Week 11 Project

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“Virtual Field Experience: Adaptation of CBT” Program Transcript

DR. NINA NABORS: Hi. I'm Dr. Nina Nabors. This week you're going to watch a video program of a simulated therapy session with a traditional therapy, in this case, cognitive-behavioral therapy, with a person of color. I will be interacting with Dr. Rodney Ford, who is the therapist illustrating this session. Let's watch.

So Dr. Ford, if you could set the scene for us. Tell us a little bit about what's happening here.

DR. RODNEY K. FORD: Yes. This is the second session with this gentleman, a Hispanic male in his late 30s experiencing moderate depression apparently connected to some marital distress that's been occurring in his family. And we took a little history last time. And I gave him some suggestions about some things that he could begin to talk to his wife about. And so we're coming into this session here with my making some inquiries about how that played out.

DR. NINA NABORS: OK, great. All right. Any particular thing we should be looking for as we watch the scene here?

DR. RODNEY K. FORD: Well one of the things I try to keep in mind in this particular case is the idea that often, Hispanics expect you to play a somewhat more prescriptive role as a professional than Anglos may expect. So I'm a little bit more assertive and a little bit more prescriptive then I might normally be. That's the most important thing you're going to see, I think.

DR. NINA NABORS: OK. Very good. All right. Well let's watch the scene here.

DR. RODNEY K. FORD: Well Luis, this is your second session. And if I recall correctly, when you were in last week we talked about you becoming a little bit depressed. And that's connected to some things have been going on between you and your wife.

She's European American. And she's given you a fair amount of criticism after family visits. She complains about your family, and their loudness, and some of their attitudes. And this has been something that you haven't been able to talk with her directly about.

And in our last session, I had advised you to make some extra-special efforts to get her into some dialogue about that. And I'm just curious how that worked out since our last session.

LUIS: She has a fairly-- I don't know. She's just kind of short tempered. And I'd just rather not deal with that stuff.

You know, I don't think she has the maturity to come back, to just talk. I mean, if it doesn't go her way or if she feels offended, she'll close up. And so she doesn't want to talk, then I don't want to talk.

DR. RODNEY K. FORD: So have you ever tried to bring this up at all?

LUIS: Well yeah. And I just get more of the same criticism. Well you know, your family doesn't know how to behave themselves, I mean, they're always talking loud, and I don't understand, when you guys get together it's all this noisy mess and everybody laughs, I mean, there's no decorum, you people don't have any decorum. Like, "you people?" I mean--

So I'm just like, all right, I don't want to hear anybody criticizing my family.

DR. NINA NABORS: Let me stop it here. He's talking about his interaction with his wife. Is there anything about what he's describing that smacks of a cultural issue for you?

DR. RODNEY K. FORD: Well I mean, clearly it's a cultural conflict between him and his wife. She apparently is, I gather, a Lutheran, Midwestern girl. And she's reacting to some of what she sees in his family. And she doesn't seem to be able to modulate herself very well or be the least bit charitable about it. She's quite frank with him.

And for some reasons that I think we'll see down the tape a bit further, he's really controlling himself, in terms of confronting her and dealing with her on this and not being entirely clear with her about what his experience is, other than maybe some things we'll see down the road here.

DR. NINA NABORS: OK. All right.

DR. RODNEY K. FORD: I have a question. Do you think that her difficulties with your family are beyond ethnic differences? Do you think there are other things that go on between her and your family? Are there other dynamics?

LUIS: I mean, if she's talking with mom or my sister or something, it's fine. It's just when we're in a group, you know? If I'm talking with her family and I just laugh like my loud self, and--

DR. RODNEY K. FORD: So she gets along with them individually. That goes pretty smooth.

LUIS: Yeah, reasonably so.

DR. RODNEY K. FORD: And does she complain to them directly about--? Or does this just come to you after family gatherings?

LUIS: Oh, yeah. Yeah, it comes to me. It comes to me and I don't like it. Why don't you tell them, you know? Tell them to bring down the volume.

DR. RODNEY K. FORD: A lot of people might get into an argument about that and say, what is the deal with you bad mouthing my family like that? What exactly is your problem with them and why can't you be a little bit more tolerant? What stopped you from doing that?

LUIS: Well, I have done that. And then it's like she escalates. She gets more angry.

