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Ethics Paper HSER 511 Liberty University Anna Baucum

Ethics Paper Abstract This paper seeks to examine group and individual therapy models to determine which model is most successful based on empirical evidence and case studies that will be reviewed and discussed within this paper. All age ranges will be looked at when making the determination as to which model is superior and results in more successful and longterm solutions for the needs of the individual going through therapy. Further, this paper seeks to establish and understand the parameters of ethics as it relates to group therapy. A conclusion will be drawn based on the evidence reviewed.

Ethics Paper A Definition of Ethics

Ethics in the modern world is met with ambiguity and a vague sense of understanding. One group may define as what my feelings tell me is right wrong while others may describe ethics as the standards of behavior our society accepts (Velasquez et al, 1987). These answers may be typical of many people in the world today. Ethics are not ubiquitous because they stem from the realm of moral grounds and morals are not globally accepted nor understood. Ethical standards are more prevalent in the United States than in other countries, due in part to government as well as non-government agencies that have been established to monitor and advise on issue related to ethics in business, education, etc. Ethical codes exist to inform the professional behavior of counselors. The American Association of Christian Counselors has established a comprehensive, clientrespecting, legally-sensitive, behavior specific, and detailed code of ethics for use by all counseling professionals (2010). There is no shortage for a Christian counselor to be able to obtain the necessary guides and assistance needed to ensure that ethical guidelines are followed. It is vital for Christian counselors to adhere to the highest ethical standards because of increased scrutiny by a modern, unbelieving society. Ethics stretch across all professions but most importantly ethics play an important role in counseling. A counselor is entrusted with the most internal and tumultuous struggles of a human being and is expected to provide guidance and professional help to those who cannot help themselves. A counselor is often faced with ethical decisions that must be faced within the group or individual setting.

Ethics Paper A Brief History of Group Therapy

Group therapy is a recent phenomenon, emerging as a standard procedure around the early part of the 20th century (Kemp, 2010). Many names appear as the forerunners of group therapy, such as Maxwell Jones, an early enthusiast and pioneer who traveled around the world consulting on mental health for the World Health Organization (Kemp, 2010). The idea of group therapy stemmed from the creation of what was termed therapeutic communities. Kemp defines therapeutic communities as having qualities of belonging, governance, communication, interdependence and participation (2010). Therapeutic communities are what are known today as groups or group counseling. It is thanks to the pioneering of the early psychologists that todays professionals enjoy the norm of group counseling. A report from Lehigh University explains why group therapy works and why it is widely used: 1. When people come into a group and interact freely with other group members, the

difficulties that brought them to individual counseling are likely to come up in the group setting as well. Under the direction of a group therapist(s), the group is able to give support, offer alternatives, or gently confront the person in such a way that the difficulty is resolved and alternative behaviors are learned. 2. Participating in group therapy allows an individual to develop new ways of relating

to people. 3. During group therapy, people begin to see that they are not alone and can be

helped. Many times people feel like their problems are very unique, and that they are alone. It is encouraging to discover that others have similar difficulties or have already

Ethics Paper worked through a problem that deeply disturbs another group member. 4. Within this climate of trust, people feel free to care about and help one another. (Source: University Counseling & Psychological Services)

Part I: Case Studies

Group Therapy vs. Individual Therapy Case Study I Rose (2010) suggests that a counselor ask themselves the question does the format of group therapy, irrespective of its quality, inevitably fail to meet this sort of need [the need for intimate relationships]? According to Rose, group therapy fails to meet the need of meeting the need for intimate relationships. Why? In part, because the group selection process that a counselor must go through involves making a judgment call about a clients ability to tolerate frustrations and scenarios that are complex in nature as well as not be the center of attention. Apparently, many people have a problem when it comes to sharing time and allowing others to have limelight rather than everyone focusing on them as an individual. Another problem with group is that the group can be lead in many different directions due to a variety of factors. People are late, the facilitator falls ill, group members go off on tangents, and the group becomes misguided and disappointing (Rose, 2010). These types of issues are commonplace in group therapy and must be met with an action plan to keep the group founded and grounded on its original goals and procedures. Rose points out that individual therapy provides a private environment where the client can feel at ease about sharing private information about themselves to another person. Some people find it necessary to keep their experiences

Ethics Paper and the things they want to talk about with a therapist in a contained and controlled space so that they can control the amount of pain and disturbance that it not only causes to themselves but to others who may be involved (2010). From Roses experience as a therapist, several topics are excluded from group conversation on a regular basis, due to the nature of the topics and the emotions they evoke: sexuality, religion, social class, violence, gender, race and disability, and many others besides these. Roses (2010) conclusion is that individual therapy is far more beneficial than group therapy.

