This is critical, because inclusion is an important social phenomenon. "Communities who are strong and inclusive lead to better quality of life, stronger sense of identity and belonging, sharing mutual respect and equality. It is further recognised that a cohesive and inclusive community is one where there is a common vision and sense of belonging for all communities; the diversity of people's different backgrounds and circumstances are appreciated and positively valued; those from different backgrounds have similar life opportunities and strong and positive relationships are being developed between people from different backgrounds in the workplace, in schools and within neighbourhoods" (Holland & Ousey, 2011). Inclusiveness would seem particularly critical in a therapeutic environment, because group members who feel excluded would seem unlikely to participate in the therapeutic process, which would, in turn, impact the effectiveness of the entire group. Inclusiveness is strongly related to the concept of social justice.
Although there has not been an emphasis on social justice in group work literature, there is a suggestion that social-justice based approaches should be incorporated into group therapy environments (Macnair-Semands, 2007). What this suggests is that cultural issues, which can include race, religion, social class, and gender issues, are probably going to play an important role in group dynamics, even in a therapeutic setting that ostensibly has nothing to do with those social classifications. Moreover, the group facilitator has to be consciously aware of the bias that exists in society, as a whole, and make efforts not to allow that bias to repeat as part of the group process.
One particular type of group that is likely to contain members from a wide variety of cultural backgrounds is an addiction/recovery group. Interestingly enough, addiction counselors frequently have to deal with ethical issues that go beyond what other group facilitators face. This is because addiction is a unique disease and is diagnosed by some of the problems that face counselors in the area, such as relapse and deceit. Both of these factors have the potential of being very detrimental in a group environment, but can also be instructive if managed appropriately. Moreover, some of the more successful addiction group models do not rely upon professional facilitators, which can create an ethical issue for counselors working in the field, who may see a conflict between these traditional approaches and what the counselor understands to be best practices in the field. As a result, addiction counselors must be cognizant of several ethical issues, including, but not limited to: the lack of agreement over credentials for group leadership; differences in what research has revealed and what is being done in the field; questions regarding the efficacy of group work to treat addictions; confidentiality; informed consent; and any reporting requirements (Scott, 2000). The last requirement is particularly important; many people are referred to addiction groups as part of court-ordered programs, so that the counselor takes on a dual function as a member of the court and as a mental-health professional. While this can occur in other group settings, it is a frequent occurrence in addiction treatment groups.
After cultural considerations, the most pressing ethical dilemma for group therapy may be the issue of confidentiality. In a one-on-one therapeutic setting, therapists are generally going to have clearly outlined professional guidelines regarding patient confidentiality, as well as specific consequences for violating patient privacy. In a group environment, these safeguards of patient privacy evaporate; the group members have no professional obligations to one another. Therefore, any member of a therapy group faces the risk that confidential information will be shared inappropriately with people outside of the group. Furthermore, it is critical to keep in mind that group members do not have to have malicious intent to violate one another's confidentiality:
Groups are social by nature, and there is often incentive for group members to gossip about what they have heard or witnessed in a group-therapy session (Lakin, 1986). To help protect clients' rights to privacy, the APA's Ethical Standard 10.03 advises clinicians to "describe at the onset the roles and responsibilities of all parties and the limitations of confidentiality" when providing services in a group setting (p. 1072). In particular, it is important for group therapists to warn members about the importance of keeping confidences, inform group members about the dilemma of confidentiality in a group therapy setting, inform clients of the possible risks associated with breaches in confidentiality, and take...
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