herself by walking home from school alone and cooking her meals. Her psychiatric history included two hospitalizations associated with suicide attempts and deliberate self-harm, the first occurring when she was 16. During her second hospitalization, at 18 years old, Ana was diagnosed with a borderline personality disorder, at which point her mother reprimanded her harshly for being “weak-minded.” Ana expressed anger toward her mother, describing her as a “bad parent”; Ana’s mother rejected her daughter by sending Ana to live with her grandmother after the first hospitalization. At the same time, Ana understood her mother’s decision to send her to live with her grandmother. Ana believed that her mother had “enough on her plate” and could not also care for a daughter with a mental illness. Her grandmother, in contrast, had cared for more than 25 foster children in the past 10 years, so her mother saw her grandmother as someone who could deal with problem behavior. Ana reported that her grandmother’s fostering of children was not due to a love for children but because the funding she received as a foster parent gave her the financial means to care for her own four children. Ana said that she wanted to learn skills to communicate more effectively with her romantic partners. Ana was adamant that she was not like other poor people, and she spoke confidently of her experiences as a high-achieving student. Ana wondered whether she was good enough for this young man, whether she spoke, dressed, or acted sufficiently well for him. Ana felt that it was useless to sit with or explore her feelings. She presents as guarded, withdrawn, tense, and avoiding eye contact. Ana states that she feels hopeless. Questions 1. What is the role of socioeconomic status/poverty in the client’s presenting problem?
2. How does the client’s social class status directly and indirectly affect her presenting concern and her ability to heal from it? 3. Do you think the diagnosis of borderline personality disorder applies to Ana? 4. How can social class, ethnicity, and gender affect the diagnosis and treatment? Discussion As this case exemplifies, poverty can be revealed as an aspect of treatment in both direct and indirect ways. Ana conveyed her family’s struggles as she shared some of her family histories. While she did not speak about their migration story, Latina/o immigration has been linked to various forms of sociopolitical oppression and economic hardship. The impact of poverty is heard in Ana’s story as well as in the process of therapy, which points to her experience and possible socialization in terms of emotional expression. Her attempts to make her sadness visible by engaging in self-harm behavior were also unacknowledged. Given her developmental experiences, Ana learned to guard and protect her emotions from others. A self-protective strategy may be crucial for clients for whom emotional expression has meant a lack of safety. Failing to recognize and understand oppression as a pathogenic agent and engaging in pathologizing individuals may lead therapists to utilize psychotherapeutic tools that further oppress poor and working-class clients of color (Sue et al., 2013). Internalized classism is also reflected in her denial of group membership and her anger and blame toward members of her working-class community. Therapists, like people in every profession, wear their social class in sessions, literally and figuratively. When clients struggle with the meaning of class membership in their lives, therapists must be aware that the messages they convey about their class status will likely impact the therapeutic relationship. Everything from our shoes to the bottle of purchased water on our desks may get notifications about class privilege.
CONCLUSION
When working with clients from diverse backgrounds, counselors must be willing to continuously look at personal dimensions of diversity and how those dimensions affect their worldview and the view of their clients? Thus, counselors enter the counseling relationship with a solid base of self-knowledge and a continuous commitment to critical self-reflection. Counselors also enter the counseling relationship with an open mind and curiosity regarding clients’ lived experiences. Counselors do not pretend to know or understand each client’s unique combination of diversity. They do not assume that the client will behave or believe in any particular way based on those facets of diversity. The culturally humble counselor “cultivates (s) openness to the other person by regulating one’s natural tendency to view one’s beliefs, values, and worldview as superior; indeed, the culturally humble therapist strives to cultivate a growing awareness that one is inevitably limited in knowledge and understanding of clients’ backgrounds” (Hook et al., 2016, p. 152). This stance of openness and equality provides an environment for counselors to
enter into respectful and equitable client partnerships. Moreover, the culturally humble counselor considers how the U.S. societal structures oppress some individuals and groups while empowering others. Clients are affected by inequality within the U.S. They are influenced by living in a society where racism, sexism, classism, homophobia, and discrimination based on a variety of other diverse identities, including disability and gender identity, are expressed in many ways; this discrimination obstructs access to resources and opportunities and impedes interpersonal relationships. The power imbalances within society and institutions and as experienced by clients, require the culturally humble counselor to take an active role in righting those imbalances. Cultural humility challenges counselors to ask difficult questions and encourages us not to reduce clients to preconceived cultural norms we have learned in training about diversity and difference (Foronda et al., 2016). Finally, the culturally humble counselor will engage in lifelong learning that supports the practice.
EliteLearning.com/Psychology
Book Code: PYTX1325
Page 38
Powered by FlippingBook