Topic 10: Ethical & Multicultural Issues {12/3}

There are two readings due this week – Brabender (2002) and Greeley et al. (1992).  Address the following two discussion points: (1) Identify and discuss at lest two potential ethical concerns/events that are unique to group therapy. (2) How can therapists increase/improve awareness of their own cultural identity and of their clients (at least, in part, based on the reading). Your original post should be posted by the beginning of class 12/3.  Have your two replies no later than 12/5.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

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18 Comments (+add yours?)

  1. Richard Hisman
    Nov 28, 2014 @ 12:02:09

    On the face of it, this article appears to be a watered down version of the ethics policies studied in other classes. Upon reaching figure 9-1 things get much clearer. This illustration is a nice and neat way of presenting the questioning process to see if an ethical question exist. Then provides a structure for solving the issue. There is also a discussion of the requirement for graduate students to be competent in areas of therapy that they are consulting in and where that training can come from. But we already know that graduate students are going to be placed in compromising situations where they are not necessarily competent. This should be overcome by participating in lifelong learning. Importantly this lifelong learning should include cultural and social economic diversity exposure, which is discussed in the next chapter. We have yet to come up with a real solution for graduate students participating in internships. The slope is slippery because of the need to complete the internship. Lastly is outside group contact by members and what really can be done about breaches of confidentiality outside the group? The vignette where a member runs into a fellow client and in the course of conversation is asked how he knows this individual, blurts out they are in therapy together. This scenario is a very good example of how outside contact can go awry. A discussion at the start of group of how to handle outside unexpected contact could prevent such alienation.
    We now look at multicultural issues, which has peaked my interest greatly while attending Assumption. I personally come from a very diverse background and have dealt with discrimination at many levels. I have often wondered what the average classmate thinks of this issue. When on internship, how has he/she felt when in a group session with multiple minorities where in fact they are the minority within the group? An adaption of the way in which one sees an issue has to change with the group involved. Outcomes desired may or may not be different, but why they exist may well. There is a real good discussion to start one thinking of how to interpret discuss cultural issues towards the end of the chapter. Have most really sat down and examined how one sees one’s own cultural identity. Within the classification of Caucasian alone there are cultural differences of ethnicity, regionalism and social economic status. These all affect the cultural outlook or identity to which one subscribes. Unfortunately lifelong learning will not mitigate the here and now of the average graduate student starting out. A class in what, how and why cultures are what they are can help with this issue. I stand outside and look at the average student and realize quickly how much my military background has helped me in this area. Being considerably older and having spent a major portion of my life in the military, has exposed me to many cultures and beliefs. This I now carry with me as I enter my internship phase. It does not guarantee me success, but it does aid my ability to feel secure in many situations.

    Reply

    • Gil
      Dec 03, 2014 @ 10:32:17

      I do agree with you that we need life-long learning in order to maintain the highest level of care. I think beyond this point, we need to have more applicable learning as grad students in order to prepare for internships. The clients that we receive in internship do give us valuable experience, but ultimately we are finding out many of our mistakes as we meet with them. No matter how much we learn, we will make mistakes, especially as beginning therapists. However, I also believe that more application of knowledge before internship would make the internship more valuable and have us practicing at higher levels. This application would look like a true breakdown, modeling, and practicing of the therapeutic style. Role playing discussions that we would have with clients, and how to handle patterns of issues. We would benefit from witnessing and then practicing delivering cognitive and behavioral strategies. For example, I know that one of my own issues was/is that I speak too clinically to my clients. Having the opportunity to try this out with a professor would have been helpful in ironing out these kinks.

      Reply

      • Richard Hisman
        Dec 04, 2014 @ 08:33:04

        This is what I was trying to get at in class last night. The examples that were brought out in Abnormal of how different races can have different triggers for their behaviors is a very good application of diversity training. It is something that needs to prevail throughout our studies. You hit it right on the head. Last night when I talked about experience, it did not mean I know everything I need to know. It did mean that I have a strong recognition of my differences from those I will counsel and that it is my responsibility to compensate for that in order to be effective.

