Abstract
Psychological aid to the client, rendered in group mode, is used to solve personal and interpersonal problems. In a group, the person can acquire social skills of communication and interaction by openly discussing his or her problems, receiving social support from their participants, and providing it to other people. He or she can also increase the level of his or her vitality, social activity, confidence, and socio-psychological competence. In psychological practice, there are various types of group work with the client. Such work’s goals are to solve problems of vital activity, search for life resources, and find new constructive stimuli and options for behavior. Vocational guidance also forms an essential part of it. In this work, group psychotherapy as a type of professional activity of the psychologist who subordinates his or her activity to ethical requirements and norms will be considered.
Introduction
Knowledge of group processes, chief among which is group dynamics, is extremely important for understanding the ethical foundations of work in group therapy and social psychological training. Kurt Lewin introduced the group dynamics concept into psychological practice. The result of his work on the problem of group dynamics and social interaction was the development of the theory of dynamic psychology. Lewin understood group dynamics as a discipline studying positive and negative forces that act in a group (Barwick & Weegmann, 2017). Dynamics is a set of intragroup socio-psychological processes and phenomena characterizing a small group’s whole cycle of activity and its stages. The stages include formation, functioning, development, stagnation, regression, and disintegration.
In the context of group psychological work, it is accepted to allocate five elements in the characteristic of group dynamics: the group goals, the structure of the group, and the phase of development of the group. When developing a group psychotherapy program or social-psychological training, it is essential not to miss any of the named elements and see possible difficulties in group work (American Counseling Association, 2014). Work on group dynamics should be conducted considering the ethical principles of activity, respect, dialogization of interaction, and feedback.
Literature Review
Even though each of the elements of group dynamics contributes to practical group work, it is necessary to emphasize such phenomena as group cohesion. If interaction in a dyad, the psychologist-consultant-client is significant in individual work, and group cohesion is significant in group work. It is understood as an indicator of the group’s stability based on trustworthy interpersonal solid relations and a coincidence of interests of its participants. Another phenomenon that is important to consider in working with a group is group tension. It is associated with the internal tension and anxiety of participants in the group.
Reasons for group tension may be dislike of the other participants or displays of aggression or conflict. Suppose group tension has a strongly pronounced character, lasts a long time, and is not compensated by group cohesion. In this case, it can lead to negative phenomena, including the disintegration of the group. Therefore, the psychologist and therapist need to maintain a balance between group cohesion and group tension (American Counseling Association, 2014). More often, group tension should be used in the first stages of the development of the group in order to bring it to be independent and constructive behavior. However, many psychologists prefer to increase group cohesion or group tension at different stages of group work.
In addition to the factors above, confidentiality is a cornerstone of the professional ethics of psychotherapy. The group therapist should constantly emphasize the requirement of confidentiality, starting with the preliminary conversation. If it turns out that any of the participants violate this requirement, it should be the subject of a group discussion. On the other hand, the requirement of confidentiality is not an absolute principle. In some cases, the group therapist is not bound by this principle. For example, Barwick and Weegmann (2017) mention a case where a participant’s intentions or actions pose a danger to him or herself or others. Barwick (2017) also provides an example where there is a threat of violence against children or special written permission from the participant.
The issue of confidentiality has certain peculiarities in child psychotherapy groups. Parents can take an interest in what their children talk about in groups (Barwick & Weegmann, 2017). The therapist is responsible for maintaining confidentiality but at the same time, cannot ignore the parents’ desire to know what is going on with their children. Parents can be told about the goals of the group and the general behavior of the children in the group but should not be told what the children are talking about specifically. It is desirable that the child also participates in the group conversation about him or her.
However, parents or guardians should also be aware of what might happen in the class. This information can be given to them in an appendix to the consent form, where one can list the topics of the class, describe some of the techniques and explain the confidentiality rules again. In this way, the legal side of the issue can be specified while giving parents as much information as necessary. Speaking about the legal side of the issue, Weegmann (2017) recommends separately stating that parents will be informed if there is a situation where confidentiality has to be broken in the process of work.
When discussing the legal and ethical impact of confidentiality on group therapy, situations of breach of confidentiality are significant factors. Breach of confidentiality is a serious problem because all group work is based on a relationship of trust. It is also based on the belief that no one in the group will tell the others about what is going on in class (American Counseling Association, 2014). Without trust, there will be no self-disclosure, and without self-disclosure, there will be no group work. People with trust issues are very wary of others. For such participants, the group appears to be a very untrustworthy place. Different from Barwick and Weegmann, Malhotra and Baker (2020) emphasize the following recommendations. For instance, all group members should be involved in discussing the consequences of breaking confidentiality. This will take the mystery out of the problem and allow clients to feel a sense of ownership of such an important issue.
