One of the most important concepts in clinical practice and group work is confidentiality. All members of the group sign an informed consent form in order to address the rules and parameters of the group sessions. The rules regarding confidentiality are stated in one section of the form. Although every member must sign this agreement, ensuring that all information shared in the group remains confidential can be difficult. As the group leader, the clinical social worker is responsible for developing strategies so that all members feel safe to share.
For this Discussion, review the “Working With Groups: Latino Patients Living With HIV/AIDS” case study. ATTACHED
Post strategies you might prefer to use to ensure confidentiality in a treatment group for individuals living with HIV/AIDS. Describe how informed consent addresses confidentiality in a group setting. How does confidentiality in a group differ from confidentiality in individual counseling? Also, discuss how you would address a breach of confidentiality in the group. .
The support group discussed here was created to address the unique needs of a vulnerable population receiving services at an outpatient interdisciplinary comprehensive care center. The center’s mission was to provide medical and psychosocial services to adult patients living with HIV/AIDS (PLWH). Both patients and providers at the center expressed a need for a group to address the needs of the center’s Latino population. At the time the group was created, 36% of the center’s population identified as Latino, and 25% of this cohort identified Spanish as their primary language. The purpose of the group was twofold: 1) to reduce the social isolation felt by Latino patients at the center and 2) to create a culturally sensitive environment where Latino patients could explore common medical and psychosocial issues faced by PLWH within a cultural context.
Planning for the group consisted of 1) defining a format for the group, 2) recruiting appropriate members, and 3) building an appropriate group composition. When considering the format of the group, I thought about structure, time, place, and language. The group was designated a closed group in that new patients were not admitted once the initial membership was determined. The group was held in the center’s conference room, which was furnished with comfortable seating around a large conference table so that members were visible to each other during group sessions. The group met once a week for 90-minute sessions during which 60 minutes were spent on open discussion and the last 30 minutes were spent on having lunch. Given the importance of food in the Latino culture, I thought members would appreciate the opportunity to share a meal with their peers. I decided to designate the group as Spanish-speaking so that all sessions were held in Spanish. This offered members not only a sense of comfort and an opportunity to explore issues in their native tongue, but it also addressed the language barrier that often isolates Latino PLWH.
I used several strategies to recruit members. I hung flyers throughout the center, and I informed my colleagues about the group during interdisciplinary staff meetings. Referrals ultimately came from physicians, social workers, and even administrative staff who had developed relationships with patients at the center. When considering group composition, I focused on creating balance in group size and the characteristics of individual members. I worked to create a group with enough members so that discussions would be fruitful and differing opinions could be presented, but at the same time, individual members would have an opportunity to discuss their unique feelings, thoughts, and opinions. When it came to member characteristics, I strove to create a balance between homogeneity and heterogeneity across such domains as age, sex, sexual orientation, socioeconomic status, etc. The goal was to create a group where no member felt isolated by uniqueness while simultaneously promoting diversity between members. Prior to being admitted to the group, potential members were interviewed/screened in person or by phone. The focus of these interviews was to 1) assess the patient’s ability to communicate in Spanish, 2) describe the purpose of the group, 3) discuss individual expectations for the group, and 4) answer questions about group process and function. A total of 15 patients were referred. Four declined to participate before the group started and two did not show up after the first session. Of the remaining nine members, three were women and six were men. All of the men had a significant history of intravenous drug use (IVDU). Two of the men identified as gay, one identified as bisexual, and three considered themselves to be heterosexual. All of the women were heterosexual, identified a risk factor of unprotected heterosexual sex, and denied a history of IVDU. Members’ ages ranged from 36 to 60.
The group ran successfully for 18 months. Throughout the life of the group, several recurrent themes were discussed, including 1) stigma of HIV and homosexuality, 2) disclosure of HIV status, 3) safer sex practices, 4) adherence to HIV treatment, and 5) the doctor–patient relationship. Each of these themes was discussed within a cultural context giving light to issues such as familialism, collectivism, simpatia, machismo (gender roles), and Latino culture’s tendency to rely on a folk model of medicine.
As in most groups, certain members adopted roles within the group. For example, Anna, a 46-year-old female member, adopted the role of the “silent member.” She repeatedly came to sessions and sat in silence, only responding when she was prompted by direct questions from me or other members. The challenge with Anna was that as this behavior continued, other members tended to ignore her and leave her out of the discussion. In turn, it became my role to try to engage Anna as much as possible and draw her into the discussion. Another example is Diego, a 60-year-old male, who adopted the role of the “help-rejecting complainer.” Throughout group sessions, Diego repeatedly presented a problem or issue and engaged the entire group by asking for help. When members responded with suggestions or solutions, he came up with a myriad of excuses why none of them would work. I will admit I was not successful at altering Diego’s behavior in any way. I attempted to point out the pattern, and I tried to ask other members how it felt to constantly have their input rejected, but nothing seemed to work. Group members did express frustration and boredom with Diego. This was manifested in their body language and during group sessions when Diego was not present. When members spoke about Diego in his absence, I always encouraged them to bring these issues to his attention when he was present, but members were not able to do this because they were fearful of hurting his feelings.
Ultimately, the group served as an arena for mutual support and commonality. Group members forged relationships with peers with whom they would not have had contact in the absence of the group. They also had the opportunity to reflect on their illness and personal experiences within a safe and culturally sensitive environment. While a scientific evaluation of the group was not performed, I witnessed and members reported positive outcomes from the experience.
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