Another Approach: Practice-Based Evidence Duncan, Miller, and Sparks (2004) have suggested a different way to incorporate data to improve treatment
1. Members should be made aware of the possibility that participating in a group (or any other therapeutic endeavor) may disrupt their lives. As mem-
bers become increasingly self-aware, they may make changes in their lives that, although constructive in the long run, can create turmoil along the way.
For example, changes that a woman makes as a result of what she gains in a group may evoke resistance, even hostility, in her partner, with a resulting strain on their relationship. Furthermore, others with whom she is close may not appreciate her changes and may prefer the person she was before get- ting involved in counseling.
2. Occasionally an individual member may be singled out as the scapegoat of the group. Other group members may “gang up” on this person, blaming him or her for problems of the group. Clearly, the group leader must take
ETHICAL AND PROFESSIONAL ISSUES IN GROUP PRACTICE
55 fi rm steps to deal with such occurrences. For more on the topic of scapegoat-
ing in group therapy, see Moreno (2007).
3. Confrontation, a valuable and powerful tool in any group, can be misused, especially when it is employed to destructively attack another. Intrusive in- terventions, overly confrontive leader tactics, and pushing members beyond their limits often produce negative outcomes. Here, again, leaders (and members as well) must be on guard against behavior that can pose a serious psychological risk for group participants. To lessen the risks of destructive confrontation, leaders can model the type of confrontation that focuses on specifi c behaviors and can avoid making judgments about members. They can teach members how to talk about themselves and the reactions they are having to a certain behavior pattern of a given member.
One way to minimize psychological risks in groups is to use a contract in which the leader specifi es his or her responsibilities and the members specify their commitment by stating what they are willing to explore and do in the group. Such a contract reduces the chances that members will be exploited or will leave the group feeling that they have had a negative experience.
Another safeguard against unnecessary risk is the ability of leaders to recog- nize the boundaries of their competence and to restrict themselves to working only with those groups for which their training and experience have properly prepared them. Ultimately, the group leader is responsible for minimizing the inevitable psychological risks associated with group activity. To best assume this responsibility, the leader will undergo the supervised practice and course work described later in this chapter.
The Ethics of Group Leaders’ Actions
Being a group practitioner demands sensitivity to the needs of the members of your group and to the impact your values and techniques can have on them. It also demands an awareness of community standards of practice, the policies of the agency where you work, and the state laws that govern group counseling.
In the mental health professions in general, there is a trend toward account- ability and responsible practice. Graduate programs in counseling and social work are increasingly requiring course work in ethics and the law.
Almost all of the professional organizations have gone on record as affi rming that their members should be aware of prevailing community standards and of the impact that conformity to or deviation from these standards will have on their practice. These organizations state explicitly that professionals will avoid exploitation of the therapeutic relationship, will not damage the trust that is necessary for a relationship to be therapeutic, and will avoid dual relationships if they interfere with the primary therapeutic aims. Typically, the ethics codes caution against attempting to blend social or personal relationships with profes- sional ones and stress the importance of maintaining appropriate boundaries.
Group counselors need to be mindful about misusing their role and power to meet their personal needs at the expense of clients. When group leaders meet their personal needs for power and prestige at the expense of what is best for the members, they commit an ethical violation. The role of leaders is to help members meet their goals, not to become friends with their clients. Of course, leaders who develop sexual relationships with current group members
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are acting unethically. They not only jeopardize their license and their profes- sional career, but they also degrade the profession at large. For a more com- plete discussion of these topics, see Herlihy and Corey (2006a, 2006b).
Socializing Among Group Members
An issue to consider is whether socializing among group members hinders or facilitates the group process. This concern can become an ethical issue if mem- bers are forming cliques and gossiping about others in the group or if they are banding together and talking about matters that are best explored in the group sessions. If hidden agendas develop through various subgroups within the group, it is likely that the progress of the group will come to an abrupt halt.
Unless the hidden agenda is brought to the surface and dealt with, it seems very likely that many members will not be able to use the group therapeuti- cally or meet their personal goals.
