The Difference of Legal and Ethical Considerations between Group/Family Therapy and Individual Therapy

Colleague’s Post
The Difference of Legal and Ethical Considerations between Group/Family Therapy and Individual Therapy
Confidentiality is a major concern for PMHNP treating patients with either individual or group therapy. Many patients are reluctant to divulge personal aspects of their lives unless they believe it will be kept private. Patients must view providers as trustworthy for a therapeutic alliance to be developed. “A meta-analytic review of research studies found that the therapeutic alliance is itself therapeutic and essential for the successful outcome of treatment no matter what model of therapy…” (Wheeler, 2014, pp. 170). Ethical principles such as autonomy, fidelity, beneficence, and nonmaleficence are important to patient confidentiality. The PMHNP is responsible for protecting the patient’s confidentiality in both individual and group environments and limits to that protection should be discussed with the patients prior to the start of therapy. Psychiatric providers must be “…honest about limits of confidentiality so clients are able to make informed decisions about self-disclosure.” (McClanahan, 2014, para 3)
Privacy concerns are easier to control with individual therapy because sessions are exclusively between the patient and the provider. Whereas, with group therapy there are other individuals involved in treatment. Group therapy is an effective intervention, however the patients utilizing group sessions are at greater risk for privacy breaches. The group leader can ensure confidentiality on there part but cannot provide certainty that all members of the group will keep the group information private. Group leaders can only encourage group participants to protect information discussed in group. (McClanahan, 2014)
The Impact Legal and Ethical issues have on Therapeutic Approaches for Clients in Group and Family Therapy
HIPAA compliance is a major concern in group and family therapy because more people are involved in the information sharing. This may affect therapy because some people may not be comfortable revealing their mental illness. Mental health stigma plays a huge role in patient compliance with mental health therapies. Currently the need for social isolation has made psychotherapeutic intervention even more difficult. A large amount of psychiatric care is provided using Telehealth services. Covid-19 is affecting individual as well as group therapy. Clinicians are challenged to provide effective care using Telehealth. Individual, group, and family therapies are being conducted via phone and/or internet sources. The increasing use of these forms of interventions are impacting therapeutic approaches due to the added legal and ethical implications. Telehealth adds to the providers HIPAA responsibilities because the chances that patient health information may be placed at risk is greater. Although individual teletherapy may have some of the same risk, group and family teletherapy have additional risk due to the number of people involved in the encounter. Some examples of breaches may occur from members of the group who attend group in locations that are not private, members of the group recording or screenshotting the groups, and members that may record other members of the group with the intent to blackmail them. (How to do group therapy using telehealth, 2020) The best way providers can attempt to limit the legal and ethical impacts on therapy is to effectively review informed consent, establish group guidelines, set expectations, clarify goals, and maintain trust. (How to do group therapy using telehealth, 2020)
How to do group therapy using telehealth. (2020). How to Do Group Therapy Using Telehealth.
McClanahan, K.K. (2014) Can Confidentiality be maintained in Group Therapy? Retrieved from
Wheeler PhD APRN-BC FAAN, Kathleen. (2014) Psychotherapy for the Advanced Practice Psychiatric
Nurse, Second Edition (p. 170). Springiquer Publishing Company. Kindle Edition

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