Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples

Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples -1

Psychotherapy is a proven method in the treatment of various psychiatric disorders in both the individual and group setting. Individual therapy consists of the application of a therapeutic process with an individual and the treating clinician and group therapy applies the same concept but consists of two or more individuals seeking therapeutic intervention. Regardless of the setting, the practicing clinician muse be aware of the legal and ethical implications that come with treating clients in both individual and group psychotherapy sessions. Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples.

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Legal and Ethical Considerations in Individual and Group Therapy

According to Wheeler (2014), group therapy offers the ability to increase access to care for clients, to diversify one’s practice by offering services other than individual, couples, or family therapy, while at the same time affording clients a cost-effective and evidence-based intervention for addressing their mental health issues. Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples. In both individual and group therapy settings there are certain guidelines that must be maintained to prevent consequential ethical or legal implications. in both individual and group therapy, privacy and confidentiality must be maintained unless the clinician has just cause to believe that either the individual client or a member of a group is a danger to themselves or another person. However, in group therapy these rules do not just span between one client and the treating clinician and the therapist must be cognizant of this fact. According to Breeskin (2011), “Anything that is said between any two or more group members at any time is part of the group and is confidential.”  Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples.

Another ethical implication seen in both individual and group therapy is informed consent. Informed consent allows the client or clients to have enough information regarding the services provided within the therapeutic environment so that they can decide whether they will participate. All clients should be given an orientation to the therapeutic setting including appropriate boundaries, limits, goal setting, and expected behaviors. In group therapy, all legal implications associated with maintaining the privacy of participants protected health information still applies as seen with individual therapy. Participants within the group should be encouraged during the orientation phase and throughout the duration of the group to maintain the confidentiality of all group members. According to McClanahan (2014), confidentiality should become one of the most important group norms, and it should be discussed openly, throughly and often among group members. This implication also applies to group therapy settings involving minors. Guardians must be informed of the application of confidentiality and given disclosure that complete confidentiality cannot be promised as seen in individual therapy settings. According to Ware & Dillman-Taylor (2014), similar to any intervention involving multiple people, therapists cannot promisr complete confidentiality because of one’s lack of control of other members and possible situations of required reporting and must be discussed with parents.

When providing services to clients in the group or family setting versus those in the individual therapy environment, the therapeutic environment might be impacted if these factors are not taken into account. The therapist must be aware that the therapeutic dynamic is altered when dealing with a group versus a individual therapy session. Client trust and therapeutic alliance will need to established not only with the group facilitator but also with the group participants to meet the goals of the formation of the particular group session. Group members should feel free to interact within the therapeutic environment without fear of intimidation, judgment or unnecessary disclosure of their private thoughts or experiences. The principles of interpersonal learning, group cohesiveness, and catharsis are all impacted by some of these considerations. The competent psychotherapist will also be aware of their abilities in providing effective treatment using the appropriate treatment modalities. According to Wheeler (2014), proficiency in specific theoretical orientations is a necessity for all practicing psychotherapists, but awareness of the nuances, ambiguities, and subtleties of interpersonal interaction, and how to handle them in the immediacy of the clinical encounter to therapeutic effect; are indispensable. Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples.

References

Breeskin, J. (2011). Procedures and guidelines for group therapy. The Group Psychologist, 21(1). Retrieved from http://www.apadivisions.org/division-49/publications/newsletter/group-psychologist/2011/04/group-procedures.aspx

McClanahan, K.K. (2014). Can confidentiality be maintained in group therapy? Retrieved from http://nationalpsychologist.com/2014/07/can-confidentiality-be-maintained-in-group-therapy/102566.html

Ware, J.N., & Dillman-Taylor, D. (2014). Concerns about confidentiality: The application of ethical decision-making within group play therapy. International Journal of Play Therapy, 23(3), 172-186. doi:10.1037/a0036667

Wheeler, K. (Eds.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how to guide for evidence-based practice. New York, NY: Springer.

 

Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples – 2

Group therapy is a form of psychotherapy in which a group of patients meet to describe and discuss their problems together under the supervision of a therapist (Tracy & Wallace, 2016). Family therapy is a form of psychotherapy that works with families and couples in intimate relationships to nurture change and development (Szapoczni, Schwartz, Muir, & Brown, 2012). It tends to view change in terms of the systems of interaction between family members and emphasizes family relationships as an important factor in psychological health (Szapoczni et al., 2012). Individual therapy is a joint process between a therapist and a person in therapy with the common goals of therapy being to inspire change or improve the quality of life for the individual in therapy (Tracy et al., 2016). Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples.

