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Legal and Ethical Considerations for Group and Family Therapy

According to Locher et al. (2019), psychotherapy is an evidence-based psychological intervention that tackles behavioral or psychiatric disorders. Several different approaches may be used to take form in either individual or group/ family psychotherapy. Group psychotherapy typically involves a clinician and a set of persons who have similar mental health or psychiatric disorders, who meet at specified times to discuss, process, or listen to persons dealing with similar issues (Exhumalai et al., 2018). Whether psychotherapy is in the individual or group setting, ethical or legal implications may arise.

Confidentiality is a significant concern not only in the individual setting but especially in the group setting. With individual psychotherapy, it is only the clinician and the client, and the patients are less concerned about this aspect being breached.  It involves other individuals in a group or family setting; thus, the therapist cannot promise or guarantee that confidentiality will be maintained (McClanahan. 2014). However, the practitioner can urge the group members to keep what is discussed or processed confidentially.

Informed consent is another ethical consideration that will differ with a group versus individual psychotherapy. Shah et al. (2020) define informed consent as the process in which a provider educates a patient about the risks, benefits, and alternatives of an intervention. In psychotherapy, the provider will inform the patient about expected behaviors and set limits or boundaries, which is done before commencing therapy. The patient can then make an informed decision about whether they wish to participate. Breeskin (2011), in his article “Procedures and guidelines for group therapy,” gives an example of how this may be presented to a client. When a client signs the document, it can be legally binding. Therefore, it is essential to know the laws of your state and how they impact your practice.

Impact on therapeutic Approaches

An important fact to remember is the consequences of breaching confidentiality and failing to inform patients properly. For example, if there is a patient in group therapy that you see individually, that client’s information should never be disclosed in the group. Similarly, not informing the patient of how group therapy may impact them negatively (not just positively) can have a lasting effect on the client. The patient should be educated on what they may encounter so they can decide on whether to be a part of group therapy or not.

Finally, the provider must realize that he/she is catering to the entire group and not a specific client. The responses given by the clinician must benefit the group as a whole and not just one patient. Exhumalai et al. (2018) remind us that group therapy aims to be corrective, educational, therapeutic, developmental, preventative, and recreational. To meet these criteria, the clinician should aim to cater to all group members.

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.asp

Ezhumalai, S., Muralidhar, D., Dhanasekarapandian, R., & Nikketha, B. S. (2018). Group interventions. Indian Journal of Psychiatry, 60(Suppl 4), S514–S521. http://doi.org/10.4103/psychiatry.IndianJPsychiatry_42_18

Locher, C., Meier, S., & Gaab, J. (2019). Psychotherapy: A World of Meanings. Frontiers in Psychology, 10(460). doi:10.3389/fpsyg.2019.00460

• An 86-year-old male parishioner is on hospice care at home, and his daughter, who is a nurse, has been trying to meet all his physical needs around the clock. The pastor, who made a home visit, calls the faith community nurse to express his concern that the daughter is becoming “burned out.” How can the faith community nurse engage the faith community as a whole to provide volunteer support to this family?
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