Reference Counseling Across Cultures 7th Edition by Paul Pedersen SAGE Publications
Each case response must be 1 page in length with an APA Cover and Reference page.
Case Study of Donna Little – Chapter 5
Donna Little is a 39-year-old Indian woman who has a history of substance misuse and has struggled with reunification with her adolescent children over the last 6 years. She was in residential school from the age of 6 to 16 years old. She has a history of domestic violence in her previous relationships. Donna was the youngest of four children in her family. Her parents siblings and herself were raised in the same small northern reservation. Both her parents had gone to residential school in the early 1950s as did her grandfathers and grandmothers on both sides of her family system in the late 1910s. Donna was raised in an environment of violence and mayhem in her early childhood which she has talked about quite extensively in counseling. Although her parents abused alcohol she emphasizes repeatedly that her family was quite ceremonial and participated in the big drum feast and singing within the community. When Donna was 6 an Indian agent wearing a red white and black checkered jacket gave her candy and took her to the residential school. She never had the opportunity to say good-bye to her mom and dad who died of tuberculosis while she was in the residential school. Donna reflects on her residential school experience with a despondent look. While in the residential school she had only one friend she could count on. Her siblings who were also at the school were older and thus not allowed to play with her or sleep near her at the residence dorms. This created an incredible loneliness that Donna did not know how to fill and often she would use alcohol to help numb that pain. She did not like to drink but it helped her to stop her thinking badly about the past. Donna was a victim of sexual abuse in the residential school primarily by the Roman Catholic priest who was in charge. The first time she was assaulted she was 7; the last assault occurred right before she ran away at age 16. When Donna had attempted to tell the head nun in charge of her dorm what was happening to her she was beaten severely to the point of unconsciousness. Donna recalls it was her friend Sue who nursed her back to health. Donna describes her life as difficult. She went home to her community only to find a partner who turned out to be as violent toward her as her father was to her mother. She loves her children and cares for them deeply. She breast-fed her three children and still today can feel that connection to them. When her children were taken from her home after the last time her husband beat her she spiraled out of control. Donna has had long periods of abstinence has a home in her community that is well cared for and now has a partner who loves her deeply. Donna is on welfare but hunts and fishes to help with sustenance. Donna and her partner have been together for 10 years however they both misuse alcohol on occasion. Donnas present partner is nonviolent and a former residential school survivor as well.
Counseling Across Cultures (Kindle Locations 3850-3871). SAGE Publications. Kindle Edition.
Case Study of Simon Ho Chapter 6
Simon Ho is a 19-year-old Chinese American sophomore attending a midwestern university. He has a good academic record with a 3.25 grade point average but he is having difficulty understanding various concepts in his advanced chemistry class. With a big exam approaching Simon is not only increasingly worried but also experiencing headaches and stomach troubles. Fearing the possibility of failing the exam and disappointing his family Simon decides to seek assistance from his chemistry professor. Upon approaching the professor he is greeted happily and courteously. His professor spends more than an hour with him reviewing some of the material for the exam. After this review Simon feels a bit more confident about his understanding of the concepts. Unfortunately Simon receives a D on the exam. Disappointed by his poor performance he begins to skip class to avoid his professor and never seeks his professors assistance again.
Counseling Across Cultures (Kindle Locations 4609-4615). SAGE Publications. Kindle Edition.
