Group Work – final
Ethics in various group counseling populations

Question 1: Ethics
Informed consent covers those aspects of the therapeutic relationship which the client is entitled to have explained to them before agreeing to participate. This may apply to initiating therapy or continuing it. Consent should be obtained verbally and documented in writing to protect all parties involved (A.2.a). Discussion of issues raised at this time helps build rapport and reassures the client about what to expect in the counseling relationship. Issues discussed at the initial interview help to collaboratively determine whether the therapist/group is a good fit (A.2.a). This would be part of the screening process when applied to group work.
Counseling should not proceed until the client has affirmed that they understand their rights and responsibilities as well as those of the therapist. (a.2.a) Such consent is generally given by the client, but may be from a parent or caregiver when the client is unable to do so. The ACA Code further alerts us to the need for balance between clients’right to make choices, their capacity to do so, and parental or familial rights and responsibilities to look out for the client’s best interests. (a.2.d) Clients should be included in decisions regarding their treatment insofar as feasible and appropriate.
Disclosures included when obtaining informed consent include things that inform the therapist’s approach to counseling and/or the group’s norms: theoretical orientation, professional experience/credentialing, religious/spiritual view, modalities used such as art therapy or pet therapy. If a political agenda comes through, such as that of feminism or nationalism, this should be disclosed as well. Potential bias from government-sponsored initiatives should be made clear, because they encourage an emphasis in one area over another.
One example of the importance of comprehensive disclosure is a provider whose funding is from a taskforce on overcoming drug addiction. Such a provider would be inappropriate for a client whose desire is to reduce the harm a substance is doing in their life, but is unready to quit. The agency might be unable to offer services because of a conflict in goals. Additionally, potential group members must be told about any research being done with the group or its records, and permitted to opt out of either it or the group (if it is one designed with the goal of research). Situations when identifiable member information would be disclosed to outside persons should be explained (F.1. c, G. 2. a). The ACA code says, “…supervision process influences the limits of confidentiality. Supervisees make clients aware of who will have access to records of the counseling relationship and how these records will be used.” (F.1.c) Confidentiality is both a personal and legal concern, so it needs careful attention within the process of providing informed consent. There should be opportunity for the client to ask what-if questions and be reassured what can and cannot be done with their information. This has the additional benefit of building rapport through trust in the integrity of the therapist. It can also communicate concern for the client’s rights. Consent forms should include the nature of counseling, its benefits/risks, permission to do assessments and diagnose, and the right to end the counseling relationship. Forms may be customized to include specifics about “… the purposes, goals, techniques, procedures, limitations, potential risks, and benefits of services; the counselor’s qualifications, credentials, and relevant experience; continuation of services…the implications of diagnosis, the intended use of tests and reports, fees, and billing arrangements… their records… “ They also include the right to refuse any services and to be advised of the consequences of such refusal. (A.2.b) If a situation changes within the group, consent must be sought again. For example, an additional form might be used to cover a request by a graduate student to do observations. (G.2.a) Going further with the idea of client rights, there is the issue of advocacy. Although section A.6.a in the ACA Code says advocacy opportunities should be used on an ongoing basis to improve client care, there is a caveat when it is on behalf of identifiable clients. The client must consent before the counselor undertakes any action on their behalf. (A.6.b)
As with individual counseling, therapists doing group work should “… take reasonable steps to consult with other counselors or related professionals when they have questions regarding their ethical obligations.” (C.2.e) The goal is to protect self and clients from errors in judgment that could do harm.

