Case Vignettes

1. Screening. A community mental health worker forms a group by asking her colleagues for names of clients who might fit into a group she is organizing. She does not make any provisions for screening because she is convinced that screening really is not worth the time it takes. Her position is that her colleagues will give her names of people who would be good candidates. Also, she sees nothing wrong with people dropping out of the group if they find it is not for them.

Do you think that referrals from colleagues constitute a good alternative to conducting screening interviews? Do you think the mental health worker is acting ethically when she encourages members to drop out of the group if they find that it does not suit their needs? What problems, if any, do you see with this group leader's method of setting up her group?

2. Informed Consent. This group leader is organizing a group in a prison mental hospital. The patients have been sent to this hospital and are expected to participate in some type of group therapy plan. Because of this setting and the requirement that the patients be involved in a group treatment program, the leader does not take any measures to secure informed consent. His rationale is that the patients have no choice anyway, so he simply gets his group together and begins.

Are there any ethical issues involved in this case? Is it important to inform members (even involuntary ones) about the goals of the group and the procedures to be used? If you were in a similar situation, what might you do differently? What would you want to tell the patients before the group got under way?

3. Confidentiality. The above leader does mention to his group at the initial meeting that he is required to take notes regarding patient progress and that these notes are part of the patient's record. He announces that what they say may not be kept confidential and that he will not show them what he is writing in their folder.

Do you see any ethical issues in this case? Do you agree or disagree with his practice of not sharing his therapy notes with his patients? In this setting, are there any things you might do differently?

4. Risks in Groups. At the preliminary meeting of a new group, the group leader avoids discussion of possible risks of participating in the group. His rationale is that if he mentions psychological risks, the members are likely to be unduly frightened. When several members do raise concerns and want to share their anxiety about their readiness for the group, he does not encourage them to talk about their reservations and concerns; instead, he attempts to reassure them.

Do you think ethical practice demands that the group leader actually bring up the topic of psychological risks before a member actually joins a group? Do you think the fears that were brought up should be fully explored? Should the members be given reassurance? What would you want to say to a group about the risks of membership?

5. Building Evaluation into Group Work. You and your field supervisor are planning on co-leading a group for the elderly in a community facility. Your supervisor tells you that she would like to develop some type of evaluation form to be given at the first group meeting and again at the final meeting. She would like your help in designing a set of questions that would assess their attitudes about themselves, as well as about a group.