NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment

NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment

Legal and ethical considerations

How legal and ethical considerations for group and family therapy differ from those for individual therapy.

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Therapy is typically dependent on the description of the clients and their expectations. In fact, this difference can be noted for individual and group/family therapies owing to the distinctions of their position level in community structures. All therapies apply professional psychotherapeutic principles to solve existing psychiatric and mental problems. However, unique differences exist with regards to their legal and ethical considerations (Sadock, B., Sadock, V. & Ruiz, 2014). In this respect, differences exist between individual and group/family therapy. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

There are three notable ethical differences between the two types of therapies. The first ethical difference is the professional qualifications of therapists who provide their services. On one hand, individual therapy is a general expectation for all therapists. On the other hand, group/family therapy requires that the therapist first undergo training to provide individual therapy before undergoing additional training to provide group and family therapy. This means that the therapists providing services for the two types of therapies are ethical expected to meet the different qualification expectations for practice (Wheeler, 2014). The second ethical difference is that for individual therapy, an informed consent can be expected to express the client’s true sentiments in terms of voluntarily attending the therapy. The same cannot be said for family/group therapy where the realities of social structures create the possibility of some of the members being coerced into attending the therapy. This implies that therapists providing family/group therapy must consider the possibility that some of the members may have been coerced into attending the therapy and would not participate fully or support the therapy exercises. This is particularly an issue of consideration where there are glaring power and authority differences such as children being coerced into attending family therapy by their parents (Whitaker & Cosgrove, 2015). The third ethical difference is that confidentiality would not be much of a concern in individual therapy, but that may not be the case with family/group therapy. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment. That is because the members are not obligated to keep any disclosures made in the therapy sessions confidential. This is an ethical concern that therapists must consider when dealing with group/family therapies since they cannot offer any guarantees that the information that any member discloses will not be exposed outside the group (Cautin, & Lilienfeld, 2015).

In addition to the three ethical concerns that have been discussed, legal difference also exist between the two types of therapies. Firstly, therapists providing psychiatric services must be licensed and certified to provide these services. This would define their scope of practice and geographical area of operation that would typically be defined in terms of states. These licenses and certifications are periodically issued by recognized organizations after ascertaining that the individual is qualified to offer the services (Cautin, & Lilienfeld, 2015). Secondly, therapists are expected to keep all information confidential as indicated by HIPAA legislation. This means that the information can only be used under express permission of the client and for therapy purposes. Therapists who breach the legislation risk facing legal sanctions that could range from their licenses being withdrawn to fines and incarceration (Wheeler, 2014). As a result, therapists should be aware of the legal and ethical considerations when providing their services. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

How the differences might impact your therapeutic approaches for clients in group and family therapy.

The differences noted in the legal and ethical considerations can influence therapeutic approaches for group/family therapies in a number of ways. Firstly, the therapist should meet the licensure and certification requirements to practice, while ensuring that all documentation is current. Secondly, the therapist should consider the possibility that some group/family members could be coerced to attend therapy thus influencing their participation and therapy outcomes. Finally, information security measures should be implemented on how to handle client information in terms of secure storage and use to conform to HIPAA requirements.

References

Cautin, R. & Lilienfeld, S. (2015). The encyclopedia of clinical psychology, volume II Cli-E. Hoboken, NJ: John Wiley & Sons.

Sadock, B., Sadock, V. & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: behavioral sciences/clinical psychiatry (11^th ed.). Philadelphia, PA: Wolters Kluwer. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

Wheeler, K. (Eds.). (2014). Psychotherapy for the advanced practice psychiatric nurse: a how-to guide for evidence-based practice (2^nd ed.). New York, NY: Springer Publishing Company.

Whitaker, R. & Cosgrove, L. (2015). Psychiatry under the influence: institutional corruption, social injury, and prescriptions for reform. New York, NY: Palgrave Macmillan.