If confidentiality is breached, participants should be allowed to express their anger, frustration, and resentment openly. Everyone has every right to speak out about what happened. They need to feel that the facilitator shares their feelings and that they are following the ground rules without fail. If a group member accuses another of revealing information about the group’s work, it is imperative that the matter be discussed in the session. This is very important and can teach the group members a lot. The algorithm for the discussion is approximately this – let one side share its information, then ask the other side to explain the situation from its own point of view. Then it is worth giving everyone the opportunity to comment on the situation and offer their own solutions to the problem.
It should be remembered that violation of confidentiality can lead to clients’ fear of group therapy. For example, Akshay Malhotra and Jeff Baker’s (2020) work emphasizes this effect of unethical non-compliance with confidentiality precisely. One of the most basic and deeply rooted fears experienced by people entering group therapy is that they will be obliged to disclose and confess shameful transgressions and fantasies to strangers. Often there is an expectation of critical, mocking, venomous, or humiliating reactions from other participants (American Counseling Association, 2014). Malhotra (2020) gives the example that it may look like the Last Judgment held by a harsh, devoid of any compassionate tribunal in fantasies or dreams. In addition, a state of anxious anticipation before group therapy can lead to anxiety related to the client’s earlier social, group, or intrafamilial experiences. Closely related to the dread of violent confessions is anxiety about confidentiality.
Therefore, to comply with ethical and legal standards of non-disclosure, the group therapist must take steps to protect group members by defining the terms of confidentiality and its limitations. If the member’s condition represents a danger for him or herself, others, or the group as a whole, the psychotherapist has a duty to take appropriate measures or to inform the relevant authorities. He should also emphasize the importance of maintaining confidentiality and defining appropriate rules for all group members. The group members should be warned about the obligation to observe these rules before the group work begins and should then be repeatedly reminded of them during the group work. However, it should be made clear that complete confidentiality cannot be guaranteed.
The psychotherapist should inform the group members of the problems associated with maintaining confidentiality in the group setting. In order to increase the level of responsibility of the group members and decrease the probability of such violations, the psychotherapist can give examples of how confidentiality may be broken unintentionally. The therapist should inform group members of the possible consequences of an intentional breach of confidentiality. All of these actions are required by ethical and therapeutic jurisdiction. This is the effect these norms have on psychological practice – they broaden the range of responsibilities of the therapist. He is responsible for maintaining confidentiality not only for himself but also for the rest of the group. The therapist is obliged to prevent violations of confidentiality by talking to the group members and explaining the rules of group ethics.
From a legal standpoint, the law imposes specific formal requirements on the therapist regarding confidentiality. The rule of doctor-patient confidentiality is enshrined in many codes of ethics, starting with the Hippocratic Oath. The subject of confidentiality is the diagnosis of illness, health data, prognosis, and all of the information the physician receives from interviews and from listening to patient complaints. Non-medical information about the patient and his relatives, which becomes known to the doctor in the course of his duties, should also be confidential. The law defines a relatively narrow range of situations in which the patient is unable to express his or her own will, for example, due to impaired consciousness or minors. It also restricts the rule of confidentiality when there is a threat of the spread of infectious diseases, mass poisoning, or lesions. The law also allows the confidentiality rule to be violated if the physician has reason to believe that the patient’s mental health impairment was the result of wrongdoing.
Confidentiality in the doctor-patient relationship is desirable because it affirms and protects another, more functional value: privacy. Each person has a closed area of the inner world – thoughts, experiences, memories, and information about psychological and social characteristics. This part of the inner world is accessible only to very close people and only partially. In the healing process, something of the content of the inner world can become known to the doctor for more effective treatment.
Regarding the ethical aspect, many researchers, particularly Jackie Woods and Nicole Ruzek (2018), emphasize that the principle of confidentiality is a condition for protecting the patient’s social status. People live in an imperfect world, where a medical diagnosis or other medical information can often become a stigma for a person, significantly limiting his or her opportunities for social self-affirmation. When such information becomes public, it often causes unconscious reactions in others, expressed in the patient’s social isolation (Corey et al., 2017). As a result, a peculiar social vacuum is formed around him. Each person’s social place and status is essential. Breach of confidentiality poses a direct threat to this human value. Confidentiality of the therapist-patient relationship is also necessary to ensure frankness of communication. When exposing himself spiritually, the patient must be assured that this will not lead to undesirable consequences. Only confidence in strict observance of confidentiality ensures frankness, without which normal professional activity of psychotherapy workers is impossible.