Question 4: Counseling considerations of pregnant teens in groups
Pregnant teens need a range of support services made available to them, including counseling and prenatal care. There is some variation depending on the age, culture, and socio-economic class of the teens.
Speaking from experience in my lower-middle class neighborhood, I would be prepared for more trauma and financial worries among lower class teens than others. I would also anticipate less sense of accountability from mid to upper class teens who have been more sheltered and “spoiled” economically, having no need to work to get what they want. My experience has been that these teens are likely to be more academically competent and less mature emotionally, at least in the sense of being “streetwise”.
Teens with access to medical care and parental money may decide to “fix” their problems by an “easy” abortion, creating other problems. On the opposite side, they may assume they can keep a baby they are unprepared to parent, because their parents have “always done everything” for them before. Sometimes this happens, and grandparents will take over the infant’s care like a forgotten birthday puppy, hoping the daughter “grows up” soon.
Lower class teens I would expect to have more health issues including malnutrition and substance use, and possibly domestic violence and assaultive sexual encounters. Younger ages of sexual and substance experimentation are also things I would be alert to. With them, I might also have trauma issues and the initial stages of sexual dysfunctions to intervene with or refer out. I would also expect lower rates of parental support, and a risk of infant abandonment in particularly negative home settings.
Issues I would anticipate include: incestual relationships, rape, wanting to “trap” a boyfriend, wanting to “get out of the house” and “move in” with a man, getting someone to love them, wanting independence, resentment towards the baby/father/parents/everyone, running away, fear of the future, depression, thoughts of suicide, wrong priorities, conflicts at home (if there is one), school harassment, emotional abandonment, health concerns, conflicted desires to keep/”be rid of” the baby, substance use, job worries.
Assuming parental consent has been obtained, I would focus on immediate needs and developing a more positive outlook. I would make a quick assessment of the type of teens I have in the group, and what their biggest concerns are right now. It would be challenging to have teens from a wide range of economic and cultural groups together, and if unavoidable, would limit the group to a small number so all could get some individual attention and be heard.
I would locate educational materials on universal pregnancy topics such as: fetal development, body changes, the birthing process, after-baby body image and “recovery”, nutrition, and locating social supports and community resources. One premise is that teens have little real-world experience navigating social services. Another huge issue is that getting medical care can be overwhelming as well as prohibitively expensive. The question “Who is paying for this?” has to be answered. I would try to get professionals to speak to my group and make presentations followed by discussion. One example might be a nurse practitioner from a birthing center. Another might be a spokesperson from County Services to explain who to contact for what issues. Providing them with a “street card” would be helpful, as would the “211” cards available that list local agencies from Meals on Wheels to Children’s Health Clinic and sliding scale dental care. Counseling to resolve resentment surrounding the unplanned pregnancy would be a priority. This is important for prenatal health as well as the mother’s. I would use art interventions to get past the defensiveness and lack of appropriate words for feelings. One activity per group might be doable, assuming a one and a half hour group. This allows for the check-in, getting on topic for the day, an activity, and then group discussion to process it. I would be alert to indications of suicidality, impulsive acting out, or other risky behaviors and refer if I needed to, with safety in mind. A teen might need individual counseling for intensely personal issues they are uncomfortable with expressing in the group, or which would be inappropriate.

Question 5: Counseling considerations of international students in groups International students need connection to their host country on social, legal, and economic levels during their time here. Much their distress comes from extreme social isolation, removal from everything familiar, strong cultural/familial demands to achieve success, and high personal standards. Concerns about getting a Visa, a work permit, and other documentation are secondary, since they are easily understood and resolved, though time-consuming. I would expect to hear issues connected to the above named stressors including: sleep problems, digestive/health complaints, headaches, loneliness, insecurity, automatic negative thoughts of failure, cultural embarrassment, confusion over gender roles, tension over religion and nationality, guilt, test anxiety, and pervasive unhappiness. In the case of social isolation, I would ask the group to come up with a list of things they were willing to do to meet people: campus events, sporting events, dance club, cycling, volunteering at an animal shelter, etc. and agree to try one in the coming week. Then next week, share what happened. Discussions might reveal common themes, which might be acted on by the group, again as a way of meeting more people, connecting with the community, and establishing a sense of familiarity with American culture. One issue to overcome might be the tendency to be reclusive and stay in the relative safety of the dorm.
Another activity might be to share the ways international students see Americans. Are there stereotypes or misinformation to challenge? How are wrong perceptions affecting the students’ ability to connect socially? What caused these impressions back home, and are they common in their nation of origin? Has there been direct proof that these ideas are accurate or inaccurate? Is there a racial bias, such as seeing Armenians as superior to Iranians, and perhaps both are intellectually superior to Americans? Is there a religious bias, such as Islamic or Hindu modesty contrasting unfavorably with “immoral” Americans and immodest American women? Are these true evaluations of American culture, and are they helpful to the students? Can a contextual shift be offered since we are not in Iran right now? Establishing personal boundaries may be reassuring, and even examining them so they can be expressed and possibly seen more clearly might be helpful to releasing internal stress. Culturally comfortable, accepting places might be pointed out, such as an Islamic center or all-male racquetball group – or all female dance ensemble. It would be important to build on personal strengths to balance the negatives a student may feel towards our society.
Also important to emotional security is family. This is vital in a number of cultures and needs to be respected instead of seen as weakness. I would have the group share ways they keep in touch and agreements made with those left back home to do so. Students may not realize loneliness goes both ways, and culture may prevent expression of it, as with Japanese males. I would ask the group to share what family means to them in their homeland, and see what connections happen as a result. Shared areas would be fuel for further group exploration, and help cross-cultural awareness. For example, an Iranian male would share some of the patriarchal views of the Japanese, including the value placed on sons, but not understand the extreme emotional reserve. Understanding more about who they are, and who their peers are, can help students understand the broader culture and increase the sense of solidarity in feeling out of place.