Discussion: Legal and Ethical Considerations for Group and Family Therapy

Considering the Health Insurance Portability and Accountability Act (HIPPA), the idea of discussing confidential information with a patient in front of an audience is probably quite foreign to you. However, in group and family therapy, this is precisely what the psychiatric mental health nurse practitioner does. In your role, learning how to provide this type of therapy within the limits of confidentiality is essential. For this Discussion, consider how limited confidentiality and other legal and ethical considerations might impact therapeutic approaches for clients in group and family therapy.

Learning Objectives

Students will:
  • Compare legal and ethical considerations for group and family therapy to legal and ethical considerations for individual therapy
  • Analyze the impact of legal and ethical considerations on therapeutic approaches for clients in group and family therapy
  • Recommend strategies to address legal and ethical considerations for group and family therapy
To prepare:
  • Review this week’s Learning Resources and consider the insights they provide on group and family therapy.
  • View the media, Legal and Ethical Issues for Mental Health Professions, Volume I, and reflect on legal and ethical considerations for group and family therapy and individual therapy.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Post to Discussion Question link and then select Create Thread to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking Submit!

By Day 3

Post an explanation of how legal and ethical considerations for group and family therapy differ from those for individual therapy. Then, explain how these differences might impact your therapeutic approaches for clients in group and family therapy. Support your rationale with evidence-based literature.

Microskills: Family Counseling Techniques 3

Microskills: Family Counseling Techniques 3
Program Transcript

NARRATOR: Aaron and Robyn are seeing a counselor, as they are concerned
about the alcohol drinking behavior of their adolescent daughter, Michelle. As
you watch this segment, observe the techniques used by the counselor.

COUNSELOR: I’m wondering, Aaron, what it would feel like if in our work
together that we could work towards having you move towards being more
connected with your family and expressing love in a little bit different way than
you’re used to? Because one of the things that I heard loud and clear is that
when you come home on the weekends– And I don’t know how accurate this is. I
didn’t check this out with you. But when you come home on the weekends, you
go out and play golf, because it’s probably a time where you get to wind down.
There’s probably still very little time that you spend with the family.

AARON: I’m willing to try anything. Whatever keeps my daughter from going
down the road she’s on now. I’ve heard some things today that are really new to
me. And I’m just trying to make sense of it now. And I’m just trying to make it
settle. But I’m OK with trying things.

COUNSELOR: My hunch is that when we begin to do counseling work together
like this, that sometimes people have this sense about counseling, that it’s this
tranquil, wonderful, feel-good type of situation. But it’s really a disruptive thing
that occurs. When you’re coming here and you’re sitting here as a family and
you’re saying, we have a problem, in some ways I communicate to you. I’m here
to help you disrupt your family right now. And that can be a very unsettling thing.

I was just thinking, Michelle, if I were you, one of the things I might feel like is
like, oh wait a second. I’m not ready to have this situation. Go away. Like I’m not
ready to have my mom and my relationship disrupted in any way.

MICHELLE: No. And at this point, I want to be out with my friends. I don’t need a
bunch of new rules. I don’t need all this right now. I’m at the end of high school.
I’m about to leave. I just– No.

COUNSELOR: So when you think about trying new things to make it work in your
family differently, your investment is up in the are with that right now. Like you’re
saying, I’m not interested in making any changes in my life.

MICHELLE: Because I’m hearing just rules.

COUNSELOR: So when you heard me to talk to your dad about him learning
how to express his love differently than he does, you hear that as rules?

© 2017 Laureate Education, Inc. 1

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Microskills: Family Counseling Techniques 2

Microskills: Family Counseling Techniques 2
Program Transcript

NARRATOR: Aaron in Robyn are seeing a counselor as they are concerned
about the alcohol drinking behavior of their adolescent daughter, Michelle. As
you watch this segment, observe the techniques used by the counselor.

COUNSELOR: So I’m wondering if you would do something for a minute. I’m
wondering if you could share with your dad what he doesn’t get about you. If you
were to think about your dad really being in a place of really not knowing what it
is that you are or who you are. To be able to say to him, this is what you’re not
getting about me. And Dad, I’m wondering if you could just hear what she has to
say. And then I want to talk with you a little bit about that.

AARON: I have to be quiet?

COUNSELOR: Yeah.

AARON: That’s going to be hard.

COUNSELOR: Yeah. I’m sure it will, yeah.

AARON: I’ll give it a shot. I’ll give it a shot.

MICHELLE: Well, I’m not a robot. And I’m not your little Barbie doll toy. And I’m
not your dancing monkey when we go out places. I don’t like performing for
people. And get things that I get– who I am. I am a person. And I want to make
my own decisions. And maybe I don’t know what I want to do. And I think that
should be OK.