Yalom (2005) maintains that a therapy group teaches people how to form intimate relationships but is not designed to provide these relationships. He also points out that members meeting outside of the group have a responsi- bility to bring information about their meeting into the group. Any type of out-of-group socialization that interferes with the functioning of the group is counterproductive and should be discouraged. This is especially true in those situations in which participants discuss issues relevant to the group, but avoid bringing up the same issues in the group itself. As Yalom (2005) explains, “It is not the subgrouping per se that is destructive to the group, but the conspiracy of silence that generally surrounds it” (p. 352).
In some cases, out-of-group contact and socialization can be benefi cial.
From the perspective of feminist group therapy, out-of-group socialization is not viewed as harmful. This is especially true if members are selected carefully and are able to manage out-of-group contact so that it works to their own best interests and to the good of the group as a whole. During out-of-group contact, members often have the opportunity to expand on their goals outside of the group.
One of the best ways for the group leader to prevent inappropriate and counterproductive socialization among group members is to bring this issue up for discussion. It is especially timely to explore the negative impact of form- ing cliques when the group seems to be stuck and is getting nowhere or when it appears that members are not talking about their reactions to one another.
The members can be taught that what they do not say in the group itself might very well prevent their group from attaining any level of cohesion or achieving its goals.
The Impact of the Leader’s Values on the Group
In all controversial issues related to the group process, the leader’s values play a central role. Your awareness of how your values infl uence your leadership style is in itself a central ethical issue. Although it is not your proper function
ETHICAL AND PROFESSIONAL ISSUES IN GROUP PRACTICE
57 to persuade clients to accept a certain value system, it is appropriate that you
be clear about your own values and how your values infl uence the interven- tions you make in a group.
Value-laden issues are often brought to a group—religion, spirituality, abor- tion, divorce, gender roles in relationships, and family struggles, to name just a few. The purpose of the group is to help members clarify their beliefs and examine options that are most congruent with their own value system. Group counseling is not a forum in which leaders impose their worldview on the members; it is a way to assist members in exploring their own cultural values and beliefs.
You need to be clear about your own values and remain objective when work- ing with values that are different from your own. Doing this may necessitate that you seek consultation or supervision, especially if you become aware of a value confl ict that interferes with your ability to respect a particular value of a member. It is critical that group counselors increase their awareness of how their personal reactions to members may inhibit the group process. They must monitor their countertransference and recognize the danger of stereotyping individuals on the basis of race, ethnicity, gender, age, or sexual identity.
Members are best served if they learn to evaluate their own behavior to determine how it is working for them. If they come to the realization that what they are doing is not serving them well, it is appropriate for you to chal- lenge them to develop alternative ways of behaving that will enable them to reach their goals. A group is an ideal place for members to assess the degree to which their behavior is consistent with their own values. They can get feed- back from others, yet it will be their responsibility to make their own decisions.
Ethical Issues in Multicultural Group Counseling
BECOMING AWARE OF YOUR CULTURAL VALUES
If group leaders ignore some basic differences in people, they can hardly be doing what is in the best interests of these clients, which is an ethical matter.
Regardless of your ethnic, cultural, and racial background, if you hope to build bridges of understanding between yourself and group members who are dif- ferent from you, it is essential that you guard against stereotyped generaliza- tions about social and cultural groups.
Johnson, Santos Torres, Coleman, and Smith (1995) write about issues that group counselors are likely to encounter as they attempt to facilitate cultur- ally diverse counseling groups. These authors point out that group members typically bring with them their values, beliefs, and prejudices, which quickly become evident in a group situation. For Johnson and her colleagues, one goal of multicultural group counseling is to provide new levels of communication among members. This can be instrumental in assisting members in challeng- ing their stereotypes by providing accurate information about individuals. An- other goal of a diverse group is to promote understanding, acceptance, and trust among members of various cultural groups. For group leaders to facili- tate this understanding and acceptance in a diverse group, it is essential that they are aware of their biases and that they have challenged their stereotypes.