Maintaining confidentiality is the foundation of psychotherapy and without the assurance of confidentiality, the clients in either forms of psychotherapy cannot be expected to reveal embarrassing, sometimes personally damaging information in the selected treatment setting (McClanahan, 2014). It is important to remember that the ethical requirement of confidentiality overlaps with the law so some of the answers to situations the therapist will experience can only occur with an understanding of both ethics and law (McClanahan, 2014). Issues of confidentiality are complex and members of the American Psychological Association (APA) report that the most common dilemma for therapist providing individual therapy involve confidentiality (McClanahan, 2014). Those dilemmas become even more complex when group or family is provided (McClanahan, 2014). Definitive guidelines are provided by associations specifically dedicated to group/family work stating group workers define confidentiality and its limits (for example, legal and ethical exceptions and expectations; waivers implicit with treatment plans; documentation and insurance coverage) (McClanahan, 2014). Group/family therapists have the responsibility to inform all individuals participating of the need for confidentiality, potential consequences of breaching confidentiality and that legal privilege does not apply to group/family discussion, unless provided by state statute (McClanahan, 2014).

Another important difference is the provider during group/family therapy is no longer dedicated to the individual client nor functions exclusively as the client’s agent (Ezhumalai, Muralidhar, Dhanasekarapandian, & Nikketha, 2018). Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples. The provider recognizes the responsibility to participate in activities contributing to an overall improved community (Ezhumalia et al., 2018).

This can be used in clinical practice by maintaining an atmosphere of trust when holding a group or family session, due to all the members potentially speaking openly about their feelings and talking directly to one another about their personal problems (Ezhumalia et al., 2018). It will be important for the therapist to promote that no one will be forced to divulge their deepest secrets and to promote an environment that group/family member to feel free to relate openly and honestly with others in the effort to discover that they are not alone in their issues (Ezhumalia et al., 2014).

References:

Ezhumalai, S., Muralidhar, D., Dhanasekarapandian, R., & Nikketha, B. S. (2018). Group interventions. Indian Journal of Psychiatry60(Suppl 4), S514–S521. http://doi.org/10.4103/psychiatry.IndianJPsychiatry_42_18

McClanahan, K. (2014). Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples. Can confidentiality be maintained in group therapy? The National Psychologist. Retrieved from: https://nationalpsychologist.com/2014/07/can-confidentiality-be-maintained-in-group-therapy/102566.html

Szapocznik, J., Schwartz, S. J., Muir, J. A., & Brown, C. H. (2012). Brief Strategic Family Therapy: An Intervention to Reduce Adolescent Risk Behavior. Couple & Family Psychology1(2), 134–145. http://doi.org/10.1037/a0029002

Tracy, K., & Wallace, S. P. (2016). Benefits of peer support groups in the treatment of addiction. Substance Abuse and Rehabilitation7, 143–154. http://doi.org/10.2147/SAR.S81535

 

Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples – 3

Legal and ethics

Legal and ethical consideration are very important during therapy  to protect patient privacy. And as a practitioner, the code of ethics  requires that I must adhere to the code. Different states have different laws that govern privacy and thus one should familiarize with them and recognize the extent and limits of confidentiality  regulated by law. Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples. Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples. The Health Insurance Portability and Accountability Act (HIPAA) contains a privacy rule that creates national standards to protect individuals’ medical records and personal health information, including information about psychotherapy and mental health.

Group verses individual therapy confidentiality

In group therapy and family therapy, confidentiality is not guaranteed, according to McClanahan 2014, the  information revealed to the therapist  is also revealed to other group members, and there is no guarantee that other group members will maintain confidentiality. For individual therapy, at least it’s between the therapist and the client and therefore confidentiality is maintained. According to The APA Ethical Guidelines, there is little specificity regarding confidentiality in group therapy.

Privileged information

The difference of group therapy and family therapy from the individual therapy is the privileged information. In most states, privileged communication does not exist in group settings due to the third-party rule, which states that information revealed in front of a third party was not intended to be private and is not privileged, McClanahan (2014). Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples. Therefore, group members may be called to testify against their peers regarding information obtained in group sessions unless provided by a state statute. On the other hand, individual therapy notes  are confidential and privileged. According to U.S. Department of Health &Human Services. (2014), Privacy Rule requires a covered entity to obtain a patient’s authorization prior to a disclosure of psychotherapy notes for any reason, including a disclosure for treatment purposes to a health care provider other than the originator of the notes [45 CFR 164.508(a)(2)].

Impact your therapeutic approaches

The impact of these differences on therapeutic approaches is the consequences of breach these confidentiality and privileges. Remember that a breach of confidentiality can be a malpractice liability (Loewenberg, Dolgoff, & Harrington, 2000). The client competence is also important because impaired cognition may impair the understanding of the consents entered between the client and the practitioner or is obtained under duress. Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples. Other consideration that may arise is mandatory reporting and mandated  treatments which may impact therapy approaches.

