The more experience a facilitator has with a minority group, the greater the likelihood the facilitator will be able to help those members feel included, rather than excluded from the group process. 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 steps to set forth rules of confidentiality to be adhered to by the group (Lakin, 1986; J.D. Moreno, 1991). In addition, ASGW Best Practices Guideline a.7.d. advises group workers to explain to members that unless a specific state statute indicates otherwise, legal privilege does not apply to group discussions (Rapin & Keel, 1998) (Klontz, 2004).
The reality is that confidentiality is an ethical risk that cannot completely be controlled in a group setting. Even if a group member could be penalized for discussing what other group members have said in therapy, the damage to the person whose confidentiality had been violated would already have been done. Therefore, it is imperative that group facilitators make it clear to all participants that, while confidentiality is expected, they need to be aware that confidentiality laws do not protect them in the same way as they would in a one-on-one group counseling scenario with a mental health professional. Moreover, if a group member appears to be talking about information that could be harmful to that person, for example, discussing participation in a crime for which that person has not previously been charged, the facilitator may have an ethical responsibility to speak to the person about the potential consequences of revealing that information in a group therapy setting.
Another ethical risk associated with groups is the lack of control that the facilitator has over the entire group process. Groups are social micro societies, and group interacts are going to impact the therapeutic process in ways that the facilitator may not have realized at the commencement of the group. "Just as the social power of the group can be an important driving therapeutic force, it can also harm group members if not closely monitored. According to Lakin (1986), social pressure to conform to norms in the group could interfere with an individual's ability to make rational and informed decisions, and the group could create a reality that might never have been accepted by the individual were he or she not a member of the group. As such, the group leader must be aware of how to moderate the influence of group pressure in ways that maximize therapeutic effectiveness" (Klontz, 2004). One way that therapists could do this is to take steps to minimize the potential negative impact of disruptive group members, perhaps through implementing strategies similar to "time-outs," which are proven beneficial disciplinary strategies that do not harm existing relationships when used correctly and effectively (Morawska & Sanders, 2011).
In addition to those overarching ethical concerns, facilitators face ethical concerns that can be specific to the subject matter that is the focus on the group. Therefore, a group focused on prenatal genetic counseling would have different ethical concerns than a sexual assault survivor support group. Therefore, an important ethical issue involves the group facilitator's familiarity with the subject matter of the group discussion. It is an impediment to the group process of the facilitator has "less than optimal training and experience" in the subject matter of the group (Hodgson & Weil, 2012). Therefore, subject-specific training and ethical concerns need to be a focus in group scenarios.
An ethical issue related to group therapy, but not part of the therapy itself involves when a healthcare professional should refer a person to therapy. In other words, is it unethical for a practitioner in an unrelated area to fail to recommend counseling or group therapy to a client who is need of some type of help? At this point in time, there is not really an ethical duty to refer a stable client to counseling. However, that premise may be unethical. It is clear that psycho-social interventions are known to positively impact people, and that these positive impacts go beyond mental health benefits. "Humans are more susceptible to a variety of illnesses when they suffer from feelings of meaninglessness or existential frustration" (Mosalanejad & Koolee, 2012). Moreover, clients believe that spirituality and mental health have a positive impact on other health outcomes and want their physicians to address those areas (Mosalanejad & Koolee, 2012).
Even when a group is coming to an end, a therapist has to be aware of potential conflicts. Ending a group can have different emotional consequences for different group members. Magione et al. identify several areas of potential conflict in group scenarios, particularly the ending of group sessions. These include: "informed consent, time and role boundaries, privacy and confidentiality, unplanned…