        Reply

  2. Richard Hisman
    Nov 29, 2014 @ 08:42:15

    Yeah socio not social, I really need to remember to turn off auto-correct

    Reply

  3. Gil
    Nov 30, 2014 @ 21:10:43

    An ethical dilemma may arise when the benefit of the individual may be in disharmony with the benefit of the group. One member may have particular needs that the therapist won’t be able to adapt to without taking care away from the other members. For example, one member struggling with his substance abuse and may benefit from the group’s involvement, yet his actions may harm the progress of others. Making people leave a group isn’t a decision that should be taken lightly as it may come with real feelings of rejection. The situation may be further complicated when the group needs sufficient members. Also, when one member leaves, other members may be more likely to leave upon the exit of the member, thus jeopardizing their progress and the progress of the other members.

    Group therapy also inherently allows the therapist less control over group. As Yalom noted, he had two similar groups, yet the first group who asked him about his injured leg was very different from the second group that was quieter. A group therapist should rely on empirical support, yet with group therapy there are more factors to consider that may limit the generalizability of research. Advising clients about these factors keeps them more informed and respects their autonomy, but it might be a deterrent or reduce their hope thus damaging beneficence. This also pertains to confidentiality between group members. Self-disclosure is important, yet the therapist cannot ensure confidentiality, so the client may experience real harm at his or her disclosure being revealed outside of group.

    Self-awareness of your own cultural identify and your awareness about the limitations of your knowledge. Next, a therapist should be aware of cultural aspects from members. The difficulty arises in adapting to relevant cultural features, yet not stereotyping or rigidly making assumptions about clients. There is often more within-group variability than between group variability, so assuming for example that all people from Mexico value family without checking, would be inadvisable. Therapist must find the modes of communication and intervention strategies that fit in well with the cultural identifies and beliefs of the clients. A therapist should read up on relevant literature including sociological, anthropological, counseling, and therapy studies. However, observing and socializing with people of different cultures seems like a more efficient way to learn about others. This combines learning with large numbers of people and firsthand experience of meeting people from other cultures. Finally, role-playing with people who are well-versed culturally can help apply the knowledge.

    Reply

  4. Sarah-Eve
    Dec 01, 2014 @ 08:00:04

    There are a multitude of potential ethical concerns that are unique to group therapy. For example, according to the Guidelines of Group Psychotherapy Practice, “The group psychotherapist safeguards the patient/client’s right to privacy by judiciously protecting information of a confidential nature.” This may be done as efficiently as possible, but individuals within the group must also be informed of their duty to protect the confidentiality of other group members. This becomes much more difficult when group members already know each other. Another potential ethical concern involving groups would involve competence. It is thus extremely important to adhere to specific inclusion/exclusion criteria and/or include screening interviews. Many individuals may experience co-morbid disorders, some of which may be outside of the scope of the group leaders practice. When a discovery is made that an individual is experiencing a disorder that falls outside of the leader’s expertise, or is so severe as to interfere with the group dynamics, appropriate referrals should be made and group members should be given time and reason as to why the other group member is leaving the group without interfering with that member’s privacy.

    A therapist may increase their awareness of their own cultural identity through self-awareness. Identifying one’s own cultural identity or sense of where one comes from is an important start. We must also be aware that we might in fact have biases, even ones that we are not yet aware of. Keeping track of our biased tendencies can help us become more self-aware. Addressing the development of racial identities can provide understanding into how one may come to terms with their own cultural/ethnic identity. After identifying how one may develop a particular identity, it would be important for these counselors to learn more about various cultures, which can foster awareness and sensitivity towards other cultural groups. Building upon cross-cultural counseling skills would also be beneficial. The group leader should be aware of how these different cultural backgrounds can influence the group’s dynamics (e.g., communication, norms, view of the therapist, etc.). Counselors may also have a discussion in the early stages of group regarding these influences.