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Social justice issue often surface when working with people from cultur- ally diverse backgrounds (MacNair-Semands, 2007). In these instances, group leaders have an opportunity to transform the group experience and work to- ward healing rather than perpetuating harmful interactions marked by sex- ism, racism, and heterosexism. Leaders can do this by assisting members in evaluating their attitudes about a range of diversity issues. The ASGW (2008)
“Best Practice Guidelines” offers this guidance on recognizing the role of di- versity in the practice of group work:
Group workers practice with broad sensitivity to client differences including but not limited to ethnic, gender, religious, sexual, psychological maturity, economic class, family history, physical characteristics or limitations, and geographic loca- tion. Group workers continuously seek information regarding the cultural issues of the diverse population with whom they are working both by interaction with participants and from using outside resources. (B.8.)
An essential aspect of training for group leaders is promoting sensitivity and competence in addressing diversity in all forms of group work. Ethical practice requires that multicultural issues be incorporated in the training of group counselors (Debiak, 2007). There is increased recognition that all group work is multicultural; thus effective training of group counselors must address multicultural dimensions (DeLucia-Waack & Donigian, 2004; Ivey, Pedersen, &
Ivey, 2008). Addressing diversity is an ethical mandate, but this practice is also a route to more effective group work.
TRANSCENDING CULTURAL ENCAPSULATION
Cultural encapsulation is a potential trap that all group counselors are vulner- able to falling into. If you accept the idea that certain cultural values are supreme, you limit yourself by refusing to consider alternatives. If you possess cultural tun- nel vision, you are likely to misinterpret patterns of behavior displayed by group members who are culturally different from you. Unless you understand the val- ues of other cultures, you are likely to misunderstand these clients. If you are able to appreciate cultural differences and do not associate such differences with superiority or inferiority, you can increase your psychological resourcefulness.
Cultural encapsulation, or provincialism, can affl ict both group members and the group leader. As group counselors, we have to confront our own dis- tortions as well as those of the members. Culture-specifi c knowledge about a client’s background should not lead counselors to stereotype the client. Cul- turally competent group leaders recognize both differences among groups and differences within groups. It is essential that you avoid perceiving individ- uals as simply belonging to a group. Indeed, the differences between individu- als within a group are often greater than the differences among the various groups (Pedersen, 2000). Not all Native Americans have the same experiences, nor do all African Americans, Asians, women, older people, or people with disabilities. It is important to explore individual differences among members of the same cultural group and not to make general assumptions based on an individual’s group. Regardless of your cultural background, you must be pre- pared to deal with the complex differences among individuals from a variety of groups. You need to be prepared to deal with differences in areas such as race, culture, ethnicity, sexual orientation, disability status, religion, socioeco- nomic status, gender, and age (Lee & Ramsey, 2006).
ETHICAL AND PROFESSIONAL ISSUES IN GROUP PRACTICE
59 Certain practitioners may encounter resistance from some people of col-
or because they are using traditional White, middle-class values to interpret these clients’ experiences. Such culturally encapsulated practitioners are not able to view the world through the eyes of all of their clients. Wrenn (1985) defi nes the culturally encapsulated counselor as one who has substituted ste- reotypes for the real world, who disregards cultural variations among clients, and who dogmatizes technique-oriented defi nitions of counseling and therapy.
Such individuals, who operate within a monocultural framework, maintain a cocoon by evading reality and depending entirely on their own internalized value assumptions about what is good for society and the individual. These encapsulated people tend to be trapped in one way of thinking, believing their way is the universal way. They cling to an infl exible structure that resists adap- tation to alternative ways of thinking.