Case Study of Liliana Chapter 8
Liliana who is 24 years old is voluntarily seeking counseling for relationship issues. She has lived in Californias San Francisco Bay Area for most of the time since her family emigrated with undocumented status from Mexico. Recently married Liliana currently lives within a few miles of her mother and sisters. Lilianas family of origin is economically poor. She has met but does not have ongoing contact with her biological father who is somewhere in Mexico. Her mother and two older sisters are deeply committed to the Apostolic Christian Church but Liliana does not attend services regularly. Liliana speaks reverently of her grandmother although relations between the two were tense for a time. Liliana and her grandmother were not speaking to each other because of her grandmothers rejection of Lilianas younger sister. According to Liliana her grandmother could not accept that her sisters biological father was African American. Despite a very difficult time in public school Liliana was able to succeed at a small private high school and she was accepted by an Ivy League university. She left the university after her sophomore year to raise her own family. She is currently working for a successful technology firm as she completes her degree. Lilianas sense of humor engages young people and adults her penetrating insights guide conversations and she is well liked by those who know her well. She continues to defy authority when she feels that it is unjustifiably imposed is occasionally impatient with what she perceives to be the irrelevance of other peoples emotions or reasoning and sometimes balks at what she sees as unnecessary or unimportant work. How might the framework described in this chapter be useful to a counselors efforts to improve Lilianas mental health? The framework does not provide a script that Lilianas counselor might follow. In fact the framework is designed to discourage a search for solutions pointing instead to better questions to guide a counselors practice. Some of these guiding questions might become actual questions that the counselor could ask Liliana. Others could guide the counselors attention during their meetings helping the counselor discern those important ecological factors identify the particulars of Lilianas orientation to the counseling situation and design and cocreate a safe physical and social space. The discussion questions that follow provide a limited example of guiding questions organized according to the broad categories of variables described in our framework.
Counseling Across Cultures (Kindle Locations 6068-6086). SAGE Publications. Kindle Edition.
Case Study of Sawsan Chapter 9
Sawsan a 17-year-old girl was brought by her father to counseling because she had withdrawn herself from family meetings and activities during the past 2 months instead spending most of her time listening to music in her bedroom. Lately she had complained about headaches that lasted all day with no relief despite the use of painkillers. The familys medical doctor had told Sawsans parents that she may be passing through a stressful period and referred them to counseling. At the initial intake meeting with Sawsan and her father the father dominated the conversation and Sawsan displayed approval of his views. The father described her as a perfect girl who always met her parents expectations in school and in social behavior. The change in her behavior made her seem to him as not her. He tried to attribute this change to bad friends or bad readings. He also denied that Sawsan was experiencing any stress and emphasized how much the family loves Sawsan and cares for her needs. He said Nothing is missing in her life. Weve bought her everything she wants. She couldnt be passing through any stress. Knowing that most Arab girls find it very difficult to express their feelings in front of their fathers (or both parents) after listening to the father the counselor asked to be allowed to have a private conversation with Sawsan and the father agreed. At the beginning of this conversation Sawsan continued to go along with her fathers views describing how much her parents love and support her and denying any stress. Only after the counselor validated to her that she indeed has good parents was she ready to reveal a conflict that had been raised recently concerning her desire to study at a university located far from her village which would necessitate her living in the student dorms. Her father rejected the idea of his daughter living away from the house far away from his immediate control. In an attempt to compensate for this he bought her a new computer and suggested that she study at a nearby college. She insisted that she wanted to study at the university and tried to push until her father became angry claiming that she was imitating bad girls who sleep away from their homes. As she described this conflict she continued to remove any accusation from her father saying He did this because he is worried about my future and He is right and I should understand this. The counseling process lasted for five sessions during which the counselor met with only the father three times in order to establish a positive joining with his position and worries. The counselor then revealed to the father some contradictions within his belief system regarding the importance of education as described in culturanalysis. After that the counselor met with both father and daughter and encouraged Sawsan to explain to her father why she felt she needed to study at the university and to express her commitment to her family values. The counselor also encouraged the father to express his care and worry to Sawsan and then to discuss a compromise that may be accepted by both of them. He agreed to allow his daughter to study at another university in a city where she could live with her uncles family. In a follow-up meeting Sawsan and her father expressed satisfaction. Sawsan had returned to normal interaction with the family and no longer complained of headaches.
Counseling Across Cultures (Kindle Locations 6760-6784). SAGE Publications. Kindle Edition.
