Scenario 1
Several ethical dilemmas are associated with confidentiality issues, as well as confidentiality exceptions, and the first scenario describes such a situation. During one session, Tom admitted that he used to be sexually attracted to a minor. Lee, another participant, is worried by this confession because his niece is a friend of Tom’s daughter, and the girls plan a sleepover. The group leader needs to consider the ethical principles related to confidentiality and help Lee find a solution that would not damage Tom’s well-being.
Ethical Principles at Play: Discussing Tom outside of the Group
Every relevant ethical code cites confidentiality as one of the primary ethical principles for therapy. Some of the examples of such codes include those by the American Psychological Association [APA] (2017), the Commission on Rehabilitation Counselor Certification [CRCC] (2017), and the American Association for Marriage and Family Therapy (2015), as well as the American Group Psychotherapy Association [AGPA] and International Board for Certification of Group Psychotherapists [IBCGP] (2002). From this perspective, the discussion of Tom’s statements outside of the group is unethical and should only be done with his permission as stated, for example, by point 2.4 of the ethical guidelines by AGPA and IBCGP (2002).
However, all of the mentioned codes of ethics also note that there are confidentiality limitations. Such limitations are commonly concerned with legal requirements, as well as the likelihood of harm and danger to a client or others (Corey, 2016; Elger, Handtke, & Wangmo, 2015). If the law requires disclosing the information from the session or if Tom’s interest in minors is a danger, no permission from him is needed for reporting his confession as indicated, for instance, by the standard 4.05 from APA’s (2017) code of ethics.
Decision-Making: Determining the Importance of Tom’s Non-Action, Offering Lee Advice, and Dealing with the Situation
Based on the above-described ethical standards, a decision-maker needs to determine if the situation warrants the disclosure of the information provided by Tom. Mandatory reporting may refer to child abuse, as well as hebe- or pedophilic interest (McPhail, Stephens, & Heasman, 2018). It is the responsibility of the group leader to be familiar with the relevant legislation and determine if reporting is necessary; it is a part of a leader’s competence as shown, for example, by the C.f standard from the CRCC’s (2017) code of ethics. However, Tom mentions attending psychotherapy for people with similar issues, and the case has probably been reported. Also, mandatory reporting presupposes providing the information to relevant governmental structures; it does not refer to informing other people about Tom’s situation.
The data from the scenario imply that Tom was diagnosed with paraphilia as defined by the American Psychiatric Association (2013). The American Psychiatric Association (2013) points out that relevant treatment allows managing the problem, which would suggest that Tom is not very likely to pose a significant danger. Also, certain potential complications for Tom are noteworthy. Non-offending people with hebe- or pedophilic interests risk stigmatization, alienation, and even abuse (Hazelwood, Baker, Murray, & Stanley, 2018; McPhail et al., 2018). Psychotherapists also report the possibility of mandatory reporting hurting their rapport with a client (Hazelwood et al., 2018). Thus, the situation may have negative implications for Tom or the work of the group in case it is not handled appropriately.
For the group leader, the following plan of action could be proposed. Lee’s concerns cannot be dismissed, but it cannot be recommended to inform other people, especially those who know Tom, about the information that Tom shared during a session. Lee asking his brother to prevent the sleep-over without explaining why would probably still raise concerns. Also, it is not fully ethical to discuss the situation outside of the sessions and without Tom being present. Therefore, it may be reasonable to arrange for Tom and Lee to consider the problem with the group leader as a mediator. If this discussion happens, the group leader should pay attention to Tom because of the sensitive nature of the topic.
Summary
The first scenario presents a situation in which the limits of confidentiality come to the forefront. However, it is important to remember that mandatory reporting laws do not presuppose disclosing sensitive information to anybody outside of the governmental structures responsible for such matters unless significant danger can be identified. As a result, the solution needs to balance Lee’s concerns and Tom’s well-being, and the group leader should offer support to both.
Scenario 2
In group therapy, confidentiality is important for members to take into account. The second scenario refers to a situation in which Lena, who reluctantly attends mandatory group therapy sessions, used sensitive information about her peer Becca to taunt the girl in the schoolyard. It is not clear if the situation involved onlookers, but it still indicates a breach of privacy. Given that the sensitive information refers to Becca being abused by her father, the scenario presupposes the consideration of multiple ethical issues.
The Problem of Selecting Group Participants: Rules for Lena and Her Potential Expelling
The rule that Lena broke is technically connected to confidentiality. In group therapy, participants are supposed to respect other members’ privacy, and Lena must have been informed about it (Cooper, Hudson, Kranzberg, & Motherwell, 2017). This responsibility is reflected, for example, in the A.7.e standard of the American School Counselor Association [ASCA] (2016). Furthermore, as pointed out by CRCC’s (2017) code of ethics, group work requires carefully selecting potential participants; their activities must not be disruptive and detrimental to other members of the group, which is established by standard A.7.a.
