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
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.
Dr. Hernandez is shaken and does not know how best to handle this situation.
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
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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.
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Brabender, V. (2006). The ethical group psychotherapist. International Journal of Group
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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,