cultural consideration

Introduction:

In the case that you are about to view, Marisol, the client, present with special ethnographic needs. As the client is introduced consider possible areas in which the client requires a treatment approach that deeply incorporates culturally sensitive considerations.

Think of ways to align specific addiction and mental health concerns with cultural considerations. How should the client be assessed? What alternative approaches should the counsellor employ to address multicultural barriers? Marisol is a 25-yrs-old Latina living in a traditional home on the South side of San Antonia, Texas. Marisol has lived in the USA for most of her life and has extended family in Mexico and in San Antonio. She is the middle child of six. Her family and friends are pressuring her to get married. Her grandmother and married friends consistently brought up the subject of marriage. Marisol worries about her ability to be a good wife and mother and sees her siblings struggle to lead a good life as much as she does. Marisol is fluent in bilingual. However, English is Marisol second language.

Marisol struggled as a student and did not finish high school. She was always nervous in school. She began working to contribute to the family income and could never find the time to complete a GED. She worried she would never be able to get a good job because of her lack of education. Marisol is being treated for comorbid cocaine abuse and benzodiazepine dependence and is having difficulty discussing her mental health issues with her Caucasian male psychiatrist. Marisol has been seeing Dr. Dan for treatment of her addictions. Mr. Dan is a Caucasian master’s level counselor who received specialized training in addiction counselling. During the past two counseling sessions, Marisol appeared reluctant to engage in communicating with her psychiatrist as evidence by her limited verbalizations. She responded to only to questions that were asked and provided little additional information beyond yes and no responses. Her responses have sometimes appeared to be insincere or evasive.

Marisol- I met with Dr. two times. Dr. Dan wants me to tell him what is going on with me. But when I started to tell him a little bit, he seemed impatient. These are the things that I don’t like to talk about. Especially with someone who’s not a member of my family. If I share too much, he may think I’m a bad woman. He is a doctor, so what he says goes. He knows what he needs to know from me, and I don’t want to trouble him. I like Dr. Dan. He seems nice and all that, but I really don’t think he’s ever had an addiction. First, I don’t think he’s ever had an addiction himself. If he hasn’t had an addiction, how can he possibly understand what am going through? He’s also a White man. The issue I face as a Latina woman are very different than those that he experiences. I just don’t understand how he will be able to help me. Let me tell you a little bit about myself. I’m 25 yrs. old, and I’ve using drugs for the past 10 yrs. I only really started using drugs to help with my anxiety. [Smiling and speaking in Spanish]- sometimes, when I get nervous, I forget to talk in English. Anyway, I’ve been nervous for as long as I can remember. [sobbing]- I’ve had some bad stuff happen, stuff that I don’t like to talk about right now. How am I supposed to talk to a man about these things? I know that in order to get better, I have to talk about these things, but I can’t bring myself to talk about them with an educated man like this. I mean, I tried to start telling him, but he was like in a hurry or something and he started writing a prescription for me. You must know what I mean. I don’t know, maybe I shouldn’t talk so much, you know? Where was I? Oh, yes, my anxiety. I guess I can tell you a little bit about it.

Please don’t tell my mother. I had some bad stuff happen but even before that, we just really struggled to make it. I was raised by a single mother, Una saints. She’s a saint. She worked 14 hours a day to make sure that [inaudible] and the rest of us had food in our system. We also moved a lot and sometimes, I was unsure if I should even unpack or if we were just going up and leave. Like I was saying, my mother worked 14 hours a day, she worked 2 jobs, and she left us kids there. We were six of us with whoever was willing to watch like Mi tia, Alejandra. I ‘m sorry, my aunt. It was hard on all of us. We fought a lot. All of my siblings have problems, giving my mother grief. My oldest brother, Juan, has spent most of his life in and out of prison. He joined up with MA, so he’s all tough and gang banger now. My sisters are in an abusive relationship. I don’t think they know how to keep their men happy and my youngest brother, my youngest brother, he’s had the hardest because he saw too much too early. We used to party together sometimes, you know? But he works too much. These days he parties just as hard as he works. I think he’s stuck on [audible] thing have been hard for us all. I try to keep it together because I know that she needs at least one daughter she can be proud of, it’s too much, I think that’s why I started using alcohol first. It was a way to help relax and forget about my problems. Plus, I mean Tia Alejanda said she had been drinking back at age 12 in Chiapas. No big thing. I never really liked feeling hung over, then I started taking Xanax. I really liked the way that made me feel. I did not feel the anxiety as much. I could go out of the house and make friends and everything. But then as I started needing it more and more and that scared me. I’ve friends who overdose and others got sick from that stuff. I thought I will just cut back. I even had an attack the day I tried to not take it. It felt like my heart was going to explode. So I called the counseling center and they had me see Dr. Dan. They told me to come see you too. I sometimes use cocaine. I don’t really like the way it makes me feel, though it usually just makes me feel more anxious. I know it sounds stupid, but sometimes I feel like if the cocaine gets me too up, I will be too up to even core about being anxious. Yeah, you know? It’s like I can take it anyway. It’s like I can take it all the time, you know? I just want to feel better. I want a normal life. I want my mother to be proud of me. I know that using cocaine and Xanax is very wrong for me, but I just don’t want to feel anxious every day. I haven’t been in a relationship for over three years. And I’m afraid that I can’t trust anyone. What kind of a woman am I if I can’t keep a husband and have a house and have my husband happy with the way I make things work? It’s all too much. So, like I can’t tell Dr. Dan any of this stuff. I will be so ashamed. I mean he is the Dr., right? He will want to lock me up or tell me that is all my mother’s fault. She is a good woman; she’s worked so much. I wish I could be like her; you know? What if she found out? It would kill her. I just think I won’t go back. I can’t stand the judgement. I talked to Dr. Dan; he can’t even pronounce my name right “Mare-ah-saul”. It’s Mar-ie-sole. I’II just might not come back. I can’t stand the judgement. Maybe my anxiety isn’t so bad. Maybe I could just cut back on Xanax and maybe only do coke like in the weekends or something. I think I’m wasting his time.