, education about confidentiality should be offered before members enter the group. Potential group members should be made aware that the therapist or group counselor might be legally obligated to breach confidentiality under certain circumstances. They should also be informed that the counselor can assure confidentiality but cannot guarantee that group members will maintain it (Cornish, Wade, Tucker & Post, 2014).
Another important aspect of confidentiality to discuss with members before offering group counseling services is the potential lack of privileged communication. In most cases, privileged communication is rarely accorded in-group settings because of the third party rule. This rule states that any information disclosed in the presence of a third party was never intended to be private and therefore cannot be privileged. This implies that group members may be called to testify (in a court of law or its equivalent) against their colleagues regarding information revealed during group counseling sessions. Nonetheless, group members should be helped to accept the concept of confidentiality as an essential aspect of the counseling process rather than a rule mandated by the group counselor (Garzon, Worthington & Tan, 2009).
According to Bruns and Frewer (2011), new members joining an existing group should be asked to sign a contract attesting to their willingness to commit to the group’s confidentiality. Another important consideration in group counseling is that issues discussed in the group should not be discussed elsewhere even if group members live in the same neighborhood. Explaining to group members that they have a responsibility to keep each other’s information private can help in clarifying the concept of confidentiality. In Jacobs, Masson, Harvill and Schimmel’s view, confidentiality should be embraced as the most important group norm in group counseling, and it should be discussed thoroughly, openly and regularly among members. Although existing literature is clear about the difficulties of ensuring absolute confidentiality in a group, it is possible that if each member commits to informed consent and makes discussions of confidentiality an ongoing process, the likelihood of breaching confidentiality decreases.
Benefits of Group Counseling In Comparison To Individual Counseling
Generally, group counseling sessions are comprised of 5-8 people who meet with one or two counselors to discuss common issues affecting them. During these sessions, members listen to each other, share personal stories and openly provide feedback to each other. Through these interactions, members get an opportunity to increase understanding of the problems at hand and learn more about new ways of solving the problem (Jacobs, Masson, Harvill & Schimmel, 2012). Because members share similar problems, group counseling can be more beneficial than individual counseling. In a way, members get to benefit from the group even during sessions when they have nothing to share but listen to others. Through group therapy, members realize that they have many important things in common and as the group works out on concerns, everybody learns much about themselves. Therefore, members serve as mirrors for others ingroup counseling environments (Scher & Koziowska, 2012).
Another benefit of group counseling is that some members may bring up issues which other members may not have been aware of or afraid to bring up on their own. For example, a member may be afraid of bringing up the issue of infidelity in marriage but can benefit from the discussion when another member brings up the issue. A natural process of self-acceptance occurs as members learn to relate more openly with others in terms of disclosing personal issues. This way, group counseling provides opportunities for personal experimentation and is thus a safe forum for members to risk personal privacy for the sake of learning (Cornish, Wade, Tucker & Post, 2014).
According to Hartman and Zimberoff (2012), group counseling is more beneficial than individual counseling because it accords members an opportunity to receive instant feedback from people with similar problems in a supportive environment. In individual counseling, it is rare to find people who can freely share personal issues without feeling offended or hurting other people. In groups, the therapist helps members give valuable feedback in open, yet respectful ways. As a study by Garzon, Worthington and Tan (2009) found, groups can act a supportive network for individuals with chronic issues, which require frequent counseling. Besides the counselor, other group members often help each other to see ways of improving difficulty situations and life challenges. For example, a member may suggest how they handled a particular situation in the past and hence help other members deal with a similar problem.
Diversity is another important benefit associated with group counseling. Although group members are treated for similar problems, they have different personalities, backgrounds and viewpoints. By seeing how people face problems and make positive changes in life, members can discover various strategies for solving their own challenges. Cornish, Wade, Tucker and Post (2014) argue that talking regularly and listening to other people’s narratives helps members put their issues into perspective. Many people experience difficulties but fear speaking about them in a group. Oftentimes, a member may feel that he or she is the only one facing a certain challenge. It therefore becomes a relief to hear other members discuss similar issues. Knowing a variety of ways in which others successfully overcame their challenges can propel an individual forward especially if they are dealing with major emotional and psychological issues (Garzon, Worthington & Tan, 2009).
Findings from a study by Bruns and Frewer (2011) shows that group counseling promotes strong interpersonal and social skills, which can be utilized even outside the group. As members meet and share with one another, they not only ease the feeling of isolation but also get an opportunity to engage with one another at personal levels. This helps members to get along with one another despite differences in terms of race, language, religion or social status. Lastly, group counseling tends to be cost effective than individual counseling. Therefore, it can be an incredibly powerful mode of therapeutic treatment for people from socio-economically challenged backgrounds (Jacobs, Masson, Harvill&Schimmel, 2012).
Conclusion
There are many differences regarding the ethical requirements for group and individual counseling. There are also differences in the ways of approaching the ethical challenges in each of the two settings. Group counseling therapists must show care for client’s confidentiality, conflict of interests, involuntary clients and dual relationship roles. All these are important ethical issues in group counseling and warrant deep consideration before starting a counseling session. As explained in the previous sections, group therapy can confer immense benefits than individual therapy. It is more suited in settings where several clients have common problems and can gain emotional support from each other’s disclosure. The technique is cheaper than individual therapy and can promote social skills among clients. It also allows clients to benefits from other client’s issues, which they could not have known otherwise. Overall, group counseling can result in optimal outcomes where other counseling techniques, such as individual therapy are not feasible.
References
Bruns, F. &Frewer, A. (2011). Ethics consultation and empathy. HEC Forum, 23(4), 247.
Cornish, M. A., Wade, N. G., Tucker, J. R., & Post, B. C. (2014). When religion enters the counseling group: Multiculturalism, group processes, and social justice. The Counseling Psychologist, 42(5), 578-600.
Garzon, F., Worthington, E. L. Jr., & Tan, S. (2009). Lay Christian counseling and client expectations for integration in therapy. Journal of Psychology and Christianity, 28(2), 113.
Hartman, D., &Zimberoff, D. (2012). Ethics in heart-centered therapies. Journal of Heart Centered Therapies, 15(1), 3.
Jacobs, E. E., Masson, R. L., Harvill, R. L., &Schimmel, C. J. (2012). Group counseling: Strategies and skills (7th ed.). Belmont, CA: Brooks/Cole.
Scher, S., &Koziowska, K. (2012). Thinking, doing, and the Ethics of Family Therapy. The American Journal of Family Therapy, 40(2), 97-114.
Stalker, C. A., Horton, S., &Cait, C. (2012). Single-session therapy in walk-in counseling clinic: A pilot study. Journal of Systemic Therapies, 31(1), 38-52.
Yamuna, S. (2013). Counseling adolescents. The Indian Journal of Pediatrics, 80(11), 949-958.
