Ethical Issues in Group Counseling, Coursework Example

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Coursework

Experiential techniques, such as psychodrama, have tremendous therapeutic potential: properly used, they can help clients to overcome fears and negative affect associated with memories and situations in life. And yet, because of the tremendous power of these techniques and the emotions they evoke, the therapist must be vigilant against their misuse. Improperly used, psychodrama and other techniques can cause great harm, undermining the goals of therapy and precipitating client resistance. The proper and ethical use of psychodrama and other experiential techniques emphasizes the empowerment of clients, respect for their self-determination, and supportive guidance to help them overcome their own resistance to positive change.

Psychodrama is a powerful experiential technique, but one that carries with it a number of particular ethical concerns. As Klontz (2004) explained, psychodrama is a very action-oriented approach, one that consists of having a client perform “’past, present, or anticipated life situations and roles in an attempt to gain deeper understanding, achieve catharsis, and develop behavioral skills’” (Corey, 1990, as qtd. in Klontz, p. 174). As such, psychodrama has a great deal of potential if used properly, but this requires a high degree of competence on the part of the therapist (p. 174). From this it follows that the clinician must be thoroughly trained and receive appropriate supervision. In fact, in addition to “supervised specialty training”, clinicians should experience psychodrama as clients before they are allowed to guide their own clients through the process on their own, unsupervised (p. 174).

There is a very good ethical reason why clinicians should receive in-depth, highly supervised training in psychodrama, as well as experience it as a client, before guiding their clients through it: the well-being of their clients (Klontz, 2004, p. 174). This much is intuitive for any technique, but with psychodrama the stakes could scarcely be higher: after all, the patients will be dramatizing life situations and roles that will typically have powerful, and potentially traumatizing, emotional resonances and meanings for them (p. 174). This is why competence carries special importance with respect to this technique: it is not enough for a practitioner to be competent in psychotherapy generally, they must also be very competent in psychodrama and aware of the risks (p. 174).

And, too, for some clients psychodrama should be avoided. As with all techniques, psychodrama has its limits, and it is imperative that the practitioner know what they are (Klontz, 2004, p. 175). With clients who are severely disturbed or psychopathic, as well as those “who are acting out”, the practitioner must take even greater care with using psychodrama, if indeed psychodrama is used at all (p. 175). The emotional catharsis facilitated by psychodrama and by certain other experiential techniques may be deleterious for some clients (p. 175). Klontz listed several categories of individuals for whom emotional catharsis-inducing experiential techniques may not be appropriate: “individuals who are actively abusing substances or individuals who (a) are heavily medicated, (b) have dissociative or psychotic disorders, or (c) have labile mood or difficulty regulating affective states” (p. 175). The therapist must keep this in mind when applying the technique, and avoid using it with clients who may be expected to be harmed by it rather than helped.

Because of the emotional power of psychodrama and other experiential techniques, the therapist should follow certain guidelines for best practices, in order to take care to ensure that the techniques are not misused (Klontz, 2004, p. 175). One absolutely essential guideline is the use of techniques to “work with emotional issues raised by group members”, as opposed to using them in a way that has the effect of stirring up clients’ emotions (p. 175). This is of great importance when using such powerful techniques, because of the sensitivity of the emotions involved (p. 175). And, too, the therapist must take care to safeguard participants from any kind of emotional coercion, whether from the therapist themselves or from other participants: participants should be free to participate as they desire and see fit, or to not participate if they are not comfortable with this (p. 175).

Leader power issues warrant especial discussion. The cardinal imperative here is that leaders must ensure that clients are not coerced in any way beyond their comfort level of participation (Klontz, 2004, p. 175). Therapists must be supportive, rather than intrusive, and must refrain from applying pressure on the client (p. 175). Applying pressure can actually harm the client, and therefore impede the goals of therapy: after all, if the client is feeling pressured, they will be less likely to actually deal with whatever is troubling them, and more likely to experience a compounding of their problems (p. 175).

As Klontz (2004) explained, “directive and confrontational therapeutic efforts evoke client noncompliance and resistance” (p. 175). The misuse of power by the therapist as leader, then, can actually undermine therapy and harm the client’s prospects for well-being. Leaders must also check their egos: an unfortunate ethical issue here is the misuse of experiential techniques by therapists in order to meet some egotistical need of their own, rather than to actually help their clients (p. 175). Therapists must also be patient, and not push clients to progress on the therapist’s timetable, but rather their own (p. 175). Rather than trying to rush or domineer their clients, then, therapists should respect their clients’ needs and rights, and the “natural growth processes” that are so foundational to the client’s well-being (p. 175). Indeed, the therapist should follow the lead of their clients in therapy, in order to allow the clients to set the pace (p. 176).

The key model here is one of empowerment: the therapist empowers the client to achieve their aims and fulfill their potential, albeit at their (the client’s) own pace (Klontz, 2004, p. 176). The therapist is responsible for providing a certain amount of structure, to be sure, and must also help the client by providing guidance; nonetheless, the intervention must proceed at the pace set by the client (p. 176). The therapist can provide insight, guidance, and support, helping the client in their journey of self-discovery and healing (p. 176).

And of course, a major task of the therapist is to help the client deal with their own resistance to the healing brought by positive change (Klontz, 2004, p. 176). Reconciling this with the aforementioned framework of empowerment and client-set pace may seem an exercise in paradox, but in truth the two are complementary, for the task of the therapist is to help the client overcome their own resistance and be comfortable with moving forward (p. 176). The therapist must work in collaboration with the client: they must be ready and willing to partner with the client (p. 176). As such, the therapist offers insight and guidance, but offers respect as well: respect for “client’s autonomy and right for self-direction” (p. 176). To that end, the therapist should help the client to either reflect on the blockage, or move away for the time being to analyze something else, and then return to the issue at the client’s pace (p. 176).

Experiential therapy can be powerful: through dramatizing key issues, memories, and situations, clients can experience emotional catharsis and gain newfound strength. The power of these techniques, however, requires proper care on the part of the therapist: care to proceed at the client’s pace and for the client’s benefit. The therapist must guard against coercion, either from the therapist themselves or from other participants in group situations. Finally, the emphasis must be on working with the powerful emotions that these techniques evoke, rather than on merely stirring them up: by so doing, the therapist can truly help their clients.

References

Klontz, B. T. (2004). Ethical practice of group experiential psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 41(2), pp. 172-179. DOI: 10.1037/0033-3204.41.2.172

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