of anxiety and depression. She asks James why he is feeling that he is not achieving as much as he should be. James shrugs and says he thought he would be at a higher position after completing college. Denise knows that Asian Americans often expect high achievement from their children, so she asks James how his parents feel about his success thus far. James surprises her again when he says his parents are extremely proud of him and think he has landed a great first job. Denise is baffled and asks James to share more about his disappointment given his parents’ support and his success at both graduating from college and getting a job so quickly. She remembers again to be careful not to stereotype. When the session concludes, she asks James to schedule another session so they can explore his concerns further. James says he will on his way out and thanks Denise for her help. Yet, he never returns to counseling. Questions 1. What are some of the possible reasons James did not pursue further therapy with Denise? 2. How could Denise have prepared differently for her session with James? 3. How might Denise have applied some of the facets of cultural humility in her counseling? Case 3: Linda Rogers Linda Rogers is a 28-year-old White woman who has two children, ages seven and three. She and her fiancé live in a trailer park in a rural area. She comes into the county mental and behavioral health clinic because she is experiencing headaches and dizziness and often has severe stomachaches. The clinic physician suggested Linda make an appointment because, upon examination, she could not find a physical reason for Linda’s headaches and stomach problems. During the intake, Linda reports that she often skips meals or eats something from the vending machine at work for lunch; she also admits to smoking. Linda also reports that she typically feels fine and tries to limit her visits to the clinic. When Janine, the upper-middle-class African American mental health nurse practitioner, asks Linda what she feels her stomachaches are caused by, Linda seems unsure and on the verge of tears. Janine compliments Linda for coming to therapy and asks her to discuss her problems more fully. Linda states that she has a lot of stress in her life, as she has two minimum-wage jobs and two kids. She states that her fiancé is supportive, but he experiences a great deal of stress, too. Janine is empathetic and agrees that there is a lot of stress in Linda’s life. Janine asks Linda what she does to reduce stress. Linda states that her breaks at work give her the opportunity to smoke and that smoking temporarily relieves her stress and her physical symptoms. Janine feels strongly that smoking is a bad habit, and although it might temporarily relieve stress, Linda should attempt healthy stress relief techniques. Linda nods in agreement but acknowledges it has been difficult to quit smoking. Janine asks what Linda likes to do in her free time. Linda states that she does not have much free time between work and her kids. Janine asks Linda if she would like information about a smoking-cessation class offered at the clinic to help her stop smoking. Linda nods and accepts the pamphlet Janine offers. They spend the rest of the session brainstorming about other ways to reduce the stress in Linda’s life. Linda is engaged in the brainstorming and agrees to try to use her work breaks to walk off her stress. At the end of the session, Janine again affirms Linda, telling her she is glad that she came in and that it is wonderful she will begin smoking-cessation classes and use her work breaks to decrease her stress by taking a short walk. Linda misses the next several sessions with Janine. She shows up for a session several months later. Janine greets Linda warmly and says she missed her at her previously scheduled sessions. Janine then asks Linda about her stress as well as her headaches and stomachaches. Linda says she is still very stressed and continues to experience headaches and stomachaches. Janine gently asks whether she attended any smoking-cessation sessions. Linda states that she
4. How do you think James feels the healthcare professional perceives him? Is it helpful to the therapeutic relationship? Discussion This case illustrates how unintentional stereotyping can hinder the development of a therapeutic relationship. Denise is aware that she may be stereotyping but is having difficulty changing her thinking about Asian Americans. James’s experiences in life are vastly different from what Denise imagines they are, and thus he feels as if he is not being understood or helped by Denise. Denise might be helped by engaging in critical self-reflection after her session with James. She might ask herself what went wrong. She might further explore her stereotypical reaction to James and how that might have alienated him rather than engaged him in working with her. Denise might have had more success if she had questioned him more about his background and his family and had engaged him as an expert on his own life as she forged a respectful partnership with him. It seems as if Denise felt she had to be the expert and display cultural competency, which may have prevented her from being able to listen to James and discover the unique diversity in his life. doesn’t have the time or energy to attend the classes. Janine asks whether Linda has been walking during work breaks. Linda looks abashed but admits that she is still using breaks to smoke. Janine is a bit frustrated and asks Linda what she thinks they should work on in session today to reduce stress. Linda doesn’t seem to know what to do, so Janine suggests they try other options to reduce stress. Linda agrees. The rest of the session is spent coming up with a detailed plan to reduce stress through breathing exercises and a plan to try to attend smoking- cessation sessions. When Linda returns to counseling several weeks later, she again admits to not following through on Janine’s suggestions. She is still stressed. Janine is frustrated at the lack of progress but continues to try to help Linda with her stress through offering a variety of self-care options. Linda continues to agree to try a variety of techniques and agrees to continue to meet, but with little enthusiasm. Questions 1. What cultural forces might have affected Linda and Janine’s interactions? 2. How might Janine have explored Linda’s stress more comprehensively? 3. How did the therapy techniques reflect a middle-class perspective? 4. If you were the nurse practitioner, what would you do? Why? Discussion It is not surprising that Linda sought help from the clinic doctor first because her poverty likely afforded her little opportunity to seek therapy. Fortunately, the clinic she went to had counseling services available and Linda was able to meet with a therapist. Although Janine is empathetic and caring, she fails to make headway with Linda’s stress and is frustrated by Linda’s lack of follow-through. Janine neglects to thoroughly explore the role that poverty plays, both in Linda’s stress response and in her ability to pursue stress reduction in the way that someone with more resources might be able to. Linda does not have the luxury of time, and smoking provides her quick relief. Although Linda may want to stop smoking, it is unlikely that she has the time to devote to smoking-cessation classes. Janine might have wanted to work with Linda on some of the stressors in her life that require advocacy outside the office. For example, Linda’s inadequate diet may be the result of not being able to afford enough food. Janine could have explored this with Linda and helped her access various governmental and nonprofit programs to help her obtain sufficient food. Although Linda agreed to continue to work with Janine, she may have done so because she does not feel that she had an option.
EliteLearning.com/ Psychology
Book Code: PYFL4024
Page 278
Powered by FlippingBook