Non-Maleficence in Group Counselling, Essay Example

The moral principle of nonmaleficence is of seminal importance in the clinical setting in general: the therapist must avoid inflicting harm, and deflect actions or circumstances that may cause the patient to come to harm. In a group setting there are special ethical considerations of this principle, due to the fact that there are more participants and thus, more complexity. By adhering to a robust ethical decision-making framework, the therapist can ensure the wellbeing of all of their clients.

Rejection is often a painful, and difficult, topic for participants to broach in the context of group therapy. As Corey (2008) explained, individuals who suffer from the pain of rejection often create shields within themselves to protect themselves from ever suffering the pain of rejection again (p. 196). Memories of rejection are often extremely painful and hurtful, and may involve feelings not only of disappointment, but also of deep pain, betrayal, and possibly anger. Accordingly, it can be very difficult for patients to open up and share with others their feelings of rejection and, in particular, the situations wherein they felt rejected (p. 196).

The starting point for the therapist in such a context is a consideration of ethical principles. The principle of nonmaleficence is of especial relevance, and will be focused on here: the very quintessence, the definition of this principle, is to do no harm (DeLucia-Waack, Gerrity, Kalodner, & Riva, 2004, p. 153). This principle is simple enough in concept, though it takes all due diligence and attentiveness to implement properly. As DeLucia-Waack et al. explained, nonmaleficence encompasses “both protection from intentional harm and refraining from actions that would risk harm” (p. 153). Accordingly, this principle affects many aspects of the clinical setting, including the activities that are selected for sessions, the “structuring and pacing of counseling and therapeutic events, levels of disclosure, modeling, and member selection”, amongst others (p. 153).

In particular, when dealing with very emotional subjects, it is important for the therapist to ensure that all participants feel that they are able to express the levels of emotion and emotiveness with which they are comfortable (DeLucia-Waack et al., 2004, p. 153). This is a concern on two different levels: participants feeling pressured to emote more than they are really comfortable with, and participants feeling inhibited, shy, or embarrassed about the prospect of expressing their emotions as they wish to, and holding back accordingly (p. 153). Different participants will doubtless display differing amounts and intensities of emotion. For some members, the emoting of other members may make them feel that they “should” express themselves more in the same fashion, even if they are not really comfortable doing so. For others, the prospect of expressing their emotions in a group may inhibit them and hold them back from the levels and types of emotional expression they wish to evince (p. 153).

Though there is no universal panacea for all of these concerns, the therapist can help to create a warm, positive, welcoming environment in which all participants feel safe and comfortable with emoting as much or as little as they wish (DeLucia-Waack et al., 2004, p. 153). Accordingly, the counselor must send the message to all participants that they are welcome to emote as they wish, and that everyone needs to be supportive of everyone else (p. 153). As Corey (2008) explained: “During the warm-up phase, members need to be reassured that the working environment is a safe one, that they are the ones to decide what they will reveal and when they will reveal it, and that they can stop whenever they want to” (p. 196).

To be sure, practicing nonmaleficence in group counseling requires a capacity and a framework for ethical decision making. This is of integral importance, being absolutely vital for any consideration of ethical responses and priorities in the event that there is a danger of violating the principle of nonmaleficence. In their study, Scher and Kozlowska (2012) explored approaches to ethical decision-making in one prominent sub-discipline of group therapy, namely family therapy (p. 97). Family therapy is an especially pertinent type of group therapy for consideration of ethical responses in contexts with significant danger of violating the principle of nonmaleficence, because with families the various participants are often at odds with each other, whereas members of a small group may be otherwise unrelated to or unconnected with each other (p. 100).

For the family therapist, then, ethical decision-making capacities come from training and from personal experience and knowledge (Scher & Kozlowska, 2012, p. 101). This is of significant import, inasmuch as the decisions that a therapist makes must often be made on the spot, without much advance planning or forethought (p. 101). The bioethical model, on the other hand, emphasizes careful consideration of the principle of nonmaleficence and other principles, such as autonomy, benevolence, and justice (p. 101).

And yet, these two responses are not so far apart as all that: indeed, the similarities between the two are profound and compelling (Scher & Kozlowska, 2012, p. 101). The bioethical requirement that a problem should be viewed “in context, with due attention to medical, social, cultural, linguistic, and legal issues… and that one listen to the patient’s narrative…” is essentially coterminous with the requirements of the family therapy model (p. 101). Context, then, is very key for framing ethical responses: one must have a proper understanding of the situation from all perspectives, another way in which the bioethical and family therapy models concur (p. 102).

Another important point here is that the therapist’s ethical responses should not be guided by “their own personal moral beliefs and values”, only by professional ones: simply put, the therapist must do no harm, which is defined in terms of professional ethical standards, not personal moral codes and values (Scher & Kozlowska, 2012, p. 102). An important skill for the therapist to cultivate in constructing and acting upon their ethical responses is that of reframing: looking at the problem, and then trying to look at it from a fresh perspective (p. 106). The fresh perspective from which the therapist analyzes the problem must be one that is capable of giving them a better understanding of the needs of all the parties involved in the group therapy (p. 106). By using this kind of outside-the-box thinking, the therapist can better understand what is really at stake. This, in turn, can help them to steer clear of potential pitfalls that might compromise their own ability to act according to the principle of nonmaleficence (p. 106).

Putting all of this into context, this kind of ethical decision-making is very relevant to group work with fears of rejection. Patients who suffer from feelings of rejection and fear of rejection are often emotionally very fragile, and great care must be taken. It takes great care and consideration to help many patients feel safe enough to share of themselves on such difficult topics, and they must not feel unduly pressured to do so. Taking these diverse and varied needs into account is a challenge, albeit an answerable one. By analyzing the problems from as many angles as possible, and by reframing the situation as needed, the therapist can ensure that the clinical setting is optimal for this kind of sharing.

By making use of a robust framework for ethical decision-making, the therapist can ensure that they adhere to the principle of nonmaleficence in all of their interactions with clients in group sessions. The principle of nonmaleficence may be simple in conception, but varied clinical settings will inevitably deliver potential pitfalls. For emotionally sensitive subjects such as the fear of rejection, it is of especial importance that the therapist adhere to the principle of nonmaleficence, ensuring that all participants feel safe, comfortable, and welcome to share as much of themselves as they wish.

References

Corey, G. (2008). Theory and practice of group counseling (7^th ed.). Belmont, CA: Thomson Higher Education.

DeLucia-Waack, J. L., Gerrity, D. A., Kalodner, C. R., & Riva, M. T. (Eds.). (2004). Handbook of group counseling and psychotherapy. Thousand Oaks, CA: SAGE Publications, Inc.

Scher, S., & Kozlowska, K. (2012). Thinking, doing, and the ethics of family therapy. American Journal of Family Therapy, 40(2), pp. 97-114. DOI: 10.1080/01926187.2011.633851