    Reply

  5. Paige Hartmann
    Dec 02, 2014 @ 20:30:40

    One potential ethical concern related to group therapy is the issue of competence, which requires the practitioner to be competent in providing the services offered. For example, if the group therapist encounters a group member that has a disorder that is beyond their realm of expertise, the therapist should refer the client to another professional who is competent to treat that specific disorder. An additional ethical concern within group therapy is the issue of confidentiality. It is much easier to ensure confidentiality within individual therapy, however, within group therapy each member is privy to one another’s self-disclosure. Breaches in confidentiality can occur within group therapy when a group member shares information from another group member’s self-disclosure outside the group.

    Both self-awareness and self-assessment are necessary for therapists to improve their awareness of their own cultural identity. Self-awareness involves the therapist being able to recognize their own cultural identity development. This may include awareness of any potential biases, as these biases would impact the treatment that is provided. Therapists should strive to educate themselves on other cultures in order to provide culturally competent services.

    Reply

  6. Angela Vizzo
    Dec 03, 2014 @ 11:26:03

    Two ethical concerns that are unique to group therapy are the issues of informed consent and confidentiality. In individual treatment informed consent is usually assumed based on attendance and participation rather than explicitly stated or discussed, however this is not the case in group therapy. In group therapy, informed consent has to be at least verbally agreed upon, if not also obtained in written form. This can lead to many tricky discussions with clients and can easily discourage a reluctant member from participating. The informed consent process in group therapy, as described in the text, is similar to the informed consent process for research, where participants are informed of potential risks to treatment. These are usually not discussed in individual treatment, though some do apply such as negative feelings that may arise. Also, it is easier to predict that an individual can gain benefit from individual treatment based on the placebo effect and unconditional positive regard that is given; however, this is not always the case with group therapy as the therapist cannot control other members’ behavior. On those same lines, the therapist cannot guarantee confidentiality in group therapy. The therapist can stress the need to keep information shared in group confidential to the members, but they have not legal or professional obligation to uphold this confidentiality, as the therapist does.

    Therapists can improve their awareness of their own cultural identity through self-awareness and coming to terms with their own stereotypes and racial attitudes. They can do this through educating themselves about the concepts of prejudice and racism to further understand unconsious prejudices. The therapist can also immerse themselves in other cultures through direct contact with other cultures as well as reading books and articles about other cultures. Therapists should also be sure to read up on any cultural group that a new client is a part of in order to better understand them and conduct therapy in a culturally sensitive manner. Specifically for groups, if there is a member of a particular culture that others may not be familiar with, doing some group education on this could be helpful as well and aid in that member’s ability to feel comfortable in group.

    Reply

    • Sarah-Eve
      Dec 03, 2014 @ 13:40:48

      Understanding one’s own stereotypes and racial attitudes might be a challenging feat. Education can help identify what prejudices a person has. When a client is of a different cultural background than the other group members, I wonder if it would be a good idea to speak to them about their own cultural views. Perhaps assumptions could be made of one’s cultural identity that are not truly there and may interfere with the group dynamics. Obtaining the information directly from the individual may be helpful.

      Reply

    • Gil
      Dec 03, 2014 @ 16:53:19

      I like your suggestion of getting the client involved. We can learn about our own culture, the client’s culture, and meet others from the client’s culture, but ultimately each person is different within a culture. Reading and researching provide a great base from which to start, but we must adapt to the specific characteristics of the client. The client may adhere strongly to one value and reject another from the same culture. Assessment whether formal or informal would help tailor treatment to that unique client.

      Reply

    • Richard Hisman
      Dec 04, 2014 @ 08:39:36

      While I agree with your premise on confidentiality, let us not forget that the team building that is done can overcome this. It may be harder to start the disclosure process, but once it starts any apprehension should dissipate. There are no guarantees that the other group members will keep confidentiality, so we must do our best to assemble groups that will work together and work through the rest.

