Linda misses several subsequent sessions with Janine. She showed up for a session with Janine several months later. Janine greets Linda warmly and says she has missed her at her previously scheduled sessions. Janine then asks Linda about her stress and 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 she does not 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 leaves to smoke. Janine is frustrated and asks Linda what she thinks they should work on in session today to reduce stress. Linda does not know what to do, so Janine suggests they try other options to reduce stress. Linda agrees. The rest of the session is spent developing 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 admits to not following through on Janine’s suggestions again. She is still stressed. Janine is frustrated at the lack of progress but continues to try to help Linda with her stress by offering various self-care options. Janine continues to try different techniques and agrees to continue to meet, but with little enthusiasm. Questions 1. What cultural forces might have affected Linda and Janine’s interactions? Case Study 4: Zarah Zarah is a 22-year-old Muslim woman who relocated to the U.S. 8 years ago from Saudi Arabia. The client believes she has adjusted very well to the American lifestyle. Recently, her parents, two younger sisters, and one younger brother moved to the U.S., and Zarah has taken on the responsibility of caring for her family. Her family is in the process of assimilation, and it appears that Zarah has already assimilated into the American culture. Zarah frequently discusses sexting, premarital sex, oral sex, and masturbation with her American friends. The family disapproves of her “American” behaviors and feels they would go away if she did not discuss these issues. Their Muslim faith prohibits fornication and forbids every circumstance or avenue that may lead to it. Her parents have tried to convince Zarah to marry as soon as possible, restraining her desires until she is ready to marry). Zarah is expected to follow strict traditions, and this causes conflict and distress for her. She reports experiencing a lack of motivation, a feeling of hopelessness that circumstances may never change, sleeplessness, and excessive sadness “every day.” The client feels she is mourning her old identity and feels that setting boundaries with her family is not an option. She states that she wants to be happy. Questions 1. Are there culturally salient elements surrounding parenting and values? 2. What mental health issues need to be addressed? 3. What are the treatment considerations given the cultural differences? Case Study 5: Hamsa Hamsa is a 30-year-old Muslim man. He suffers from chronic pain because of a fall off a ladder while doing work on his home. Hamsa is a powerful, independent man who is very proud of his culture and religion. His injury was severe, and he needed emergency surgery to fix the damaged
2. How might Janine have explored Linda’s stress more comprehensively? 3. How did the counseling techniques reflect a middle-class perspective? 4. If you were the counselor, 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 counseling. Fortunately, the clinic she went to had counseling services available, and Linda could meet with a counselor. 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 result from not being able to afford enough food. Janine could have explored this with Linda and helped Linda access various governmental and nonprofit programs to help her obtain sufficient nourishment. Although Linda agreed to continue to work with Janine, she may have done so because she did not feel she had an option. 4. How should the counselor examine and discuss religion? Discussion The counselor may assume that the issue within this case is boundaries. Boundaries may be appropriate for a client interested in setting them. In the case of Zarah, encouraging the client to set boundaries would likely be inconsistent with the client’s ultimate goals and discriminatory. The client’s goals include showing respect for the parents while practicing autonomy. Suggesting that the client integrates boundaries into the home environment could further distress the client’s life. The client believes the counselor does not understand the specifics of her culture. Gaining information from the client regarding cultural values and religion will help the counselor to understand the specifics of the culture without the counselor assuming traditions of the culture based on past information gained from other “similar” clients. Acculturation is a process through which a person or group from one culture comes to adopt the practices and values of another culture while retaining their own distinct culture. This process is most commonly discussed regarding a minority culture adopting elements of the majority culture, as is typically the case with immigrant groups that are culturally or ethnically distinct from the majority in the place to which they have immigrated. The counselor should inquire about how acculturation is associated with the issues between Zarah and her family. Additionally, intergenerational cultural conflicts and disagreements stemming from differences in acculturation orientations between parents and their offspring should be examined. nerves in his back. He will need to rest in bed for the first 4-6 weeks, or his back will not heal properly. His doctor has prescribed him a rigorous regimen, including meeting with the doctor, meeting with a chiropractor, and taking the prescribed pain medication. The doctor and the nursing
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Book Code: PYTX1226
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