Group Therapy vs. Individual Therapy Case Study II Graves (2009) conducted a study on children and families who were recipient of both individual and group therapy. The study looked at children who came from dysfunctional families and had behavior problems. The study suggests that therapists must be consistent with the children they are serving. In a particular controlled study, it was seen that as children increased the amount of individual therapy sessions, their negative behaviors decreased dramatically (Graves, 2009). Children with problematic behavior are difficult to manage and Graves suggests that these children receive both individual and group therapy coupled together to ensure the child is getting help from each angle. De Groot et al (2007) found that treating a large number of youth at the same time (through group therapy) was the most cost-effective way to carry out CBT, aka, cognitive-behavior therapy. The patients who benefit from this type of group therapy are youths with anxiety and emotional disturbance. De Groot et al (2007) goes on to explain that group treatment provides several advantages over individual therapy: normalization, modeling, prompting, reinforcement, heightened mastery, and increased opportunities for

Ethics Paper social experience. However, while these benefits exist, the group approach to CBT may prove to be a disadvantage because it is too tailored towards one type of youth rather than the group as a whole. The conclusion was drawn that the family or group focused CBT proved to show a distinct improvement by the children in the clinical trial. De Groot et al (2007) explains: On a practical level, intervention used in the present study can be delivered in a time-limited group format, and has the potential to be a practical and usable psychosocial intervention for professionals who need to provide time- and cost-efficient treatments.

Group Therapy vs. Individual Therapy Case Study III A study by Jaurrieta et al (2008) conducted a pilot that compared individual versus group therapy for dealing with obsessive compulsive disorder. Jaurrieta et al found that other studies suggested the same conclusion, that is, individuals from both experimental conditions (individual and group cognitive-behavior therapy) showed a high level of improvement in the obsessive-compulsive behavior, as well as improvements in their depression and anxiety symptoms at the end of a 6-month treatment schema (2008). The time-frame of the group therapy plays a role, whether it is a short-term group or a long-term group. Further, the study cited by Jaurrieta et al showed that a group of 63 patients achieved a more rapid response to changing obsessive-compulsive behavior after having gone through individual therapy (2008). The results of the study conducted by Jaurrieta et al concluded that both individual and group treatments were effective in reducing the intensity of anxiety, depressive, and obsessive compulsive symp- toms compared with patients in a wait-list

Ethics Paper control group, who showed no clinical change (2008). The study leaned more towards favoring the individual treatment over group treatment because, as Jaurrieta et al explains, patients attending individual therapy received more individualized treatment, aka, face to face time with the therapist and more interaction which in turn promoted more rapid growth in the patient. However, the caveat would be that the study was based on short-term therapy and not long-term, therefore, it should be taken with a grain a salt.

Group Therapy vs. Individual Therapy Case Study IV Liber et al (2008) suggests that there are various arguments for evaluating the efficacy of providing treatment in a group or an individual format. On a conceptual level, group treatment (GCBT) could function as a source of reinforcement, normalisation, (peer) modelling and helping behaviour. Arguments to offer treatment in a group setting concern a closer representation of daily life experience in the group format, exposure to social situations or practical reasoning, i.e. cost-effectiveness. On the other hand, individual therapy has its own set of drawbacks, such as the costliness and time constraints that come with it. In the study conducted by Liber et al (2008), a number of children were selected who had previously been diagnosed with some type of anxiety disorder. As expected, the conclusion was drawn that children with anxiety disorders benefitted from both models of therapy (group and individual) and there was no outstanding evidence to say that one model outshined the other. While this study found both models equally acceptable, the argument would be that each child or individual in need of therapy may or may not

Ethics Paper respond to one model better than another. It really will depend on the individual and what type of setting he or she is going to be able to gain the most help from. This study simply shows that there is an equal acceptance of both models. A study by Monga et al (2009) found that after conducting group therapy with a total of 32 children with two or more anxiety disorders, only five continued to have two or more anxiety disorders after treatment was over. This study was conducted on young children between the ages of 5 and 7, and included parents. Because of this inclusion of parents (authority figures), this could be part of the success of the study and a determining factor in arguing that group therapy is more successful, in some cases.

