Case Study
Patient Demographic: Client s Age: Client 1: age 12 Client 2: age 14 Client 3: age 14 Client 4: age 16 Client 5: age 13 Client 6: age 16 Sex: Males Gender: Males Sexuality: Varying Ethnicity: Multiracial Relationship Status: Single Counseling Setting: Juvenile Justice Facility Type of Counseling: Group Counseling Presenting Problem: Involvement with the Justice System That Includes Various Mental Health Disorders and Crimes Diagnosis: Imprisonment (Z65.1)
Mental Status Exam: Mental Status Exam: All of the clients appear to maintainappropriate hygiene, and they are all oriented to person, place, time, and situation. They are all somewhat reserved with regard to going into deeper topics, but theyparticipate f
Presenting Problem: You are a licensed counselor working in a juvenile justice facility for teenage males. The group comprises six males that are required to attend as part of their incarceration with the expectation that it will shorten their sentences. The purpose of the group is to work on emotional regulation and to work together to share common experiences and identify goals that can be helpful in preventing reincarceration. During the intake session, you explained the purpose of the group and started with an ice-breakeractivity. The clients participated in the ice-breaker activity that required you to redirect them back to the activity several times because they would joke and get off task. You attempt to go a little deeper by encouraging your clients to start talking about what happened to get them incarcerated, and they appear to be taking pride in the reasons they were in juvenile detention and making fun of those with lesser sentences. You redirect the clients to another topic.
Other Contexts: You meet with the group for the sixth session, and they are focused and appear to be more respectful toward you because it appears that you can get their attention more easily to start the session. You separate the group into dyads at the start of the session and prompt the group members to talk about feelings related to the pros and cons of engaging in school. You overhear client 4 telling client 3 that it does not matter if client 3 does well in school because he is in juvenile detention for sexual assault and therefore he cannot redeem himself. You intervene and remind client 4 of the group rules about respecting others.  Client 4 continues to accuse other members of the group of engaging in sinful activities and continues to be disruptive to the group process

Question: Client 4 continues to accuse other members of the group of engaging in sinful activities and continues to be disruptive to the group process. All of the following are important considerations EXCEPT:
(A): Considering to ask client 4 to sit silently or in the same room but not participate.
(B): Having a conversation with client 4 about finding a more appropriate group during the session because it can be a good moment to teach other group members what is tolerable in the group, especially considering the detention setting.
(C): Whether significant attempts have been made to redirect client 4 and to reinforce group rules.
(D): If client 4 is actively causing harm to others, you can ask him to leave the group immediately without a discussion.

Correct Answer: Having a conversation with client 4 about finding a more appropriate group during the session because it can be a good moment to teach other group members what is tolerable in the group, especially considering the detention setting.
Explanation: The client has been causing significant disruptions that have affected other group members, and you need to address this after the group with the client. If you plan to address the client’s disruptions and his need to be in another group provided by the facility, you do not want to do this in front of the other clients because this would present a power struggle in front of the others. It is important to consider your attempts at redirection and enforcing rules in order to assess and adjust your interventions. If the client is actively causing harm, you need to protect your other clients, which may involve ejecting the member from the group immediately or asking them to sit silently for the rest of the session. Although ejecting the client may affect his sentence, this was a decision that the client made, and attempts to refer to another group or problem-solve can be done after the group. Therefore, the correct answer is (B)
Competency: counseling skills and interventions