And then if I try to engage in a conversation at the same level of intensity, then she shuts up and doesn't talk to me for two or three days.

DR. RODNEY K. FORD: And then what do you do?

LUIS: Well, I just don't talk to her. Just, we say, hi, bye, or what's for dinner.

DR. RODNEY K. FORD: So at this point there's this impasse. One you back off. You're kind of gun shy in terms of talking to her. And even when you overcome your gun shyness, she'll just escalate her own emotions to a point where you can't continue to have a dialogue.

LUIS: I just back off. She quiets down anyways, so what's the point? She says, I don't want to talk anymore, I don't want to talk anymore. OK.

DR. RODNEY K. FORD: Well sometimes when we get to a point like that, it makes sense to do some couples therapy. Because when there's another person in the room, it often helps one of the two or both people modulate their emotions a little bit more effectively than if you're just one on one.

DR. NINA NABORS: Let me stop that, actually, right there. I mean, you said this is your second session, right? So it's interesting that you're talking about couples therapy. What were you thinking then?

DR. RODNEY K. FORD: Well, I was thinking that I had given him a suggestion the week before about trying to open things up. But the more I learn here, they don't seem to be able to have a reasonable dialogue about this matter. And I'm throwing that out there as a firm thought, not an absolute recommendation. Although as we go along here, it seems more and more that that's something that probably needs to happen.

DR. NINA NABORS: Is there anything in your suggestion that also reflects maybe a cultural perspective, in terms of suggesting couples counseling or anything like that?

DR. RODNEY K. FORD: I hadn't thought about it that way. What did you have in mind?

DR. NINA NABORS: Well, I'm just wondering. I know that some of the literature suggests that Latinos in particular-- it's been recommended that family therapy is a really good intervention for dealing with some of the distress that they bring to therapy. And so I was wondering if perhaps you were thinking about that, as well.

DR. RODNEY K. FORD: I was thinking about it more generically. And fortunately it--

DR. NINA NABORS: It works

DR. RODNEY K. FORD: --it matches. Yeah.

DR. NINA NABORS: OK.

DR. RODNEY K. FORD: And that is something, based on my experience and training-- it makes sense for me here to have you consider family therapy for the two of you.

LUIS: I mean, try to get her to come in here and talk with you?

DR. RODNEY K. FORD: My thought about that would be that I would refer you to a colleague because you and I have already established enough of a relationship that she might see that as problematic, in terms of my being your ally as opposed to somebody who wants to help the family.

LUIS: Yeah, I could see that, I could see that.

DR. NINA NABORS: I was wondering if you were picking up on his body language there.

DR. RODNEY K. FORD: Yeah see, I think he's a little ambivalent about it. And he's not sure it's going to be able to be facilitated. And so you can see he's a little in conflict about it there. I think that's what's going.

DR. NINA NABORS: OK.

DR. RODNEY K. FORD: Now I mean, it's also possible that there are some things that you could do to facilitate more dialogue at home. You could try that again by, for example, scheduling-- maybe even writing her a note about your concerns or scheduling a time that you could talk to her that might be days off, so that she has some time to think about it and prepare herself for it. That's another possibility.

LUIS: Like, make an appointment?

DR. RODNEY K. FORD: Literally.

LUIS: With her?

DR. RODNEY K. FORD: To talk about a specific topic. The reason I suggest that is because oftentimes in the heat of the battle after a family visit, you may bring it up or she'll be going on, and you'll talk about it. But everybody's all emotional at that point. And those aren't always the best times to have a serious discussion about serious conflicts. It's sometimes better to do it once people have calmed down and some time has passed.

LUIS: Hm. Interesting.

DR. RODNEY K. FORD: But if that fails, then the next step would be a couples- counseling situation.

LUIS: What if she doesn't want to go?

DR. RODNEY K. FORD: Well, if she absolutely, forever for the rest of history never wants to go, I guess it won't work out. But sometimes people think about these things. And I certainly would be willing to talk with her one time to make that recommendation to her.

LUIS: You know, she'll say, it's your problem. I can just hear her say, that's your problem, I don't need to do anything, that's your problem.

DR. RODNEY K. FORD: Well it sounds like it may be a problem for both of you. It's not just your problem. It's not just her problem.

LUIS: Well I know that and you know that. But she doesn't know that.