COUNSELOR: Anything else? Now I want to stop for a second. It looked to me,
as you were talking to dad, that there were a couple times where you were
looking to mom, almost for some reassurance. I wonder if you noticed that, Mom.
Yeah. And Dad, what were you hearing? What were you hearing Michelle say?

AARON: I’ve got to be honest with you. My internal language was just telling me
to just be quiet and listen to her. So I was hearing my own internal voice at the
same time I was trying to listen to her. But I kept hearing words like “Barbie doll”
and “dancing monkey.” And that’s not what I want my daughter to think that I
want of her.

MICHELLE: You get the message that she feels like you want her to perform.

AARON: Yeah, that’s what I heard. I just… That’s not what I want at all.

© 2017 Laureate Education, Inc. 1

Microskills: Family Counseling Techniques 2

COUNSELOR: So one of the things that may be happening in your family is that
you may be making some assumptions about your dad, about what he wants you
to do, that may not be his intention. Do you think that he wants to

Microskills: Family Counseling Techniques 1

Microskills: Family Counseling Techniques 1
Program Transcript

NARRATOR: Aaron and Robyn are seeing a counselor as they are concerned
about the alcohol drinking behavior of their adolescent daughter, Michelle. As
you watch this segment, observe the techniques used by the counselor.

COUNSELOR: So really one of the defaults for you, one of the positions that you
take is, honey, because you don’t know what’s going on in our lives. I don’t hear
that just about you and Michelle. I hear it’s about, or Michelle’s life, it’s about your
lives. We’re living our lives and you’re out working. I mean that’s kind of the
sense that I’m getting from you.

And it’s interesting to see the way in which, when you came in today, the way
that you sat. You’re very close together. Michelle, it’s almost like you’re between
your mom and dad. So I’m wondering if that feels like that way sometimes for you
if you feel like you’re kind of in the middle of a, I don’t know, a conflict between
mom and dad.

MICHELLE: Well, sometimes, I mean, when he’s gone, everything’s perfectly
fine. But then when it comes to the weekends, everything has to change. And
that’s when all the conflicts happen. Otherwise, everything’s fine.

COUNSELOR: Yeah, I noticed earlier that one of the things that you said, Aaron,
is that you said the rules in my house. And I’m wondering if that’s how it feels like
to be a member of this family is that it’s your house and these girls have to follow
your rules. I mean, does that feel– you look like that’s really something that
happens for you.

ROBYN: I notice with myself, I start getting very stressed on Thursday night,
because I know that he’s coming home, and he’s going to be critical of how I
parent Michelle, and critical of the decisions I’ve made in the week. It didn’t used
to be like that. We used to be a family. And now it’s just him wanting to have
things perfect. He’s so worried that someone’s going to see that we’re not
perfect, and that we have to work really hard on Thursday night, Friday morning,
to make sure everything is the way that’s going to make him happy when he gets
home.

COUNSELOR: So one of the ways in which you manifest that things aren’t
perfect, is you land here, you’re in my office. I’m wondering if this feels hopeful to
you, like finally, we’re at a place where we can start addressing something that
hasn’t felt perfect, that we’ve been trying to put up this front about perfection.
Does that fit for you? Or does this feel like you are here, because you’re in
trouble just like you were taking care of your daughter who was throwing up in
the toilet?

Psychotherapy with Groups and Families

Psychotherapy with Groups and Families
Program Transcript

[MUSIC PLAYING]

NARRATOR: Up to this point, you’ve had the experience of counseling people
with a variety of psychiatric and mental health needs, on a one-to-one basis. In
this course you’ll take those skills and apply them to groups of people and entire
families.

Sometimes called the Third Psychiatric Revolution, the discovery of the
effectiveness of treating people in groups has added new approaches to our
therapeutic arsenal. The evidence for the efficacy of group and family therapy
has become so well documented– and extensive in the literature– that insurance
companies not only reimburse, but encourage individuals in treatment to consider
group therapy options.

Specific to families, the psychiatric- mental health nurse practitioner uses a wide
variety of family therapy approaches, to help individuals in a family improve the
way they relate to one another. And in so doing, improve their individual mental
health as well. Not only does the deliberate use of psychotherapeutic approaches
to family therapy improve the functioning of the current family, but it has the
potential to improve family functioning for future generations.

In the group setting, the psychiatric-mental health nurse practitioner works with
individuals with a wide range of issues– to improve not only themselves, but their
ways of interacting with and relating to others. In group therapy, individuals have
the opportunity to try out new communication and coping skills. Not only do group
members draw on the strength of the group, but they contribute to the overall
mental health of the other group members. As Dr. L. Cody Marsh once noted– by
the crowd they have been broken, by the crowd they will be healed.

[MUSIC PLAYING]

© 2017 Laureate Education, Inc. 1