      Reply

  7. Michelle
    Dec 03, 2014 @ 13:22:41

    Counselors wishing to counsel any particular population should first become familiar with the issues and concerns related to it, and have gained thorough education, training, and supervision. Group therapy differs from individual therapy in that the setting requires attention to a different set of challenges, and in a setting where interacts are increasingly dynamic. A part of competency is understanding the specifics about a given population or environment. Before leading a group, counselors should ensure that they are competent not only in the area of treatment, but should be appropriately trained in the specific area of group therapy.
    One such way that a counselor can ensure competency is through proper supervision. Prior to leading a group, the counselor can co-lead or support a leader, gaining skills and knowledge that will later ensure readiness to treat in a group setting. Although individual treatment affords opportunities to observe, it doesn’t generally afford the opportunity to co-lead. Also important to acknowledge is that while treatments are continually being assessed, research proven in an individual setting may not have been empirically supported in a group one. Counselors should, once having obtained proper training, maintain skills by continuing to be aware of new research findings.
    Another issue of ethical significance in a group setting is confidentiality. While in an individual setting, the environment is controlled, and the client with only the therapist; in a group setting, there is an increased risk of a breach of confidentiality. It is thus the therapist’s responsibility to discuss these issues with the group, and encourage an environment where members understand both their responsibility to the other group members, and the risk involved. By sharing with members that the counselor cannot guarantee confidentiality among members, they can provide informed consent, in which the members fully understand the risks of group participation.
    Interestingly, the most common issue with confidentiality is not shared information, but instead revelation that the member is in the group. Again, the counselor can share these issues with members, and offer role plays and discussions if it seems necessary.
    Cultural and ethnic identity is formed over the years of development and into adulthood. Counselors can improve their own identity and understanding of the dynamics of the differences among the human race partly by engaging in it. By remaining open to talk, share, and openly ask and answer questions of another culture, both members and counselors can increase their cultural awareness, as well as any hidden biases of beliefs that they, themselves, may not have realized exist. Once counselors examine themselves, they can become increasingly self aware, and gain a more full understanding of their own as well as other races and cultures.
    At times, counselors or people in general, in an attempt to become culturally aware, may end up pin pointing specific and general cultural norms on a given culture. It’s also important to remain aware that even within culture or race, there are many differences, both through groups, subgroups, and in individuals, as well. Increased interactions with other cultures should help the counselor find a greater sense of awareness, understanding, and most importantly openness, and bring that back to the group.
    Another, simple way of increasing awareness is through reading books and articles, and watching various programs that may provide education about other cultures. Counselors well-versed may also find that they become more able to recommend various readings to clients who can also benefit from increased awareness. Discussion in professional organizations, with peers, and with supervisors can also be a helpful source of information. Overall, by remaining open, the counselor can learn by a variety of sources and environments, new information about both themselves and other cultures.
    An aside to this is my own journey, in which I have explored other cultures throughout my lifetime. One enlightening opportunity for me was being a host of exchange students as a teenager. My ex-husband was Chinese, which also provided a rich variety of experiences. Overall, and again, in my own life, I have found that encouraging a spirit of respect, interest, openness, and understanding, can help both ourselves and others to remain willing to explore other cultures and races.

    Reply

    • Sarah-Eve
      Dec 03, 2014 @ 13:36:32

      Understanding the way different cultures interact is important, especially in a group setting. This is important to understand as it may be unique to a client’s ethnic identity. Having competence in this area is ethically important, and acquiring appropriate training for the specific populations a group leader will be working with is vital to a successful group. Proper supervision and adequate training through research and continuing education could greatly help increase that competence.

      Reply

  8. Robert
    Dec 03, 2014 @ 15:28:03

    Many if not most ethical dilemmas involve two legal rights of informed consent and privacy. Before group therapy can begin, group therapists need to provide information to enable individuals the adequate basis for making a decision on whether or not to join the group and on their level of participation in the group. Clinicians are tasked with providing what constitutes a reasonable risk within their informed consent. They neither want to jeopardize client autonomy nor reduce the client’s motivation to be in group, denying the possible benefits of group therapy to the person. Violations in member-to-member confidentiality, whether intentional or not, is another unique concern to group therapy. It is crucial for candidates interested in group therapy to be made aware of this risk and the negative consequences a breach can pose. Securing a commitment to observe confidentiality from a potential member and specifying the consequences of violations of confidentiality are some methods of preventing breaches.
    Therapists’ understanding of their own cultural identity can be improved through self-awareness and assessment of their racial attitudes. It allows a group leader to sort out what his or her own conflicts on racial issues are, what the group’s conflicts are and the possible interactions. The therapist can experience other cultures through direct contact or reading books on other cultures. However, with the great variation in individual presentations of culture, formulating general approaches towards individuals of certain cultural backgrounds should be treaded cautiously. It is advisable that a clinician balances between understanding a client’s culture and being aware that the client is an individual who may be a product of their culture, but is not bound by it.