Discussion: Legal and Ethical Considerations for Group and Family Therapy

Considering the Health Insurance Portability and Accountability Act (HIPPA), the idea of discussing confidential information with a patient in front of an audience is probably quite foreign to you. However, in group and family therapy, this is precisely what the psychiatric mental health nurse practitioner does. In your role, learning how to provide this type of therapy within the limits of confidentiality is essential. For this Discussion, consider how limited confidentiality and other legal and ethical considerations might impact therapeutic approaches for clients in group and family therapy. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.
Learning Objectives
Students will:
• Compare legal and ethical considerations for group and family therapy to legal and ethical considerations for individual therapy
• Analyze the impact of legal and ethical considerations on therapeutic approaches for clients in group and family therapy
• Recommend strategies to address legal and ethical considerations for group and family therapy
To prepare:
• Review this week’s Learning Resources and consider the insights they provide on group and family therapy.
• View the media, Legal and Ethical Issues for Mental Health Professions, Volume I, and reflect on legal and ethical considerations for group and family therapy and individual therapy. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.
By Day 3
Post an explanation of how legal and ethical considerations for group and family therapy differ from those for individual therapy. Then, explain how these differences might impact your therapeutic approaches for clients in group and family therapy. Support your rationale with evidence-based literature.

The Group Psychologist | April 2011

Group Psychotherapy Column

Procedures and guidelines for group therapy

Detailed procedures and rules members of group therapy must adhere to.

By John Breeskin, PhD, ABPP

1. Confidentiality

Anything said between any two or more group members at any time is part of the group and is confidential. I understand that everything said in group is confidential. I agree to keep secret the names of other members of the group and what is said in the group. I agree to keep secret anything which occurs between or among group members. I understand that there is an exception to this confidentiality which applies to the group leader. If the group leader believes that someone is in danger, the leader has a professional obligation to take direct action in order to keep everyone safe.

I agree not to keep secret from the group anything which occurs within the group. Anything which occurs between or among any members is part of the group is kept secret from anyone outside of the group but is not kept secret from the group. This also applies to any individual meetings you may have with a group leader. I understand that if I violate this confidentiality I could be removed from the group. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

2. Privacy (The Stop Rule)

No group member is ever required to answer any question, to participate in any activity, or to tell anything. If I am asked questions or asked to participate in an activity which makes me feel uncomfortable, I understand that I have the right to pass, that is, the right to refuse. I agree that will never pressure other group members to participate in any discussion or activity after the member has passed or refused. I understand that the group leader is obliged to protect this right. I also understand that I will benefit more from group the more I am able to take risks in sharing and participating.

3. Dignity

No group member is ever humiliated, hazed, or abused in any way. I agree to avoid this destructive behavior.

4. Violence or intimidation

Violence or intimidation toward other group members is never tolerated. I understand that I must never be violent or intimidating toward other group members and that if I threaten to harm persons or property I will be asked to leave the group. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

5. Alcohol and Other Drugs

Group members cannot participate in the group under the influence of alcohol or other mind altering drugs. When under the influence of chemicals, persons do not have access to their emotions and have less control over their behavior. I understand that if the leader believes that I am under the influence of alcohol or other drugs, I will be asked to leave the group.

6. Exclusive relationships

Dating and other exclusive relationships between or among group members are not a good idea. The relationships can make other group members feel left out. When a couple breaks up, for example, this can be most painful and may make it impossible for these people to continue in the group. Since anything which occurs between or among group members is part of the group, members who are dating or in very exclusive relationships may be embarrassed when their intimate moments are discussed in the group.

7. Gossip

Gossip and secret grudges can be very destructive in a group. I agree that if I have something to say to another group member, I will try to say it to the member directly rather than talk about him/ her behind his/her back.

8. Attendance

I agree that I will attend every meeting unless an emergency arises. If an emergency should arise I will notify the group leader prior to the meeting to tell him or her that I will be unable to attend. I understand that the group leader will tell the group what has happened. I understand that if I have three unexcused absences, my continued group membership will be discussed. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

9. Internet Connectivity

I feel very strongly that the members of the group should form and participate in an online group limited to the group members. Of course, the same cautionary notes apply to the internet communications in terms of both confidentiality and inter-group sharing. (I have used this model very successfully, and it significantly enhances a healthy form of interconnection.)

10. Responsibilities

I understand that it is the group leader’s responsibility to enforce these procedures and guidelines. The group may, when it wishes, propose other procedures and guidelines which will be up to the group to monitor.