Ezhumalai et al. (2018) also highlight the opposite side of the lack of confidentiality. The therapists’ ability to maintain confidentiality determines their image in the eyes of society and their popularity. Modern legislation gives patients the right to choose a doctor and a medical institution. Naturally, in a situation of choice, preference will be given to the one who demonstrates compliance with a high moral standard in addition to high professional qualities. By protecting confidentiality, psychotherapy practitioners ensure trust in the relationship with the patient. The concept of trust is broader than that of candor. For example, a patient may find themselves in a situation in which, due to severe psychological trauma, control of their condition is entirely in the hands of the therapist. The patient must trust the therapists to have their best interests at heart in all such situations.
Returning to the legal aspect, confidentiality is also relevant to the patient’s right to autonomous and effective control over what and how things happen in his life. In a number of cases, this right intersects with the protection of privacy and the need to safeguard patients’ social status and economic interests. The disclosure of medical information makes a person more vulnerable and dependent. Ethical norms and rules are adjacent to the legislation on health care. They are formulated in deontological (moral) codes, which can guide the therapist in his/her interactions with patients, colleagues, representatives of related professions, and the public. Medical ethics is not a speculation but a real phenomenon that determines the doctor’s image, whose successful activity requires knowledge of medical ethics and general medical deontology. Medical deontology determines the job description of each medical professional and formulates rules of official conduct, fixing them in appropriate instructions. It also determines the primary means of enforcing these rules and forms of control over their implementation.
Conclusion
Today, when psychotherapeutic and psychological aid is becoming more and more in demand, one can sometimes see violations of the ethics of professional psychotherapeutic relationships. With the broad expansion of psychotherapeutic practices and the numerous studies in psychotherapy, ethical problems are becoming more and more pronounced. Many professional communities are developing their own ethical frameworks for psychotherapy. Emotional disorders are treated much more effectively in an environment where there is a lot of interaction, namely when several people are reacting both verbally and non-verbally. During individual psychotherapy, the only reaction the patient receives is that of the therapist. In group therapy, the patient receives an emotional response from everyone in the group.
The implications of confidentiality in group dynamics are significant. They are that in order to comply with the ethical and legal principles of confidentiality, the therapist has an additional obligation and follows a number of strict rules. This is because confidentiality is one of the most important components of group psychotherapy (Wheeler & Bertram, 2019). The condition of confidentiality is one of the basic ones on the list of ethical standards. The psychotherapist is called upon to protect the details of the patient’s private life and observe the principles of confidentiality of the information he or she communicates. Confidentiality in the psychotherapeutic process accelerates the self-disclosure of the patient and the establishment of qualitative contact.
However, there are conditions under which confidentiality breaks down. The exception to the rule may be those exceptional cases in which there is a real threat to the health or life of the patient or others. In these cases, the therapist may take the steps necessary to inform third parties or organizations without the patient’s consent. Ethical and legal aspects may be intertwined in these cases of confidentiality restrictions when it comes to the psychotherapy of a patient prone to cyclical offenses. In a situation of potential threat, confidentiality inevitably breaks down.
The therapist’s attitude toward humanity and the patient’s right to confidentiality must all be reconciled with the therapist’s professional and citizen aspirations. The therapist has a strict duty of confidentiality concerning the client or the group. Breaking confidentiality is only possible if there is a breach of the law or danger to the client’s life or of others. In this case, the client is immediately informed of the need for the therapist to break the principle of confidentiality. If all ethical and legal rules of confidentiality are respected, the process of group therapy through group dynamics can be conducted successfully. In this way, all patients will feel comfortable and be able to approach a solution to their problems.
References
American Counseling Association (2014). 2014 ACA Code of Ethics. Alexandria.
Barwick, N., & Weegmann, M. (2017). Group therapy: A group analytic approach. Routledge.
Corey, G., Corey, C., & Callanan, P. (2017). Issues and ethics in the helping profession (10th Ed.). Cengage.
Ezhumalai, S., Muralidhar, D., Dhanasekarapandian, R., & Nikketha, B. S. (2018). Group interventions. Indian Journal of Psychiatry, 60(4), 514–521. Web.
Malhotra A, & Baker J. (2020). Group therapy. StatPearls Publishing.
Wheeler, A. M., & Bertram, B. (2019). The counselor and the law: A guide to legal and ethical practice. Wiley.
Woods, J., & Ruzek, N. (2018). Ethics in group psychotherapy. In M. D. Ribeiro, J. M. Gross, & M. M. Turner (Eds.), The college counselor’s guide to group psychotherapy (pp. 83–100). Routledge.