Group Therapy vs. Individual Therapy Case Study V Watson et al (2008) discovered that cognitive-behavioral therapy resulted in just as much effectiveness in patients overcoming depression as did those patients who took antidepressant medication to overcome their psychological problems. The premise of the study was to look at whether or not gender plays a role in cognitive-behavioral therapy and if the results differ in any way. Some studies cited by Watson et al (2008) showed that gender did in fact play a part, while others were inclusive. Watson et al found that in an uncontrolled trial of group therapy, more often males in the group had more favorable outcomes than did females (2008). In addition, the study conducted therapy sessions for the patients in both models of therapy, group and individual. The results on both models did not show distinct differences in terms of failure or success over one or the other. In this case, group therapy versus individual therapy does not have any bearing on the role of gender in therapy. Rather, the idea is that therapy is needed for many types of people.

Ethics Paper As to what model of therapy, this will be left up to the profession handling the patient. There are both pros and cons to both models of therapy. Studies tend to stay in the middle of the road when determining which model is most favorable.

Part 2: Why a Therapist Chooses Group over Individual Therapy Based on the evidence presented by the above case studies, the conclusion is drawn that a therapist can opt for group therapy in a majority of cases, in order to best serve his or her patients. Why is the group therapy model seemingly a better idea? Think of the human being element. As newborns, each child is born into a family group (obviously there are some who are born into a dysfunctional, non-traditional family setting, but that is beside the point for this particular assessment). From birth till death, a human being is apart of some type of group setting, whether it be a family group, educational group, employment group, etc. Group therapy is simply another way to bring people into a setting that they are already comfortable with. As such, group therapy provides the link between a patient and a therapist being able to connect on a group level, rather than individually. While some people may prefer the individualized attention, it could be said that group therapy allows for a broader range of success because of the element of underlying understanding of being in groups. Group therapy sessions also provide benefit because it allows a quiet individual to mingle with others in the group who may not be as quiet. Further, group members can feed off of others in the group and by doing so gain more insight into their own psyche and make greater progress. While a group therapy session may be able to mask certain elements that would appear in an individual group setting, the group model presents more

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Ethics Paper favorable conditions. Not only this, but the group sessions are most cost-effective and while they take slightly more time than individual groups, the overall time line could be cut short because of more that is accomplished during each group session. The question should be asked, who is therapy designed for? Group therapy is designed for those who desire to change or be changed from a pattern or habit of behavior or psychological problem. Jennifer Daw Holloway of Monitor magazine cites The American Psychological Association definition as to the purpose of group therapy being a result of the need for change. There are four stages of change that each member of a group will go through: y Preparing for change y Changing y Accepting and adjusting y Maintaining change (Source: American Psychological Association) Part 3: Ethical Implications in Counseling Many types of counselors exist with each a distinct field and type of individual that is identified based on the field. Ethical standards are universal in the profession of counselors. An understand of what type of counselors exist is important in understanding how ethics fits into the specific type of counseling field that is being looked at.

Educational, vocational, and school counselors Rehabilitation counselors Mental health counselors Substance abuse and behavioral disorder counselors Marriage and family therapists Counselors, all other

275,800 129,500 113,300 86,100 27,300 33,400

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Ethics Paper

(Source: bls.gov) Professionals in the human services field must realize that ethical dilemmas will happen on a regular basis. The problems and issues that people face are many times in sync with what is going on today in the world, whether it be physical, mental, or spiritual in nature. The National Organization for Human Services lists a number of guidelines for professions to keep in good standing as an ethical professional: 1) Responsibility to Clientshuman services professionals negotiate with clients the purpose, goals, and nature of the helping relationship prior to its onset as well as inform clients of the limitations of the proposed relationship. 2) Responsibility to the Community and Societyhuman service professionals are aware of local, state, and federal laws. They advocate for change in regulations and statutes when such legislation conflicts with ethical guidelines and/or client rights. Where laws are harmful to individuals, groups or communities, human service professionals consider the conflict between the values of obeying the law and the values of serving people and may decide to initiate social action. 3) Responsibility to Colleagueswhen a human service professional has a conflict with a colleague, he or she first seeks out the colleague in an attempt to manage the problem. If necessary, the professional then seeks the assistance of supervisors, consultants or other professionals in efforts to manage the problem. 4) Responsibility to the Professionhuman services professionals know the limit and scope of their professional knowledge and offer services only within their knowledge and skill base.

