Case 10. Handling Unexpected Disruptive Member Behavior During Group Therapy Esther Hernandez, Ph.

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.

University of Phoenix Material                      

Case Study Ten Worksheet

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

2.     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 Angel's safety outside the group therapy context?

3.     How are APA Ethical Standards 2.01a, 2.01e, 4.01, 4.05, 4.06, 10.03, and 10.10, and the clinical Practice Guideline for Group Psychotherapy relevant to this case? Which other standards might apply?

4.     What is Dr. Hernandez' ethical alternative for resolving this dilemma? Which alternative best reflects the Ethics Code aspirational principle and enforceable standard, as well as legal standards and obligations to stakeholders?

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5.     What steps should Dr. Hernandez take to ethically implement her decision and monitor its effects?

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