The Ethical Group Psychotherapist

Ethical Issues in RecordKeeping in Group Psychotherapy

This article discusses numerous ethical issues regarding the keeping of records in group psychotherapy, those activities that have to do with the creating, retaining, storing, releasing, and disposing of them. A central dilemma for the group therapist is whether to keep records separately for each individual group member or to keep one record for the group as a whole. Confidentiality of records, patient access, and release of information tend to be more complex issues for group psychotherapists than for individual psychotherapists. Although notes written about the entire group may capture important themes, such notes can compromise the privacy and confidentiality of individual group members. An individual record for each patient is recommended.

Informed Consent in the Practice of Group Psychotherapy

Endorsed as part of ethical practice in group psychotherapy by professional organizations, informed consent is a process of communicating essential information about group treatment to patients so that they can make rational decisions about treatment-whether to enter and how to participate. Its benefits as well as necessary precautions are discussed. The design and implementation of the informed consent process for group is discussed in terms of who should obtain it, when it should occur, how it should be communicated, and what information should be considered for inclusion. Specific suggestions are included as well as a discussion of some potential ethical dilemmas.

Buried Treasure: Money, Ethics, and Countertransference in Group Therapy

Exploring money in the context of group therapy highlights the powerful way that groups can magnify the most intimate and charged aspects of our patients as well as ourselves.A thorough self-examination that includes an ethical framework for decision-making about money matters can safeguard against problems resulting from therapists' and patients' unconscious relationship to money. This paper addresses the setting and raising of fees, pre-group evaluations, third-party payers, handling of payments and statements, as well as combined treatment. Special attention is paid to countertransference with an exploration of the particular difficulties inherent in reconciling one's identity as a healer with the business of clinical practice.

Confidentiality and Privileged Communication in Group Psychotherapy

The concept of confidentiality is fundamental to all forms of psychotherapy. The idea of protecting confidential material goes as far back as the Hippocratic Oath in ancient Greek history. Centuries later, authors continue to assert that "only by maintaining confidentiality can the essential groundwork of trust in treatment be developed" (Hough, 1992, p. 106). Others have even argued that without confidentiality, psychotherapy has no value (Epstein, Steingarten, Weinstein, & Nashel, 1977). Confidentiality in group psychotherapy is more complicated than in individual therapy because self-disclosure is at the core of group therapy and there are numerous people hearing the disclosures. Confidentiality in group therapy, once ignored in the literature on ethics, is gaining more attention as this modality becomes more widely practiced; so too is an acknowledgement that ethical dilemmas surrounding confidentiality in groups are commonplace. This article discusses the major considerations and dilemmas on confidentiality in group psychotherapy. We first review confidentiality broadly and discuss the ethical principles that are related to confidentiality. In the next section, we discuss the complexities of confidentiality in group psychotherapy. Finally, we review research on confidentiality in groups and describe common ethical dilemmas.

The necessity of combined therapy in the treatment of shame: a case report

Abstract In some situations, combined psychotherapy may not be merely a choice, but a necessity for successful treatment. I present a case report of a hospitalized Vietnam veteran who had sexually abused one of his daughters. In individual therapy, the patient learned to speak about himself, his significant guilt, and his shame, in a trusting environment. After a year of outpatient individual work, I felt that the addition of group psychotherapy would help this withdrawn man to connect to a social milieu. Although anxious about self-disclosure and confidentiality, he joined a heterogeneous veterans' group, and came to reveal his secrets there. While he continued to use the individual sessions to broach painful issues, the group served to uncover material that had not emerged otherwise. The acceptance he experienced in the group expanded and cemented gains made in the dyad, which in turn made the ongoing group experience tolerable. His self-exposure and efforts at bonding and reparation catalyzed therapeutic movement for other members as well. The two modalities served to reinforce and make more powerful the effects of each. Therapeutic progress depended on the combined treatment-both were necessary, neither was sufficient.

Ethical hot spots of combined individual and group therapy: applying four ethical systems

Abstract Combined therapy presents ethical quandaries that occur in individual psychotherapy and group psychotherapy, and dilemmas specifically associated with their integration. This paper examines two types of ethical frameworks (a classical principle-based framework and a set of context-based frameworks) for addressing the ethical hot spots of combined therapy: self-referral, transfer of information, and termination. The principle-based approach enables the practitioner to see what core values may be served or violated by different courses of action in combined therapy dilemmas. Yet, the therapist is more likely to do justice to the complexity and richness of the combined therapy situation by supplementing a principle analysis with three additional ethical frameworks. These approaches are: virtue ethics, feminist ethics, and casuistry. An analysis of three vignettes illustrates how these contrasting ethical models not only expand the range of features to which the therapist attends but also the array of solutions the therapist generates.

Ethics and endings in group psychotherapy: saying good-bye and saying it well

Endings in group psychotherapy are suffused with complexity and potential conflict, some of which entail ethical quandaries. Ethical issues attending endings in group therapy are explored through a discussion of informed consent, time and role boundaries, privacy and confidentiality, unplanned endings, therapist-initiated termination, and competence. Findings from an exploratory survey of members of the American Group Psychotherapy Association and clinical-ethical vignettes are presented to highlight these issues. Clinicians need to develop and maintain ethical fitness and awareness, including attunement to personal responses, to endings and loss.