Professional Counseling Case Prompt

Professional Counseling Case Prompt

Jim had been seeing Tina, age 23, in individual therapy for a year and had been aware of longstanding difficulties in her interpersonal relationships dating back to middle school years. Tina had a history of brief and intense friendships, and later intimate relationships, that ended badly with her feeling betrayed and inferior. At the time Tina began therapy with Jim, she had had the traumatic loss of a parent due to a car accident. Her distress was such that Jim felt that the group situation would create too much privation, given that Tina would not be the group’s sole focus. A year later, Jim contemplated placing her in a psychotherapy group so that Tina could make strides in lessening her social anxiety and ambivalence about trusting others.

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Jim was running a group that had declined from eight to four members, a number he found neither therapeutically nor financially optimal. Jim questioned his motivation for the placement: was it fiscally driven or genuinely for Tina’s well-being? Eventually Jim referred Tina to another group, but this placement did not prove to be effective, and Tina stopped attending after a few sessions. Jim decided to go ahead and bring Tina into his group, despite continued reservations about motive and some hesitancy about how Tina might connect with the other women in the group. The group was comprised of all women, most were in their late 20s with one in her early 30s, and all had significant anxiety and problems with interpersonal relationships.

The group had been together for well over a year and the ladies were very outspoken, but kind. Tina joins the group and the first few sessions go well enough, she is quiet but does contribute some. About three sessions in, she opens up when they are talking about loss. She is hesitant, and slow to share, and as soon as she pauses, another member jumps in and begins to share. Jim notices that Tina shuts down and is appears to emotionally disconnect from the group. The next session, Tina is withdrawn again, but does share when the topic turned to trouble trusting others. Tina shares about her last girlfriend who cheated on her and blamed her it because she said Tina was too clingy and needed to “get a life.”

Professional Counseling Case Prompt

Tina cried, and at first seemed relieved to connect then retreated again. As Tina shared, Jim notices a few of the ladies nonverbal reaction to Tina’s mentioning her partner was a female. The following group session, Tina did not talk at all and seemed to be completely shut down and did not make eye contact with anyone. At her next individual session, she tells you that before the last group, she walked in the bathroom and heard two of the ladies talking loudly about the previous group, she swears they were talking about her and what she shared in the group. She knows this goes against the group rules, but clearly they are not being followed and she is unsure if she can come back. (adapted from Brabender & Fallon).

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Questions

1. Discuss Jim’s decision making around having Tina join the group. Would you have screened her in or out and why? What value and ethical issues do you need to consider in bringing a current client into an existing group, given the group make up and background?
2. Jim notices some reaction to Tina’s sharing, should Jim have addressed the response to Tina in the group? Outside of the group? Do counselors have a responsibility for bringing these observations into the here and now? Did Jim miss an opportunity in the moment or could he have brought this up in the next session, or just let it go since it was over?
3. Finally, Tina says she overheard two ladies in the public bathroom and believes they were talking about her. What ethical issues are involved in this and how would you proceed?