Case Study of Nikki Chapter 10 Nikki is a 17-year-old male-to-female transgender client. She was sent to counseling by her parents because of their concern that she has become more withdrawn in the past few months. They noticed that she spends much of her time alone in her room and sometimes does not go to school. They are fearful that she will not be able to graduate and go on to college. Nikki disclosed to the counselor that she began to be bullied by her classmates after she asked a friend to the Sadie Hawkins dance. Since then her classmates have shunned her and she has not felt safe going to school. She mentioned that she would prefer to be homeschooled or to drop out of school. During the course of therapy the counselor spent time validating Nikkis experiences providing psychoeducation to her parents about the effects of bullying and advocating with school administrators to provide a safe learning environment for her. Nikki eventually was allowed to pursue independent studies while taking select classes with supportive educators who were able to provide her a safe space on campus so that she could work steadily toward graduating with honors.
Counseling Across Cultures (Kindle Locations 7421-7429). SAGE Publications. Kindle Edition.
Case Study of Sean Chapter 11 Sean a 15-year-old multiracial (Native American White and Black) male initiated services of his own accord to manage symptoms of depression including suicidal ideation. Sean was academically advanced for his age and excelled as an artist and skateboarder. He prided himself most on his academic success and he aimed to graduate from high school early and attend college. Sean had poor self-esteem and lacked a strong cultural identity. In the state where Sean resided he could consent to treatment. He did so stating that his father who was his legal guardian would not consent. The counselor developed a strong rapport with Sean. Sean was raised in a single-parent household. Seans father had a severe and chronic mental illness for which he received sporadic treatment and he was currently stable. According to Sean during his childhood he was placed in state custody for a year due to his fathers alcoholism and physical abuse toward him. Sean also spent a year living in a homeless shelter with his father. During this time he was required to attend therapy which he found unhelpful to his family. Seans father believed it was yet another example of the White man trying to destroy the Indian. Seans siblings were all incarcerated. His grandparents experienced relocation boarding school abuse and slavery. Seans immediate family was relatively isolated because of his fathers outrageous behavior. Sean reported that his father would often denigrate him. One day Sean was limping when he arrived for a therapy session. When asked what had happened he stated that his father had been angry with him for not doing well in his Native language class and had taken a belt to his legs and then shoved him through the screen door breaking it. Sean further reported that his fathers fits of rage were a rare occurrence (every few months) and Sean had learned to manage them by accepting the abuse. The counselor reminded Sean of his duty to report child abuse or neglect. Sean then attempted to downplay the story reporting that he had fallen through the door himself. Sean asked that the counselor not report the incident because he feared being taken away from his father again; Sean felt that his father depended on his care. He was also concerned that any type of investigation would disrupt his schooling and cause his grades to suffer. The counselor was conflicted about whether to report. He considered the following points: (a) client safety including assessment of the severity frequency and impact of the abuse and the vulnerability of the client; (b) obligation to report given the state laws around child abuse and neglect; (c) psychological benefit versus harm to the client as a consequence of reporting including betraying the clients trust potential family fragmentation and loss of stability predictability and family social supports in the clients environment; (d) client level of independence and maturity; and (e) concern regarding the client family and community perceptions of social services as a systemic enactment of violence on families. Seans family had experienced generations of marginalization and victimization enacted through systems meant to uphold social policies. The counselor consulted with several colleagues. In addition to emphasizing the legal and ethical obligations of the profession one colleague asked What if something more violent or lethal were to happen to this child and you did not report? Would you be able to live with that? The counselor decided that he could not. He talked with Sean about the need to report encouraging Sean to report with him but ultimately the counselor made the call. The counselor had plans to work closely with the family if the case was investigated to ensure that the caseworker considered the familys context and culture. He also hoped to help the adolescent develop a safety plan and build broader networks of social and cultural support while also continuing to support him in his academic strengths. However after the counselor reported the abuse Sean did not return to counseling.
Counseling Across Cultures (Kindle Locations 7999-8029). SAGE Publications. Kindle Edition.
Case Study of Ling and Mohammed Chapter 12
Case Study of Eduardo Chapter 13 Laura is a counselor at a small private progressive and predominantly White university in the northeastern United States. Laura is a White straight U.S.-born cisgender woman of Dutch descent who graduated from an Ivy League university. She has been a mental health practitioner for the past 8 years and considers herself to be an effective and competent clinician. For the past 2 months Laura has been working with Eduardo a 19-year-old cisgender man a freshman at the university who initially presented with a depressed mood inability to concentrate and general anhedonia. Eduardo is an immigrant from the Dominican Republic; he was 5 years old when he arrived in the United States with his family. He grew up in the Southeast which he considers home and where his family still lives. He is the eldest of four siblings (Mara Carmen and Lissette are 14 12 and 6 respectively) and the first one in his family to go to college. Eduardos parents who are extremely proud of their college boy worked multiple jobs while he was growing up and now own a small neighborhood restaurant. Eduardo works there during school breaks and is studying business so that he can take over the management of the restaurant and allow his parents to retire. In the course of treatment Eduardo discloses that for the past 6 months he has been having erotic encounters with men. He discounts these encounters as just playing and after a recollection of every encounter he tells Laura about his plans to get married to a woman and to have a large family. He tells Laura that he is not gay because he is very masculine (un tigre) and always the top during sex which he considers comparable to having sex with a woman. Lately Eduardo has been talking a lot about one particular young man Clive with a lot of tenderness and affection. Eduardo talks about Clive wanting to go on real dates and finds these requests ridiculous as he does not date men. At the same time Laura notes Eduardos worsening mood and apathy turning into passive suicidal ideation. She is familiar with research linking closeted homosexuality with negative psychological consequences. Since coming out is empirically correlated with improved mental and general health functioning Laura is convinced that Eduardos worsening mental health is related to his inability to come out and decides that she will assist Eduardo with this process. Lauras therapeutic goals are not easy to implement however. No matter how gently she brings it up Eduardo becomes angry and at times leaves sessions prematurely. At one point Laura shares her experience of being the only nonlegacy student among her friends at her Ivy League university in order to show Eduardo that she knows what it means to feel different and not always accepted. She also shares the story of her gay cousin who came out about 10 years ago. She states that she knows how hard it is to come out but she imagines that things must be so much easier for gay people now than they were for her cousin. Lauras disclosure is met with a blank stare from Eduardo. One day Laura looks around her office and notices that none of the books or pamphlets she has available relate to gay issues. She makes an effort and brings in pamphlets advertising the universitys Gay Lesbian Bisexual and Queer Student Union. At Eduardos next session she asks him if he would be willing to go with her to the organizations open house the next week. Eduardos eyes well up with tears. He says I cannot believe you. You have no idea who I really am. He storms out of the room and does not come back for his next three scheduled appointments.
Case Study of The Team Chapter 16
As a member of a team of Native American mental health professionals and traditional spiritual leaders (hereafter called the Team) I have had the opportunity to respond to community crises in Native communities. Often these responses have come after communities have experienced clusters of youth suicides. The following is a description of one of those responses. The health director of a remote tribal community of approximately 2500 contacted and met with the Team leaders (one of the communitys traditional spiritual/cultural leaders and me a clinical psychologist). She described the occurrence of 17 youth suicides in the community all by hanging over a 2-month period. Most members of the community had been affected directly in some way and some families had lost more than one child. Service providers and first responders in the community were overwhelmed and exhausted as suicide attempts were continuing almost every day. Community leaders had sent the health director to request that the Team respond as soon as possible to help stop the suicide attempts and help the community begin a healing process. Team Activities The Team prepared itself through spiritual ceremony and then traveled to the community within 3 days. The following are some of the activities of the Team over the next several weeks. Meeting with first-line service providers (FLSPs). The Team spent the first day meeting with a group of service providers and first responders from the community providing training on the effects of traumatic stress and using talking circles to give the FLSPs a chance to talk about the ways they had been affected by the suicides. The FLSPs became the lead group for all the following work and worked closely with the Team for the remainder of the visit. Community meeting. The Team conducted an open community meeting to hear the perceptions and ideas of community members about what had been happening. Meeting with tribal government. The Team met with the tribal government to ensure that community members recognized that the Team had been authorized to be in the community and to present a report and recommendations to tribal leaders at the end of the visit. The Team maintained contact with tribal leaders as recommendations were implemented over the next several years. Meeting with spiritual leaders. Traditional Native spiritual leaders and