Western models need to be adapted to serve the members of certain ethnic groups, especially those clients who live by a different value system. Many clients from non-Western cultures, members of ethnic minorities, and women from nearly all cultural groups tend to value interdependence more than in- dependence, social consciousness more than individual freedom, and the wel- fare of the group more than their own welfare. Western psychological thought emphasizes self-suffi ciency, individualism, directness of communication, as- sertiveness, independence from family, and self-growth. However, many Asian Americans come from collectivistic cultures that value interconnectedness with family and community (Chung, 2004). In Asian cultures, moreover, family roles tend to be highly structured, and “fi lial piety” exerts a powerful infl uence;
that is, obligations to parents are respected throughout one’s life, especially among the male children. The roles of family members are highly interdepen- dent, and family structure is arranged so that confl icts are minimized while harmony is maximized. Traditional Asian values emphasize reserve and for- mality in most social situations, restraint and inhibition of intense feelings, obedience to authority, and high academic and occupational achievement. The family structure is traditionally patriarchal in that communication and author- ity fl ow vertically from top to bottom. The inculcation of guilt and shame are the main techniques used to control the behavior of individuals within a fam- ily (D. Sue & Sue, 1993).
These traditional values are shared by other cultural groups. For instance, Latinos emphasize familismo, which stresses interdependence over indepen- dence, affi liation over confrontation, and cooperation over competition. Par- ents are afforded a great deal of respect, and this respect governs all inter- personal relationships. The role of fate is often a pervasive force governing behavior. Latinos typically place a high value on spiritual matters and religion (Comas-Diaz, 1990). Torres-Rivera (2004) describes research that suggests that the common topics of discussion among Latino group members include rela- tionships, friendship, intimacy, sexuality, time, money, parenting, commitment and responsibility, decision making, power, rules, and morality.
The central point is that if the group experience is largely the product of values that are alien to certain group members, it is easy to see that such members will not embrace the group. Group counselors who practice ex- clusively with a Western perspective are likely to meet with a considerable amount of resistance from clients with a non-Western worldview. Culturally sensitive group practice can occur only when leaders are willing to reveal the
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underlying values of the group process and determine whether these values are congruent with the cultural values of the members. Group members can also be encouraged to express their values and needs. The major challenge for group leaders is to determine what techniques are culturally appropriate for which individuals.
Religious and spiritual beliefs are part of the cultural background of clients and can be considered as an aspect of multiculturalism. Group workers need education on how to effectively incorporate exploration of members’ spiritual and religious values as a part of a group experience. It is essential that group counselors also understand their own spiritual beliefs and values. Being sen- sitive to how cultural and spiritual values infl uence their own thinking and behavior will help group leaders work ethically and effectively with members who are culturally different from themselves. It is clear that ethical practice demands that group counselors possess the self-awareness, knowledge, and skills that are basic components of diversity-competent practitioners.
Uses and Misuses of Group Techniques
In leading groups, it is essential that you have a clear rationale for each tech- nique you use. This is an area in which theory is a useful guide for practice.
As you will see, the 11 theories at the core of this book give rise to many ther- apeutic strategies and techniques. Such techniques are a means to increase awareness, to accomplish change, or to promote exploration and interaction.
They can certainly be used ethically and therapeutically, yet they also can be misused.
Some of the ways in which leaders can practice unprofessionally are using techniques with which they are unfamiliar, using techniques in a mechanical way, using techniques to serve their own hidden agendas or to enhance their power, or using specifi c techniques to pressure members. Many techniques that are used in a group do facilitate an intense expression of emotion. For example, guided fantasies into times of loneliness as a child can lead to deep psychological memories. Such techniques should be congruent with the over- all purpose of the group. If leaders use such techniques, they must be ready to deal with any emotional release.
Leaders should avoid pushing members to “get into their emotions.” Some group leaders measure the effi cacy of their group by the level of catharsis, and group leaders who need to see members experience intense emotions can ex- ploit the group members. This expression of emotion can sometimes reveal the leader’s needs rather than the needs of the members.
Techniques have a better chance of being used appropriately when there is a rationale underlying their use. Techniques are aimed at fostering the client’s self-exploration and self-understanding. At their best, they are invented in each unique client situation, and they are a collaborative effort between the leader and members. Techniques assist the group member in experimenting with some form of new behavior. It is critical that techniques be introduced in a timely and sensitive manner, with respect for the client, and that they be abandoned if they are not working.
In working with culturally diverse client populations, leaders may need to modify some of their interventions to suit the client’s cultural and ethnic