Discussion: legal and ethical considerations for group and family



The Health Insurance Portability and Accountability Act (HIPPA) is one of the acts that guide the practices of a nurse when it comes to Group and Family Therapy. Ethical and legal considerations such as confidential information of a patient as defined by HIPPA is part of what psychiatric mental health nurse practitioner does. Therefore, in this discussion, the primary objective is to provide an explanation of how legal and ethical considerations for group and family therapy differ from individual therapy.  The differences between the considerations significantly affect therapeutic approaches for clients depending on whether the clients are put on group or family therapy (Schiefele et al. 2018)

The differences in legal and ethical considerations for group and family therapy and individual therapy

Group and family therapists face more ethical and legal challenges than individually oriented therapists do. First, in group and family therapy, the ethical consideration is grounded in the foundational premise of the family as a system and therefore, the focus of the therapy is on the relationship. Some of the specific ethical and legal considerations that require special attention on the part of individual and group and family therapists include responsibility, informed consent and confidentiality. The first difference in ethical considerations for group and family therapy and individual therapy based on responsibility (Schiefele et al. 2018). Unlike individual therapy, group and family therapy is associated with the dilemma of multiple clients who are in the same situations and therefore, an intervention that serves one person’s best interests may be counter therapeutic to another. It means that the therapy process must consider an intervention that serves all the parties involved (Gurman & Burton, 2014). In group and family therapy, there are conflicting goals, as well as, the interests of the parties involved. It is unlike individual therapy in which the therapist encourages the client to explore potential ramifications of his or her actions. The group and family therapist is set apart from the individual therapist because of the family therapist’s ethical clear commitment to promoting the welfare of every member involved in the treatment process. It implies that group and family therapist has more responsibility than an individual therapist does for exercising judgment, which must take into account all the individuals (Gurman & Burton, 2014)

When it comes to legal consideration, informed consent is a key difference between group and family therapy and individual therapy. In treating each member’s confidences in-group and family therapy, the therapists should act as though that person were an individual client (Shaw, 2015).  The information got during a private session, or a telephone call from one member is not divulged to other family members. The therapist upholds the individual client’s confidentiality to other family members (Hertlein, Blumer & Mihaloliakos, 2015). When it comes to individual therapy, one obtains only one client’s permission to use information while in the group and family therapy the permission is obtained during the conjoint sessions.

How the differences might affect therapeutic approaches for client’s in-group and family therapy

By considering responsibility as ethical considering in group and family therapy, the therapist must ensure that improvement in the status of one the member in the therapy is not occurring at the expense of another member. As part of ethical consideration, the group and family therapist should be an advocate of the family system during therapeutic process and avoids becoming an agent of any one of the members. When it comes to preservation of confidentiality, therapeutic approaches for clients in group and family therapy is such that the therapists arrange for sessions with individual family members to actively encourage the sharing of “secrets” as part of better understand what is occurring in the group or family (Shaw, 2015). When dealing with clients in group and family therapy, I will ensure that informed consent is obtained from each member in the therapy process before any information is used. If permission is not granted, all information must be kept confidential (Hertlein,  Blumer & Mihaloliakos, 2015)


Gurman, A. S., & Burton, M. (2014). Individual Therapy for Couple of Problems: Perspectives and Pitfalls. Journal of Marital and Family Therapy, 40, 4, 470-483.

Hertlein, K. M., Blumer, M. L. C., & Mihaloliakos, J. H. (2015). Marriage and Family Counselors’ Perceived Ethical Issues Related to Online Therapy. The Family Journal, 23, 1, 5-12.

Schiefele, A.-K., Lutz, W., Rubel, J., Barkham, M., Saxon, D., Bohnke, J., Delgadillo, J., … Lambert, M. J. ( 2018). Reliability of Therapist Effects in Practice-Based Psychotherapy Research: A Guide for the Planning of Future Studies. Administration and Policy in Mental Health and Mental Health Services Research, 45, 6, 598-613.

Shaw, E. (2015). Ethical Practice in Couple and Family Therapy: Negotiating Rocky Terrain. Australian and New


Psychotherapy is a way to help people with a broad variety of mental illnesses and emotional difficulties. Psychotherapy can help eliminate or control troubling symptoms, so a person can function better and can increase well-being and healing (APA, 2018). There are two major types of therapies which are Individual therapy and group therapy. On individual therapy, the individual expresses his or her freedom and ability to talk to the therapist without fear of anything. Individual therapy involves the patient and the therapist alone while the group or family therapy includes the patient and the family members or another patient in a group therapy. The group and family therapy help to improve the relationship and interaction of the patient with other people in the group or family which leads to an improvement in the patient mental health (Laureate Education (Producer), 2017).

Legal and Ethical Considerations for Group/Family and Individual Therapy

Ethical consideration that is most seen individual therapy versus group and family therapy is the process and content of interactions in individual versus group therapy. In individual therapy, is mostly talk about one particular patient on his or her feeling and the patient privacy is maintained. Group or family therapy involves two or more people where privacy is not maintained and where one individual’s perception may be criticized by another member of the group which makes the patient endorse a feeling that his or her feelings do not count and respected (Nichols, M., 2014). The level of confidentiality in groups is far less secure than it is individual therapy. Although group members are generally instructed that the information and events that occur in the group are to be held confidential and only to be shared with group members during therapy, the potential for a breach of confidentiality is far greater in group therapy (AAC, 2018).

Both the individual and group or family required the therapist to obtain informed consent before the commencement of the therapy. The therapist is expected to explain the dos and don’ts of the sessions, the goals, and the expected outcome of the therapy to his or her clients. In addition to that, the therapist will make sure that the client’s signs form for confidentiality. This will ensure that anything said between any two or more group members at any time is part of the group and is confidential (Breeskin J., 2011).

Impact of the Ethical factors and Strategies for the therapeutic approaches for Clients in Group/Family Therapy

The patient will be educated on the importance of confidentiality and not reveal other patient’s mental health problem to other people. The therapist should use appropriate therapeutic skills when interacting with group therapy.  Ethical issues in group psychotherapy are complex and differ from individual psychotherapy with regard to the types of ethical dilemmas that are encountered. Confidentiality is a special area of concern, given that there are more threats to confidentiality in group therapy than in individual therapy (Klontz B.T., 2004). 


American Addiction Centre, 2018. Group Therapy verses Individual Therapy. Retrieved from https://americanaddictioncenters.org/therapy-treatment/group-individual

American Psychiatric Association, 2018. What is Psychotherapy? Retrieved from https://www.psychiatry.org/patients-families/psychotherapy

Breeskin J., 2011. Procedures and guidelines for group therapy. Retrieved from https://www.apadivisions.org/division-49/publications/newsletter/group-psychologist/2011/04/group-procedures.aspx

Klontz B.T., 2004. Ethical Practice of Group Experiential Psychotherapy. Retrieved from https://www.researchgate.net/publication/232563953_Ethical_Practice_of_Group_Experiential_Psychotherapy

Laureate Education (Producer). (2017). Introduction to psychotherapy with groups and families [Video file]. Baltimore, MD: Author.

Nichols, M. (2014). The essentials of family therapy (6th ed.). Boston, MA: Pearson.

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