11. Termination

Usually, group members decide, within the group, with the leader, when it is time to leave the group. Sometimes it is necessary for a group member to leave the group unexpectedly. This can cause group members to wonder if they have harmed the leaving member. I promise that if I must leave the group unexpectedly, I will come to a last group meeting and tell the members that I am leaving and say goodbye. I agree to announce this at the beginning of the last meeting so that the group has time to ask questions and say goodbye. If I decide to leave the group the group members may express their concerns but also respect the decision of the person wishing to leave. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

I have read the procedures and guidelines for group and agree to be bound by them while I am a member of the group

_____________________         ____________
Group Member                         Date

I promise to faithfully enforce procedures and guidelines for this group.

____________
Date

JB
Group Leader

Discussion: Legal and Ethical Considerations for Group and Family Therapy

1. Comparison of legal and ethical considerations for group and family therapy to legal and ethical considerations for individual therapy

In individual therapy, informed consent involves explaining to the client about the treatment and all for the client to decide whether to take part in the therapy or not. On the other hand, in group therapy and family therapy informed consent involves presenting essential information regarding the group treatment to individuals to ensure that they are in a position to rationally decide whether to take part in the group and how to participate (Cooper et al, 2017).  This indicates that informed consent in group/family therapy is relatively different when compared to informed consent in individual therapy. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

In individual therapy confidentiality and privacy are not a major issue because only the client and the therapist are involved. However, in both group and family therapy, confidentiality and privacy issues become a challenge. For example, in group therapy, there is more than one client and during the therapy group members may discuss and reveal their diagnosis, treatment and other issues. The confidentiality and privacy of such information is hence disclosed to all group members (McClanahan, 2014). Similarly, in family therapy, the therapist may be forced to keep quite on some issues, due to the promises the therapist made in good faith. One family member may reveal some vital information, that they may not want the other party to know (Breeskin, 2011). This brings in confidentiality and privacy issues not present in individual therapy. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

The aspect of neutrality and dual relationships is common in family therapy (Laureate Education, 2015). While in individual therapy the therapist is only handling a single client, during a family therapy the therapist handles more than one party and hence the issue of neutrality and dual relationships may arise (Bellesheim, 2016). For example, family members may be having conflicting issues they want addressed. Therapists may hence find themselves in an ethical dilemma regarding their role on conflicting issues of family members.

2. Impact of the Differences on Therapeutic Approaches

These differences render therapeutic approach more complex and challenging. For example, obtaining an informed consent in group therapy and family therapy is more complex and comprehensive and hence consumes a lot of time (Cooper et al, 2017). In addition, some parties may refuse to take part in the therapy, for instance in family therapy and this leaves the therapist in an uncomfortable situation regarding what to do.  Secondly, confidentiality may be difficult to maintain in family and group therapy because there are more parties involved (Bellesheim, 2016). At times confidentiality and privacy may be breached by one of the group or family member, which eventually impacts the therapeutic approach; for instance, some members may become very affected due to confidentiality breach while some may even terminate treatment. Finally, since maintaining neutrality may be challenging in a family therapy, often the therapist may face a dilemma on the action to take which may slow and even hinder the therapy (Bellesheim, 2016). NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

Strategies to address the Legal and Ethical Considerations

• Always have the group members read, understand and sign a document detailing procedures and rules for members of group therapy (Breeskin, 2011).
• The therapist should always set and maintain group therapy rules
• Any client who attempts to or actually breaches the set rules should have an appropriate action taken such as being referred for individual therapy
• The group members need to be educated regarding confidentiality and privacy to ensure they are well versed and minimize the risk of breaching confidentiality
• Zero tolerance to rule violation NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment
• The therapist should model the required behaviors, for instance by maintaining the confidentiality of the client’s information (Riva & Erickson, 2018).

References

Bellesheim K. (2016). Ethical Challenges and Legal Issues for Mental Health Professionals Working With Family Caregivers of Individuals with Serious Mental Illness. Ethics & Behavior . 26(7), 607-620.

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

Cooper E, Hudson J, Marti K & Lise M. (2017). The Future of Group Therapy: Current and Future Challenges in Group Therapy. International Journal of Group Psychotherapy . 47(1), S219-S239.

Laureate Education. (2015). Microskills: Family counseling techniques 2 [Video file]. Baltimore, MD: Laureate Education. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment

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

Riva, M & Erickson J. (2018). Ethical Considerations in Group Psychotherapy. In M. Leach & E. Welfel (Eds.), The Cambridge Handbook of Applied Psychological Ethics (Cambridge Handbooks in Psychology, pp. 218-238). Cambridge: Cambridge University NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment