Case Study Scenario #2: Janet
Too often, we tend to under-emphasize the variety of cultural influences that impact any given individual, making him or her the unique person he or she is (Diller, 2011). According to Diller (2011) by identifying an individual by race or ethnicity alone, we unintentionally turn them into stereotypes an one-dimensional beings, losing the full complexity of their cultural experiencing and limiting our understanding of them as complex individuals. When working with culturally diverse populations it is safe to say that there will be specific issues that will arise when working with these clients. It is agreed among practitioners that cross-cultural helping is becoming more demanding, challenging, and energy draining than work with same- cultural clients.
Hays (2008) in her ADDRESSING framework offer an excellent tool conceptualizing the diverse social identities that define each individual. The acronym ADDRESSING refers to the initial letter of the various social identities that each individual possess: age and generation, developmental disabilities (current) as well as developmental disabilities that may develop later, religion upbringing and practice, ethnic and racial identity, socioeconomic status, sexual orientation, indigenous heritage, national identity and gender. This information should be collected and updated as new information is forthcoming for each client seen
According to Hays (2008), the ADDRESSING model in multicultural counseling emanates from the transcultural-specific perspective. It focuses on ethnic minority cultures that have traditionally been marginalized by the counseling field but incorporates research on a number of nonethnic minority groups to increase the understanding of people of color (Hays, 1996). This will be an appropriate taxonomy model to use in counseling Janet.
In the initial session of counseling with Janet, several pieces of vital information would be obtained. I would start by completing an intake on her as a new client. This intake process would include collecting demographical information from her to include her current, valid contact information (i.e. address, phone, emergency contact, etc.) and insurance information for billing purposes. I would want to know what specific issue led her to seek counseling. I would address her family history and current family situation. This information will be used to better understand the problem Janet is having and to make an initial assessment of her situation. I would also build rapport during this first session with Janet. The trust and confidence that is developed can greatly enhance my ability to manage the counseling sessions effectively, and it is most likely going to keep Janet coming back for more. In addition, building rapport is a principle method for gathering information. It helps motivate your client to talk spontaneously and reveal important personal data. I would give ample amount of time for Janet to discuss her family and relationship backgrounds to gather as much information as possible to fully assess her presenting problems for therapy.
The first step in multicultural training is always that of considering one's own biases and areas of inexperience; the ADDRESSING model can be used as a framework for this ongoing work. In a classroom setting, the challenge can begin as simply as asking students to think about their own identities in relation to the ADDRESSING factors. In addition, the ADDRESSING model can be used in raising awareness is to broaden and deepen counselors' understanding of racism, ethnocentrism, and other forms of oppression that affect people of color.
However, the ADDRESSING model does not assume that membership in or awareness regarding one minority culture automatically leads to awareness with other minority groups. The ADDRESSING model can be used to counteract the compartmentalization of awareness by reminding counselors that everyone has biases and areas of inexperience and ignorance. That is, no one individual can possibly have an insider's knowledge of all the ethnic and nonethnic minority groups included in the ADDRESSING model. Framing the task of challenging one's own biases in this way helps to decrease defensiveness among members of dominant cultural groups but also emphasizes the life-long commitment and hard work needed (whatever one's cultural identity) to become a culturally responsive counselor.
In working with Janet, the possible identified problems that could arise would be that of a bias of why married couples should divorce. A judgmental attitude could present itself when addressing the issue of divorce. From a Christian perspective, there was only one reason given as to why a married couple could divorce. According to Matthew 5 and its explanation on divorce, sexual immortality was the only reason for a divorce. If Janet divorced for any other reason than that, bias may surface and possibly affect my ability to counsel Janet.
Janet would assist therapist to develop goals to achieve in three phases. The early phase goals would address problem assessment, goal setting, and early referrals; the middle phase goals is the working phase of therapy and is generally client specific; and the late phase goals which include addressing long-term issues, solidifying gains, strategies for handling future issues and referrals. Janet has low self-esteem, relationship issues, addiction issues, victim of sexual abuse and family issues. Goals would assist to provide a safe environment for Janet to begin discussing past and present issues associated with her sexual abuse, addiction, multiple divorces, and low self-esteem. It is important for Janet to set attainable goals to address these areas so that she understands why they might be occurring and the effects on her life and the life of her children. If Janet refused to accept a goal that is beneficial, I would use motivation to get her to change. Different strategies I might utilize include setting the stage for negotiation, be encouraging, identify legitimate client interests, identify non-negotiable aspects of intervention, identify negotiable aspects of intervention, negotiate the case plan, and agree on criteria for progress. However, I must respect that Janet has the right to make her own decisions and the responsibility to face the consequences of those decisions associated with her treatment. The one goal I would develop would be that to help Janet understand why her behaviors exist, continue to exist and effect her life and he children. If Janet can grasp the important outcome that the counseling was at least a positive experience in which the client felt listened to, respected and not judged, then she may be able begin putting the pieces of her life back together.
Cognitive Behavioral Therapy (CBT) is a brief form of psychotherapy used in the treatment of adults and children. Its focus is on current issues and symptoms versus more traditional forms of therapy, which tend to focus on a person's past history. The usual format is weekly therapy sessions and daily practice exercises designed to help the patient apply skills in their home environment. Very simply put, CBT attempts to help patients recognize, avoid, and cope (Dakai, 2003). CBT is a short-term, comparatively brief approach well suited to the resource capabilities of most clinical programs and has been extensively evaluated in rigorous clinical trials with solid empirical support as treatment for substance abuse. CBT is structured, goal-oriented, and focused on the immediate problems; is a flexible, individualized approach that can be adapted to a wide range of patients as well as a variety of settings (inpatient, outpatient) and formats (group, individual). According to Dakai (2003) CBT is compatible with a range of other treatments the patient may receive, such as pharmacotherapy. This would be an effective theoretical model to use with Janet since she has been having substance abuse issues since her teenage years. The goal of this model is to increase desired behaviors/cognitions, decrease undesirable behaviors/cognitions, and improve problem-solving skills. The techniques of CBT used to treat Janet would include contracting, functional analysis, modeling, charting, disputing irrational beliefs, and psychoeducation. Janet would have 8 to 10 sessions depending upon several factors such as onset, duration, and severity of symptoms, progress made, and how much support she is receiving from family members.
CBT is not effective for everybody that enters a therapeutic counseling relationship. While CBT may not cure Janet's issues, it can give her the power to cope with her life situations in a healthy way and to feel better about herself and her life. While working on emotional issues it can be painful for Janet and will require hard work. She will feel worse during the initial part of therapy as she begin to confront past and current conflicts. Several sessions maybe held before improvement seen. However, there are many ways to measure success when using the CBT model such as questionnaires, self-reports, and treatment planning with objectives. I would use appropriate self-report measures and have her complete the reports on a regular basis to monitor treatment progress and discuss progress or problems with Janet throughout the course of treatment. After eight sessions, I would evaluate progress made and decide if additional sessions are warranted. Treatment planning would also be another effective way to measure progress and success with Janet and the progress she is making. When each of her goals are met, I would assist her in identifying which reinforcements of goal will help her maintain progress.
Dakai, S.H. (2003). Addiction Counseling: Examination of various Addiction Counseling
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Hays, P. A. (1996). Addressing the complexities of culture and gender in
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Hays, P. A. (2008). Addressing cultural complexities in practice. Washington,
DC: American Psychological Association.