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Ethics Paper 5) Responsibility to Employershuman services professionals strive to personify those characteristics typically associated with the profession (e.g., accountability, respect for others, genuineness, empathy, pragmatism) (2009). All of these guidelines serve as a roadmap to the professional in order to be able to keep in line with the best way to go about pursuing their goals and objectives as their occupation allows. At the same time, a professional must know his or her patients. It is not unusual that a therapist would take part in both methods of therapy, given the various types of patients that are seen. Determining factors for which model to use would be first and foremost, the patient themselves. Then, considerations such as are there other patients who are also requiring the same treatment and if so, are they in similar life circumstances, i.e., age, etc? An ideal way to create the best possible therapy method is for the professional to have a checklist that is gone through each time a new patient or patients are seeking help. Dr. Dea, chair of psychiatry of Northern California Kaiser Permanente suggests that careful screening, referral by licensed clinicians and one-on-one pre-group orientation make good business and clinical sense (Ellen, 1999). The main concern by Dr. Dea is that not enough time is put into screening patients for the benefit of group therapy. In addition, Dr. Dea suggests that what we have foundoperationally, experientially and through data-based review, is that shorter-term [group] therapies are quite effective for the majority of patients who come in.anyone who says everyone should be in individual treatment is just irresponsible (1999).

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Ethics Paper Certainly it can be expected that group therapy is a great solution for patients. The fact that group counseling provides an environment where people can have others around them and seek to gain acceptance is important when trying to heal or overcome some problem. Furthermore, constructive feedback is a benefit of the group model, in that instead of the patient simply receiving feedback from the therapist, he or she can be understood and helped by fellow group members. If a group member feels insecure about meeting alone with a therapist and would rather take part in a session where they are not in the limelight, the group model is perfect. Always, the group model promotes an atmosphere of dignity and respect. Never should there be a group environment that does not clearly establish the guidelines of behavior by group members at the onset of the group. In addition, the group model can allow people afraid to open up an excellent opportunity to face fears and overcome them. Finally, the group model can help an individual gain insight into themselves and by observing others within the group, know better how to handle themselves and beyond that, help others in similar situations (TX Tech, 2007). As aforementioned, human beings are apart of a group from the moment of birth. From that day forward, group is a concept that is accepted as a daily part of life, no questions asked. A group provides the support and security that human beings yearn for during the length of life. Intimacy in groups is also a way for people to be able to identify with one another. For the therapist, group therapy allows the therapist to be spared session after session, meeting with multiple individuals on a daily basis. The group model also allows more time for the therapist to focus on preparations and presentation of the group sessions, by which the group members can experience a higher benefit. When the

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Ethics Paper therapist is not spread too thin, this carries over into the attitude and behavior of the therapist and ideally will translate into a more successful outcome. Therapists typically will be cognizant of the needs of their patients. This being the case, the therapist is the best determining component to distinguish the type of therapy that is needed for which patients.

Part 4: My Approach The leadership qualities that I possess stem from the many experiences and circumstances, both positive and negative, that Ive encountered during my adolescent and adult life. By nature I am a strong-willed person who, in a leadership role, demands people to take responsibility for themselves and take initiative to work to accomplish what they want to get out of life. I believe where leadership sees the most success is when a leader leads by example. There is nothing worse than a leader who is hypocritical in nature and dictates actions for which the he himself is not willing to be accountable. The apostle Paul was the best example of this in scripture. I Corinthians 9:27 states, But I keep under my body, and bring it into subjection: lest that by any means, when I have preached to others, I myself should be a castaway. My philosophy as a leader is one that requires self-sacrifice in that I must set the standard for myself much higher than what I expect from those who follow. Otherwise, there is nothing to differentiate the leader from the follower. My approach group therapy as the leader is to facilitate the group and inspire them to accomplish the outcome they wish to achieve. My primary focus is to encourage the participants to open up their feelings to the group and enable them to express

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Ethics Paper themselves and interact within the group. This brings a sense of self acceptance to those who might be reluctant to display their true feelings and opinions due to the possible fear of rejection should their viewpoints be scoffed upon. Interjecting questions for the group for discussion and fielding disagreement of opinions needs to be handled with tact not allowing for any participants perspective to be discounted. Many times there are ethical challenges that must be addressed. I believe the best way to handle these types of issues to have a set of principles already predetermined for which one will not deviate. Then, when these situation arise, which they will, they can be handled according to principle and not based merely on emotion or obligation. Our Lord and Savior, Jesus Christ lived His life based on principle. When tempted by the devil, He did not have to determine what His reaction would be. He simply referred to his set of principles, which was scripture, and based his decision on those set of boundaries, not on his physical or emotional state at the time. Matthew 4:3,4 And when the tempter came to him, he said, If thou be the Son of God, command that these stones be made bread. But he answered and said, It is written, Man shall not live by bread alone, but by every word that proceedeth out of the mouth of God. I firmly believe in the benefit of group therapy. As a general rule, I would prefer to see patients in a group setting, rather than on an individual basis. In this way, not only am I being conscious of my financial position (cost-effective solutions), Im also able to distribute more of myself and my assistance to more patients, thus benefiting more all around. Clearly, there will be times when I must adapt and meet with a patient in a oneto-one basis, and that is to be expected. Through the experience of a group model in my recent psychoeducational group, I found it to be extremely delightful and influence on my