church leaders had never met together before but were able to come together to provide united spiritual support to community members. Working with schools. All of the schools serving the reservation children (public church-based tribal) were visited. This was facilitated by school counselors who were part of the FLSP group. Team members working with members of the FLSP group held talking circles with children in every grade all teachers and all administrators to educate (in grade-appropriate formats) about the effects of traumatic stress and to identify high-risk children. Meeting with affected families and relatives. Team members traveled to families homes or met them in places they felt comfortable. In some cases families had not yet reentered the homes where their children had died. Spiritual leader members of the Team conducted the appropriate ceremonies that would allow them to go into their homes or enter their childrens rooms. Mental health members of the Team worked with the children adults and families to help them express their grief honor their loved ones and support one another. Meeting with representatives of the judicial system. Some children whose siblings had died were afraid to return to school because they were afraid someone else in their families would die. The schools had started to press charges against the parents for truancy. Team members met with representatives of the judicial system and were able to work out solutions that included in-home schooling for affected children. Building a context. Meetings with the tribal health director over a 2-week period revealed a broader context that included 4 years of massive flooding on the reservation basements that held 34 feet of standing water increases in respiratory illnesses deaths of elders occurrence of hantavirus and washed-out roads requiring school buses to detour 70 miles (resulting in children going to school in the dark and not returning until dark). Many families had moved to the central district of the reservation where services and schools were centered but a severe housing shortage required them to live with friends or relatives. Families were separated with members scattered among multiple households and their possessions somewhere else. Federal funding cuts meant that service providers were overwhelmed. Overcrowded living conditions led to increases in substance abuse domestic violence and gambling. Preexisting racial tensions between the reservation residents and people living in the nearby town were exacerbated. There was a single half-time mental health professional for the reservation and when the suicide attempts started young people who attempted to harm themselves were sent off the reservation to hospitals more than 100 miles away for evaluation. Often their families did not have access to transportation and could not go with them. When the young people returned their families were not informed about diagnoses medications or warning signs and there was no aftercare in the community. This was the case for many of the young people who had died. People started to believe that when their children were sent away they were put on medicine that contributed to them killing themselves so now there were many more suicide attempts that went unreported. The young people who had died were actually seen as the youth leaders in the community. Sharing the context. The Team worked with the health director and tribal governance to build the context for the current crisis situation. The tribal chairperson called a mandatory meeting of all community members so that the Team could share the context with community members. People in the community had not connected the long-term stress brought on by the flooding to the suicides. The tribe did not think of the flooding as a disaster because it was a part of the natural world (there actually is no word for disaster in the tribal language). Team members had also been working with the young people developing a new set of youth leaders. These youth shared their grief feelings of loss and need for adult guidance at the community meeting. Sharing this context allowed community members to get a big-picture view of what had been happening and allowed them to come together and mobilize community resources to support each other and begin a healing process. Developing a community crisis team. The Team worked with the FLSP group to develop a community crisis team with an emergency plan and connection to needed resources. The Team had discovered a pattern of suicide attempts and planning was done for the community crisis team to use time periods when no suicide attempts were happening to do community education and outreach. Engaging in advocacy. The Team was able to advocate with FEMA to get needed resources to the community. Acknowledging the relationship. The Team maintained contact with the community and its leaders. Follow-up visits focused on further development of the crisis team the youth leadership community education and advocacy for resources. It was important for the Team to acknowledge that its relationship with the community did not end at the end of the crisis. Engaging in self-care. The Team met at the end of every day so that members could debrief and check in with each other. Even when the Team worked late into the night this meeting was important to make sure that everyone remained healthy. In a situation where children have died and everyone in the community has been affected it is difficult for helpers not to be overwhelmed as well. Throughout this intervention and the several years that followed the Team maintained a supportive presence stayed in the background and empowered community leaders and service providers to shape and implement their plans. Community members who had felt helpless in the beginning became active leaders for change in their own community. The suicide attempts stopped the youth leadership asked for representation in tribal governance and needed resources (including mental health professionals) were received in the community.