References

U.S. Department of Health &Human Services. (2014). HIPAA privacy rule and sharing    Information related to mental health. Retrieved from http://www.hhs.gov/sites/default             /files/ocr/privacy/hipaa/understanding/speail/mhguidencepdf.pdf

Loewenberg, F. M.; Dolgoff, R. & Harrington, D. (2000). Ethical decisions for social work          practice, 6th edition. Itasca, IL: F. E. Peacock.

McClanahan, K. K. (2014) Can confidentiality be maintained in group therapy? Retrieved            from http://nationalpsychologist.com/2014/07/can-confidentaility-be-maintained-in-       group-therapy/102566.html

 

Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples – 4

During this week’s group and family therapy sessions, I have been able to witness how different these sessions are compared to individuals’ sessions from previous class. Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples. Some of the differences and challenges, I noted were in relation to different groups and family’s dynamics and issues 

issues like group members privacy and confidentiality.It’s very importance to maintain confidentiality during group or family session to have trust and maintain cohesion failure to which can have major legal and ethical consequences. According to Letitia, Thomas & Emily (2013) as group treatment gains popularity, so does the awareness of the ethical dilemmas that often pose more of a problem in group treatment than in individual therapy. Confidentiality, for one, is an issue warranting much-needed attention in groups. Although therapists are ethically and legally bound, there are no standard rules in place for members of a group engaging in therapeutic dialogue. To reduce the fear surrounding violations of confidentiality, it is speculated that enhancing cohesion and trust among group members will put members at ease. Confidentiality is a cornerstone of healthy therapeutic relationships and effective treatment and is based upon the ethical principles of autonomy and fidelity, and to a lesser degree, beneficence and nonmaleficence. Group members should be encouraged to embrace the concept of confidentiality, making it their own rather than a rule the group therapist has mandated. When new group members join an ongoing group, they may be asked to sign or may have already signed a contract attesting to their commitment to confidentiality (McClanahan2014). 

There are several ethical standards that differential group from individual therapy. According Corey et al., (2014) it’s important to screen clients in group therapy to ensure that they are in the right group for the topics being discussed and on the same token, screening client ensures that they and their issues are a good fit for the therapist and their level of expertise and experience with those issues is important.  Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples.

One of the issues addressed in this week’s video assignment was how to address client’s confidential information in case of court subpoena. Each State and on rare occasional county addresses this issue differently and it’s on us as therapists to stay up to date with their jurisdiction mandate. Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples. As already noted, group and family therapy require a different level of confidentiality compared to individual therapy session. These differences have major impact on therapy and how the sessions are conducted including the rules and group members obligations to each other. Therapists must consider the group dynamic and objective while ensuring that each individual client in the group is catered for (Cottone Tarvydas, 2016) 

  

References

Corey, G., Schneider-Corey, M., & Haynes, R. (2014). Groups in action: Evolution and challenges (2nd ed.). Belmont, Ca: Brooks/Cole. 

Cottone, R. R., & Tarvydas, V. (2016). Ethics and decision making in counseling and psychotherapy., 4th ed. New York, NY, US: Springer Publishing Co. 

Letitia, E., Thomas, W., & Emily, E., (2013) Confidentiality and Cohesion in Groups:  Collaborative Story Building and Telling as a Means of Improving the Therapeutic Experience.  Eastern Group Psychotherapy Society. Vol. 36, No. 4 (Winter 2013), pp.  317-331 . Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples.

McClanahan, K. K. (2014). Can confidentiality be maintained in group therapy? Retrieved from  http://nationalpsychologist.com/2014/07/can-confidentiality-be-maintained-in-group- therapy/102566.html 

 

Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples – 5

Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior and overcome problems in desired ways. Psychotherapy aims to improve an individual’s well being and mental health to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills (Psychotheraphy, 2018). Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples.

The role of psychotherapy is to facilitate the client’s work in ways which respect the client’s values, personal resources and capacity for self determination. The aim is to empower clients and encourage them to take control of their lives. Only when both therapist and client explicitly agree to enter into a therapy relationship does it become psychotherapy (Stefanazzi, 2018).

Ethics are important, because they provide a map, a science of morality, which can support us to determine where our duty lies, what is the right course of action to take, that will cause no harm, and is not limited to personal advantage (Stefanazzi, 2018). Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples.