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Ethics Paper own life. This experience gave me the drive to promote the benefit of group therapy over individual therapy.

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Ethics Paper References

Rose, C. (2010). Emotional needs and group therapy. Therapy Today, 21(8), 16-19. Retrieved from Academic Search Complete database. Kemp, R. (2010). The Emergence of Group and Community Therapies. Existential Analysis: Journal of the Society for Existential Analysis, 21(2), 282-294. Retrieved from Academic Search Complete database. Graves, K., Shelton, T., & Kaslow, N. (2009). Utilization of Individual versus Family Therapy Among Adolescents with Severe Emotional Disturbance. American Journal of Family Therapy, 37(3), 227-238. doi:10.1080/01926180802403328. de Groot, J., Cobham, V., Leong, J., & McDermott, B. (2007). Individual versus group family-focused cognitive-behaviour therapy for childhood anxiety: pilot randomized controlled trial. Australian & New Zealand Journal of Psychiatry, 41(12), 990-997. doi:10.1080/0004867070168943 Cabedo, E., Belloch, A., Carro, C., Larsson, C., Fernndez-Alvarez, H., & Garca, F. (2010). Group Versus Individual Cognitive Treatment for Obsessive-Compulsive Disorder: Changes in Severity at Post-Treatment and One-Year Follow-up. Behavioural & Cognitive Psychotherapy, 38(2), 227-232. doi:10.1017/S135246580999066X. Watson, H., & Nathan, P. (2008). Role of gender in depressive disorder outcome for individual and group cognitivebehavioral treatment. Journal of Clinical Psychology, 64(12), 1323-1337. doi:10.1002/jclp.20524. Jaurrieta, N., Jimenez-Murcia, S., Menchn, J., Alonso, M., Segalas, C., lvarez-Moya, E., et al. (2008). Individual versus group cognitive-behavioral treatment for obsessivecompulsive disorder: a controlled pilot study. Psychotherapy Research, 18(5), 604-614. doi:10.1080/10503300802192141 Liber, J., Van Widenfelt, B., Utens, E., Ferdinand, R., Van der Leeden, A., Gastel, W., et al. (2008). No differences between group versus individual treatment of childhood anxiety disorders in a randomised clinical trial. Journal of Child Psychology & Psychiatry, 49(8), 886-893. doi:10.1111/j.1469-7610.2008.01877.x. Velasquez, M., Andre, C., Shanks, T., & Meyer, M. (1987). What is ethics? Issues in Ethics, IIE V1 N1. American Association of Christian Counselors. (2010). AACC code of ethics. Retrieved online December 15, 2010, from: http://www.aacc.net/about-us/code-of-ethics/ University Counseling & Psychological Services. (N.d.) Leigh University. Retrieved

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Ethics Paper online December 15, 2010, from: http://www.montclair.edu/psychservices/grouptherapyhandout.pdf Monga, S., Young, A., & Owens, M. (2009). Evaluating a cognitive behavioral therapy group program for anxious five to seven year old children: a pilot study. Depression & Anxiety (1091-4269), 26(3), 243-250. doi:10.1002/da.20551 Occupational Outlook Handbook. (2010). 2010-2011 edition. Retrieved online December 15, 2010, from: http://www.bls.gov/oco/ocos067.htm National Organization for Human Services. (2009). Ethical standards for human service professionals. Retrieved December 15, 2010, from: http://www.nationalhumanservices.org/index.php?option=com_content&view=article&id =43 Ellen, E. (Oct. 1, 1999). Group therapy requires good clinical judgment, careful screening. Psychiatric Times. Retrieved online December 15, 2010, from: http://www.psychiatrictimes.com/display/article/10168/50786 Texas Tech University. (2007). Student counseling center: participating in groups. Retrieved online December 15, 2010, from: http://www.depts.ttu.edu/scc/Group_Counseling/group_participation.php

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