Handling Unexpected Disruptive

Case 10. Handling Unexpected Disruptive

Member Behavior During Group Therapy

Esther Hernandez, Ph.D., a specialist in the psychology of addictions, conducts

group therapy sessions for patients treated at a local methadone Medicaid clinic.

She has been meeting with a group of 12 women on a weekly basis for 2 months

and has been pleased that, for the most part, members attend the meetings regularly.

Although the women take methadone as a substitute for their heroin habits,

many also take other illicit drugs. At the initial session, Dr. Hernandez and group

members agreed on a rule that members should not come to a session if they are

high or intoxicated. The rule has been enforced several times during the past

2 months.

At the beginning of the most recent session, Angela, one of the group members,

walks in late and is obviously intoxicated. Dr. Hernandez reminds Angela about the

rule, noting that Angela must leave but will be welcome back at the next meeting if

she is sober. Angela starts crying and begs to stay. Dr. Hernandez expresses sympathy

and then restates the rule. Angela stands up and states that a drug dealer to

whom she owes money has found out where she lives and she is afraid for her life.

Then as she rushes out of the building, she tells the group “You will all be sorry

when I’m dead.”

The other group members are obviously shaken by Angela’s behavior. Some in

the group feel Dr. Hernandez should end the group meeting and try to find Angela

to make sure she is okay. Others think Dr. Hernandez should call the police. Still

others in the group believe that Angela was trying to manipulate Dr. Hernandez

into permitting her to break the rule. They note that in the past she has tried to get

around other group rules.

Ethical Dilemma

Dr. Hernandez is shaken and does not know how best to handle this situation.

Discussion Questions

1. Why is this an ethical dilemma? Which APA Ethical Principles help frame the

nature of the dilemma?

2. Who are the stakeholders and how will they be affected by how Dr. Hernandez

resolves this dilemma?

3. Is Angela’s current situation one that Dr. Hernandez should have anticipated

in establishing group therapies designed to treat addiction and substance

dependence? Does Dr. Hernandez have a professional responsibility for

Angela’s safety outside the group therapy context?

4. How should Dr. Hernandez immediately address the group members concerns,

keeping in mind that group members have voiced different opinions

about the situation?

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372——DECODING THE ETHICS CODE

5. From a treatment perspective, how important is it for Dr. Hernandez to uphold

the group’s self-generated and agreed-upon rules regarding intoxication? Do

group members have the same confidentiality obligations as Dr. Hernandez?

6. What legal concerns should Dr. Hernandez consider?

7. How are APA Ethical Standards 2.01a, 2.01e, 4.01, 4.05, 4.06, 10.03, and 10.10

and the Clinical Practice Guidelines for Group Psychotherapy relevant to this

dilemma? Which other standards might apply?

8. What are Dr. Hernandez’ ethical alternatives for resolving this dilemma? Which

alternative best reflects the Ethics Code aspirational principles and enforceable

standards, legal standards, and obligations to stakeholders? Can you identify

the ethical theory (discussed in Chapter 3) guiding your decision?

9. What steps should Dr. Hernandez take to implement her decision and monitor

its effect?

Suggested Readings

American Psychological Association. (2007). Guidelines for psychological practice with girls

and women. American Psychologist, 62, 949–979.

Bernard, H., Burlingame, G., Flores, P., Greene, L., Joyce, A., Kobos, J. C., . . . American Group

Psychotherapy Association. (2008). Clinical practice guidelines for group psychotherapy.

International Journal of Group Psychotherapy, 58(4), 455–542.

Brabender, V. (2006). The ethical group psychotherapist. International Journal of Group

Psychotherapy, 56(4), 395–414.

Lasky, G. B., & Riva, M. T. (2006). Confidentiality and privileged communication in group

psychotherapy. International Journal of Group Psychotherapy, 56(4), 455–476.

Vannicelli, M. (2001). Leader dilemmas and countertransference considerations in group

psychotherapy with substance abusers. International Journal of Group Psychotherapy,

51(1), 43–62.

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