DR. RODNEY K. FORD: Well, obviously we have to get her to a point of realizing that there needs to be some dialogue about this. You can't go on the way things are going. Because in our last conversation you did say to me that the idea of separating was, you thought, might be in her mind. And it's crossed your mind although it's not something that you would initiate.

LUIS: She comes from a good, traditional family. And my parents divorced. So I don't want to put my kids through what I went through. And though I have to admit that I've wondered what it would be like, when I continue wondering, it's no, I'm not doing that to my kids.

So I need to make this marriage work. And I'm fully vested in making it work, whatever it takes. If we have to move away from her parents and my family, then so be it.

DR. RODNEY K. FORD: So in your role as a father and a husband and a family leader, you really would take any steps that you would need to take to improve this situation.

LUIS: Yeah.

DR. RODNEY K. FORD: See, what I'm emphasizing there is what I suspect is his strong sense of a family leader. And I even used that word. And I'm welding the idea that he does need to take some kind of action here. And I'm preparing him for the tasks that are before him and what I'm going to recommend to him. I really want to get him on board with this and dip into his sense of family responsibility.

And you can see that that's very strong. He's willing to even move away from that family that she's bad mouthing just to preserve the marriage.

DR. NINA NABORS: Right. And again, that struck me. Because again, in a cultural perspective the family is pretty important. So for him to even discuss--

DR. RODNEY K. FORD: I think he's demonstrating his commitment. And I'm certainly going to make use of it, because we certainly need him to be a leader in this situation.

DR. NINA NABORS: I was going to ask you actually right before this last interchange. You were talking to him about talking to his wife. And it seemed to me that he was giving you "yes, but." And I'm wondering what you thought about that.

DR. RODNEY K. FORD: What I was thinking about it is that she sounds like she flies off the handle. And he's saying she's immature and she actually can be a little sadistic at times. And I'm really wondering about this woman. And there's a part of me who would like to meet her and get the other side of this picture, not that I'm doubting what he's telling me.

And it's part of what happens in this whole session. I'm trying to get a picture of what's really happening with this marriage and how bad things are. Because he does waffle in some of his descriptions. But I see him as suppressing an awful lot of anger and irritation, and maybe even the sadness that we talk about a little bit later.

He doesn't want to blow the family apart like his parents did. And he's really in conflict between a lot of strong feelings that would push in that direction versus containing himself.

DR. NINA NABORS: I see.

DR. RODNEY K. FORD: And there's a lot of thinking going on within him about what he can't do and shouldn't do. And I think it's resulting in his under communication, and ultimately his dysphoric mood.

DR. NINA NABORS: So he's pretty conflicted.

LUIS: Yeah, that's why I'm here. I mean, I'm not the kind of guy to come in and talk stuff out with a therapist. You know, the truth is, I already told you this is crazy to come in here. It feels like I'm weak. But I'm kind of uptight about this.

And I know that if I were to let off the way she lets off--

DR. RODNEY K. FORD: --it would be a bad scene.

LUIS: It would be a really bad scene. That's why I don't like confrontations, because I'm afraid I'll lose it. I'll just lose it. And so I'd rather just back off.

DR. RODNEY K. FORD: Yeah. And that's why I think the context of couples therapy would make more sense, because having a third person there would maybe helpful to both of you. It might permit you to talk a bit more and emote a bit more about how you're really feeling. And it might help her calm down. It could have a dual effect there.

DR. NINA NABORS: How did you interpret his talking about he didn't want to appear weak, and that he doesn't come to a therapist, and--?

DR. RODNEY K. FORD: Well, that all fits in with this machismo business. I think that's something that's in his head about what it is to be a man, and what it is to be the leader of a family. And he's working very hard at not even allowing the least bit of that-- in fact, there's kind of a paradox here.

Part of him responds to that by not wanting to come in. And it's killing him to have to do this because it's eating away at him that he's got a problem and he feels bad. And on the other hand, he's got a lot of strong feelings about his wife and what's going on in the family. And he stuffs them and suppresses them. So he's got all kinds of little conflicts here about what we should and shouldn't do based on this model of what he is as a man.

DR. NINA NABORS: OK. Interesting. And then thinking about that, how are you feeling about the report that you're building with him in this particular session?

DR. RODNEY K. FORD: Well I feel relatively comfortable with what's going on. And he seems to be pretty cooperative and responsive. And it seems to be fairly reasonable to me.