What are some of the reactions to traumatic stress seen in the community described above? Would you describe the community above as resilient? Why or why not?
How did culture play a role in the crisis that occurred in this community?
How do the IASC guidelines apply in this setting? How do they serve to protect a community during a crisis response?
Case Study of Jeanette – Chapter 17
Jeanette a 54-year-old married African American woman presented at a community mental health center in rural Georgia with symptoms of depression (weight gain irritability social isolation crying spells). Jeanettes husband is an independent contractor but construction jobs have been few and far between with the economic downturn and Jeanette herself is currently unemployed. Jeanette has one adult daughter with whom she describes a distant relationship because her daughter identifies as a lesbian and lives in Atlanta with her girlfriend. Jeanette states that she garners the majority of her social support through her womens group at church though she notes feeling guarded around friends who dont know too much about her past. As a child Jeanette experienced severe physical and psychological abuse from her mother and sexual abuse from her older brother. Despite having been raised in the 1960s Jeanette grew up in a childhood home that had no indoor plumbing or heat and she states that she was too embarrassed to make friends for fear they would find out about her poverty. She dropped out of high school in the 10th grade in order to get a full-time job as a line cook that enabled her to move away from her abusers and support herself. Jeanette entered therapy at the prompting of her husband who claims that she overeats away her pain rather than facing her past trauma. Jeanette has a history of severe drug abuse but she indicates that due to Narcotics Anonymous raising her daughter and her Baptist faith she has been able to remain substance-free for 17 years and has instead shifted her coping method to food. Since her daughter moved away and came out as lesbian Jeanette reports feeling that she has lost her identity as a mother and homemaker. Jeanette completed her GED after her daughter was born and has since enrolled in a few classes at the community college but she has little desire to earn her associate degree. To pass the time she is currently seeking employment but because of her past involvement with narcotics she has a criminal record and has been unsuccessful in securing even a minimum-wage position. Jeanette indicates that she would like to work on her anger toward her family of origin her feelings of helplessness and her lack of a sense of purpose. In sessions she explores the context of her traumatic experiences. Growing up in the rural and racially segregated South she felt as though she could not report her abuse or rely on law enforcement for support or intervention. Moreover as a Black woman she describes feeling pressure not to bring negative attention to her family and community by reporting these assaults. Through therapy she begins to process how these early traumatic experiences may have contributed to her feelings of hopelessness and disempowerment which eventually led to substance abuse and overeating. Jeanette feels trapped and discouraged by her inability to find employment and notes that her present disempowerment is triggering her to relive past trauma. At the end of her fourth session Jeanette expresses the desire to set concrete goals for reestablishing her sense of personal mastery while allowing for a more healthy release of anger toward her mother and brother. Jeanette also notes that she would like to work on her relationship with her daughter but feels stuck because of her spiritual beliefs that same-gender romantic relationships are immoral. She fears that if her friends in the Baptist womens group find out that her daughter is a lesbian she and her husband will be marginalized by their community and they might also lose the sporadic economic support they receive from religious leaders and food banks run by faith-based organizations.
Jeanettes presenting concerns emerge at the nexus of several poverty- and racism-related factors. How would you describe the influence of these systemic forms of oppression in her life and in her presenting concerns?
A primary element within Jeanettes history is the childhood abuse that appears to have triggered a pattern of withdrawal depression and avoidance of emotions via substance abuse. How has the impact of the trauma been exacerbated by the poverty that Jeanettes family faces?
To supplement her husbands sporadic wages Jeanett