    Reply

  9. Jessica
    Dec 03, 2014 @ 16:43:40

    One reason group therapy has particular ethical considerations is that there are many more possible ways for ethical dilemmas to arise – not only between the therapist and one individual client but between the therapist and multiple group members, between the members themselves, or between one member and the rest of the group (if that member is an outsider in some respect). Ethical practices such as confidentiality (other members could share things about other members), informed consent (members may understand and expect different things from the therapy), preventing previous, concurrent, or future dual relationships, become much more complicated in group therapy than individual. Multicultural issues are much more salient in group. In individual therapy, it may be likely that my client is white and issues of race will never come up, but in group it is likely not all members will be of the same race, cultural background, age, and gender so it creates a micro-community in which stereotypes may be inevitably be enacted or delicately avoided (including by the leaders). The leaders should promote a healthy dialogue about these stereotypes, and this kind of dialogue doesn’t often happen in individual sessions and certainly not with other people with different experiences all contributing. Therefore it is extremely important for group leaders to be educated in ethics and in the population they are working with, and to receive supervision to get guidance on how to handle the many possible ethical and multicultural issues that can arise in group.
    One way therapists can increase their awareness of their own cultural identity and clients is to educate themselves more about different cultures through taking classes, reading, taking workshops, seeking out resources, etc. But nothing is going to educate a therapist as much about multicultural issues as working with or surrounding oneself with many people of different cultures. It should be more than just one person representing that culture so that the therapist doesn’t draw broad generalizations based on that one person, such as “My one gay client is really effeminate, so therefore all gay men are effeminate.” This can only come with experience and time, but a new therapist can seek out diverse populations to work with to gain this experience.

    Reply

    • Paige Hartmann
      Dec 05, 2014 @ 11:15:15

      Jessica, you make a valid point that therapist’s can increase their cultural awareness through educating themselves, although direct exposure to working with other cultures may be more beneficial.

      Reply

  10. Sarah Gagne
    Dec 03, 2014 @ 17:35:34

    I think competency can be difficult in group therapy. As we have seen among our classmates, individuals are often thrown into group therapy with very little knowledge, assuming individual skills can cross over. There are dynamics in group therapy that require expertise, and I feel that graduates and professionals do not get as much training as would be ideal. Competency involves understanding how to deal with multiple agents of change as therapists are unable to fully predict dynamics between multiple people, including reactions of others. Privacy and confidentiality can be tricky within a group setting as well. Clinicians need to be very clear about how confidentiality works in a group a setting, especially outside of group where it may not be appropriate to discuss what goes on in group with others. Informed consent should be involved and all group members should be aware of potential difficulties in treatment. There is also a question of privilege in court when group therapy is involved; it is not so cut and dry as in an individual therapy situation.

    Therapists must be aware of their own biases and how they are projected to the group. Therapists can increase self-awareness through monitoring their own interactions with others and through utilizing educational materials and opportunities of various cultures, especially if an individual in the group if a part of a culture the therapist knows little about. Leading a group with a diverse clientele, as much as possible in a given agency, can be a helpful learning experience for both the therapist and the client, and individual differences can be discussed in the group setting.

    Reply

    • Paige Hartmann
      Dec 05, 2014 @ 11:05:02

      Sarah, I agree with you that competency can be difficult within group therapy as often times the facilitators do not have the expertise needed to run an effective group. It is important for therapists to be aware of any possible limitations to their competency in running particular groups.

      Reply

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Adam M. Volungis, PhD, LMHC

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