DR. NINA NABORS: OK, great.

DR. RODNEY K. FORD: That's something for us to think about. But you say that she may be resistant to that. And you're saying, "what if she" this, and "what if she" that. I think what we need to do is to try something. First you need to suggest that to her. And you need to remind her that you have a family here.

Something I'm doing here that I wouldn't necessarily do with somebody from Bloomfield Hills, Michigan, which is--

DR. NINA NABORS: For those of us who are not from Michigan--

DR. RODNEY K. FORD: --an upper-middle class, fundamentally Anglo neighborhood, and outside of Detroit, Michigan.

I might be far more collaborative in that context. I might ask him how he thinks this would work. I might ask him to give this some thought or what ideas does he have. I'm doing less of that here. I'm being more prescriptive, as I initially mentioned.

DR. NINA NABORS: Right. So again, as a way of making a bridge culturally, understanding that that's probably more what he's expecting.

DR. RODNEY K. FORD: Meeting his expectations, exactly.

DR. NINA NABORS: OK. Very good. You

LUIS: See, that's the crazy thing. I almost feel like, here I am coming from divorced parents, that it would be easy for me to say, forget it, I'm out here, [SPANISH]. But--

DR. RODNEY K. FORD: There's a part of you that won't allow that to happen.

LUIS: But then it seems to me like she would be willing to maybe separate, even though she comes from a-- you know, maybe I'm reading too much into it.

DR. RODNEY K. FORD: Well, the only way we find these things out is by talking about them and examining them. And there's not enough talk going on between you.

LUIS: Oh, there's plenty of talk. It's just not good.

DR. RODNEY K. FORD: But it doesn't sound like it's kind of talk that leads to clearer understandings and plans of action that will calm things down and have you feel better about each other. Which leads me to ask you some additional questions here. Are there other things going on between you that are not directly

related to this family-criticism issue? Because I'm getting the sense that there's more going on here than just that.

DR. NINA NABORS: OK. This is the second time you actually asked him this question. What I was going on and what were you thinking in asking about that? What were you picking up?

DR. RODNEY K. FORD: Well, he seems to be under a considerable amount of distress about what's happening in this marriage. He seems to lack faith in her ability to be a partner in solving these problems. And it's getting me to think that there's more going on between them than just this business of the relatives.

And I want to make sure I have a clear picture of that. This is only the second session. And even though I asked him about it before, I still want to come back to it again because I have a sense he may have left some things out.

DR. NINA NABORS: Ah, OK. And so it would be important to get as complete a picture as possible.

DR. RODNEY K. FORD: Absolutely.

DR. NINA NABORS: Yeah. OK.

DR. RODNEY K. FORD: I mean in a sense, there's still an assessment process occurring here. And so I'm just making sure I get my ducks in a row, in terms of the information.

DR. NINA NABORS: OK. That makes a lot of sense.

LUIS: There's nothing that stands out to me. I mean, she might be able to say something.

DR. RODNEY K. FORD: Well--

LUIS: But--

DR. RODNEY K. FORD: So I mean, more and more it sounds to me like we need to get some kind of a couples thing going so we can get her side of the picture. Because these things can be more complicated than just your feelings or just her feelings. And talking about it together is something that's going to make more headway.

LUIS: Yeah. See, I'm easy to please, all right? If she wants to serve me a bowl of cereal or if she doesn't want to cook, no problem. I'll just go grab some cereal and milk and I'm good to go.

I try not to be too-- I consider myself a "neo-machista." I try not to be this demanding guy that says, you got to treat me like this or whatever. I don't demand kind of so that way she doesn't demand of me.

DR. RODNEY K. FORD: How tough is that alteration in roles?

DR. NINA NABORS: You're nodding your head as he's talking. Could you explain for us a little bit about what you think he means by that, "neo-machista?"

DR. RODNEY K. FORD: What I think he means-- and I think I'm understanding it correctly at the time and that's why I'm shaking my head. He's saying that in my culture, the male of the household is often very demanding and expects to be treated like a king, and gets special service and everything attached to that. And he's trying to play a role that's a modification of that and is more consistent with traditional American culture, which is where his wife is from.

And he's doing it to preserve his marriage, and not end up acting like his father acted, and give his children a good family to live out their lives in. So this is what he means by that, I believe.