 

References

Stefanazzi, M. (2018). Psychotheraphy. IHIAP .Retrieved from https://iahip.org/inside-out/issue-58-summer-2009/ethical-issues-in-psychotherapy

Psychotheraphy. (2018). Wikipedia .Retrieved from https://en.wikipedia.org/wiki/Psychotherapy

 

Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples – 6

Group therapy is a cost-effective choice for many patients without insurance (Wheeler, 2014). Group therapy provides therapists the opportunity to treat multiple patients at once allow greater access to treatment for clients (Wheeler, 2014).  Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples. Approaches for individual psychotherapy offer understanding of the client from an intrapsychic, interpersonal, humanistic-existential, or cognitive behavioral perspective while family therapy strives to understand the client in the context of a system (Wheeler, 2014). IN terms of family therapy, clients have lived most of their lives growing up in a family and starting a new family.

In group and family therapy, information revealed to the therapist as well as to other group members. Legal and ethical considerations differ from those of individual therapy. Therapists have the responsibility to inform all group participants of the need for confidentiality, potential consequences of breaching confidentiality, and that legal privilege does not apply to group discussions (Mclanahan, 2014).

Confidentiality should be discussed with group members prior to entering the group therapy session. Potential group members should be informed that therapists may have a legal obligation to break confidentiality in certain circumstances such as a group member verbalizing intent to harm self or others. Therapists can assure confidentiality within the constraints of the law but, are unable to promise that other group members will maintain confidentiality (Mclanahan, 2014). Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples. In most states, privileged communication does not exist in group settings due to the third-party rule, which states that information revealed in front of a third party was not intended to be private and is not privileged (Mclanahan, 2014). So, group members can testify against other group members regarding information that was revealed in group. In order to help maintain confidentiality, group members must embrace the concept of confidentiality and trust that other members will not reveal information discussed within the constraints of the law. In my own practice in the future, I will educate all members of my psychotherapy groups that is essential to maintain confidentiality to promote trust within the group.

References:

Mclanahan, K., (2014). Can confidentiality be maintained n group therapy? Retrieved from https://nationalpsychologist.com/2014/07/can-confidentiality-be-maintained-in-group-therapy/102566.html

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer. Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples.

 

Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples – 7

Group Therapy Premise

Group therapy is formulated under several historical assumptions of human behavior and relationship. Fehr & Gaska (2013), explains that psychological basis for group dynamic stems from earlier philosophies regarding the inner circle as in ancient Chinese philosophy, to Rudolph Dreikurs’ group benefit philosophy. The group therapy model harness tribal instincts that may perhaps illicit benefits to the entirety of a tribe, but also reap benefits for the individual.

Besides the inherent differences, group therapy compared to individual therapy helps the individual’s identity and personality emerge. Individuals may exhibit personalities that are different given the social conditions or environment ( Fehr & Gaska, 2013). For example, in a group setting, there can be social requirements, whether explicit or not, in order to progress a given interaction. The group dynamic helps people understand how they may shape the environment, and the environment could influence them ( Fehr & Gaska, 2013). For the sake of practicality, a group therapy model provides a greater simulation of the real-world. As in individual psychotherapy, there are many modalities that have been described and developed. Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples.  However, not all are necessarily accepted by professionals.

Legal and Ethical Implications

Legal and ethical implications are especially concerning due to an increase in participating parties in group therapy. Unlike individual therapeutic relationships, where the client is reliant of the therapist for confidentiality, group dynamics require all participating members to adhere to ethical conducts. The Health Insurance Portability and Accountability Act (HIPPA), outlines the responsibilities of clients, and providers in order to maintain privacy. Only under the patient’s discretion, or extreme circumstances can health information be shared (U.S. Department of Health & Human Services, 2014). Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples. However, confidentiality under the third party rule may not legally bind other participants within the group to the same standards as between the therapist and his or her clients (McClanahan, 2014). Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples.

Approaches to Group Therapy Implications

The impact of these requirements require that the therapist take an active role in clearly establishing rules of conduct among group members. It may also be prudent to remove individuals when they are harmful to the standards of therapeutic relationships set forth. If members are known to be discussing the health and care of other members, while not illegal, it could be detrimental a trusting environment. Signed agreements can help hold members accountable, such that participants are given the rules beforehand and agree that they can be removed if they infringed on those prior agreements. Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples.

Fehr, S. S., & Gaska, J. M. (2013). Introduction to group therapy : a practical guide. New York, New York ; Oxfordshire, England : Routledge, 2013.

McClanahan, K. K. (2014). Can confidentiality be maintained in group therapy? Retrieved from http://nationalpsychologist.com/2014/07/can-confidentiality-be-maintained-in-group-therapy/102566.html

U.S. Department of Health & Human Services. (2014). HIPAA privacy rule and sharing information related to mental health. Retrieved from http://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/special/mhguidancepdf.pdf. Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples.

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