Given that Lena’s actions may be described as disruptive and harmful, excluding her from the group is not out of the question. The mandatory nature of Lena’s participation is also a problem. It is an explanation for her lack of motivation, and it is not fully in line with the respect for clients’ autonomy that is required from a therapist by various codes of ethics; see, for example, ASCA’s (2016) preamble to the Ethical Standards for School Counselors. Depending on the group leader’s assessment of Lena’s behavior during sessions, it may be fully justified to expel her from the group.
However, it appears reasonable to discuss the issue with Lena first. She needs to be reminded of group therapy requirements, and her misconduct needs to be highlighted. An explanation of the negative effects of her behavior may be a good idea. She should also be informed about the possibility of her being expelled, which could be problematic for her since she is attending mandatory therapy.
Finally, she can be offered to remain in the group if she agrees to follow certain rules. Those rules are going to be concerned with her having to take into account the needs of other participants. She will be asked to refrain from disrupting sessions and reminded of her responsibilities, especially those related to privacy. The rules should establish that further misconduct will not be tolerated. This way, Lena could be provided with the structure necessary for her improved engagement in the therapy.
Ethical Responsibilities of the Group Leader: Reacting to the Scenario and Taking Additional Steps
An important additional step is concerned with the group leader’s responsibilities toward Becca. Even if she is not a minor anymore, she is apparently in danger, which is why, according to every code associated with psychotherapy, the case needs to be reported (Elger et al., 2015). The standard A.8.d from ASCA’s (2016) code of ethics may serve as an example. It is also necessary to approach Becca with a discussion of the abuse that she has suffered from and suggest solutions, including those that might remove her from her father’s house or otherwise protect her from repeated abuse until the case is sorted out by the relevant authorities. After she is safe, she may require other interventions, including psychotherapy; ASCA’s (2016) A.11 standard provides suggestions on this topic.
However, when the conflict with Lena is concerned, the group leader’s primary responsibility is to manage the current instance of bullying and prevent future ones. The standard A.11 by ASCA (2016) may be used for guidance in this regard. School counselors work with victims and perpetrators, which means that the group leader has a responsibility to protect Becca and propose interventions for Lena that would assist her in correcting her behavior. It is the ethical responsibility of the group leader to attempt to help her with her behavioral problems.
Summary
The behavioral issues exhibited by Lena could be classified as bullying, and they involved handling sensitive information rather carelessly. While it is possible to expel her from the group, it is more ethical to attempt to assist her in correcting her behavior by establishing strict rules. Becca’s situation is rather dire and requires significant interventions, which are going to be concerned with reporting the abuse she was subjected to and providing her with relevant services.
References
- American Association for Marriage and Family Therapy. (2015). Code of ethics. Web.
- American Group Psychotherapy Association, & International Board for Certification of Group Psychotherapists. (2002). AGPA and IBCGP guidelines for ethics. Web.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders; DSM-5 (5th ed.). Washington, DC: American Psychiatric Publishing.
- American Psychological Association. (2017). Ethical principles of psychologists and code of conduct. Web.
- American School Counselor Association. (2016). ASCA ethical standards for school counselors.
- Commission on Rehabilitation Counselor Certification. (2017). Code of professional ethics for rehabilitation counselors.
- Cooper, E., Hudson, J., Kranzberg, M., & Motherwell, L. (2017). Current and future challenges in group therapy. International Journal of Group Psychotherapy, 67(sup1), S219-S239. DOI: 10.1080/00207284.2016.1238750
- Corey, G. (2016). Theory and practice of group counseling (9th ed.). Boston, MA: Cengage Learning.
- Elger, B., Handtke, V., & Wangmo, T. (2015). Informing patients about limits to confidentiality: A qualitative study in prisons. International Journal of Law and Psychiatry, 41, 50-57. DOI: 10.1016/j.ijlp.2015.03.007
- Hazelwood, T., Baker, A., Murray, C., & Stanley, M. (2018). New graduate occupational therapists’ narratives of ethical tensions encountered in practice. Australian Occupational Therapy Journal, 0, 1-9. DOI: 10.1111/1440-1630.12549
- McPhail, I., Stephens, S., & Heasman, A. (2018). Legal and ethical issues in treating clients with pedohebephilic interests. Canadian Psychology/Psychologie Canadienne, 59(4), 369-381. DOI: 10.1037/cap0000157