DR. NINA NABORS: OK.

DR. RODNEY K. FORD: But however, I think he's struggling with that because there's a part of him that would like to be a little more assertive and a little bit more in control of things. But he's suppressing it. And I think part of his fear of what would happen, even if he was a little bit that way, is resulting in some of this dysphoria that he's experiencing.

DR. NINA NABORS: So he comes from one culture. And he's married to someone from a different culture. And he's trying to suppress parts of the culture he was raised with in order to make the relationship work.

DR. RODNEY K. FORD: Exactly. And this is a tough thing to do.

DR. NINA NABORS: Absolutely, absolutely. OK.

DR. RODNEY K. FORD: How difficult is it for you trying to be a "new machismo," as opposed to what you might otherwise be?

LUIS: Well see my dad, he-- you know, successful businessman. But Mom and he would work together. And they'd come at the end of a long day. And he'd just kick up his heels, and chill while mom, she landed and continued working, cooking, washing the dishes, doing stuff.

And so I said, I don't want to be that kind of a husband. I don't want to be demanding anything. If my wife and I both come from a long day's work, then if

she doesn't feel like cooking, fine. And if I feel like cooking and I do, that's fine, too.

DR. RODNEY K. FORD: You know, one of the things that people often have trouble with is making major role shifts to something they're not used to. And when they do it, they overshoot the mark on a number of things. And I think there's a little bit of that going on here.

I'm going to be super good, and super mellow, and super unauthoritarian, to the point that I suppress any personal, normal interests or expressions, in terms of anger and other feelings. I'm just going to suppress all of that. He struggles with that.

And he tells us earlier that I could just throw my hands up, and really tell her off, and blow the whole thing away. But I can't let myself do that because of my children and my commitment to my family. So there's this real conflict here.

DR. NINA NABORS: So in trying not to be like his dad, he's going all the way to the other extreme, in some ways.

DR. RODNEY K. FORD: Exactly.

DR. NINA NABORS: I see. OK.

DR. RODNEY K. FORD: Is this role difference that you have from your father, is this a difficult thing for you or is this a pretty natural part of who you really are?

LUIS: Yeah. I remember being a kid saying, I am not going to be like my dad.

DR. RODNEY K. FORD: So you're quite comfortable with that.

LUIS: Yeah.

DR. RODNEY K. FORD: The only part of that that I think might be somewhat problematic is that you are being super unconfrontational, and she's not even getting a clear picture how much this is hurting you.

LUIS: Hm. Interesting.

DR. NINA NABORS: What just happened there?

DR. RODNEY K. FORD: Well, we got a little closer. See, I used the word "hurt." Because the little bit of anger that he talks about and the depression, that's one thing.

But an important underlying feeling here is just being flat-out hurt. This is his wife. This is somebody he loves. And here she is saying things about other people he loves. And it hurts. And she doesn't understand. And I think I hit a nerve there, with that word.

DR. NINA NABORS: So you're giving him words, giving him a new way of looking at it.

DR. RODNEY K. FORD: Exactly.

DR. NINA NABORS: Yeah. OK.

LUIS: So maybe a little bit of dad would be OK?

DR. RODNEY K. FORD: A little bit of dad would be OK, sure. In fact, it might be essential here because she needs to understand the effect that this has on you. And maybe you're denying these feelings, at least in terms of the interpersonal relationship, she's just not aware of how much impact this has on you.

You know, sometimes people squabble and they don't fully appreciate the impact on the other person because the other person is defensive, and tough, and looks like he's handling it. But it's not quite that simple.

DR. NINA NABORS: What are you telling him when you say, a little bit of dad is OK?

DR. RODNEY K. FORD: I think what he said before I said that is, you mean a little bit of dad is OK? And I think what he's saying is, a little assertiveness, a little aggressiveness, a little authority is OK.

That's really more symbolic of a little bit more directness is just fine. There's nothing wrong with being more direct. And he's not being direct enough.

DR. NINA NABORS: The other interesting thing I'm thinking as I'm watching this is you're also implying that his culture is OK. What he's hearing from his wife, according to his perception, is that his culture is not OK, and how his family interacts, and so forth. And his dad sort of represents his culture. And what you're saying us, well yeah, a little bit of dad is OK.

DR. RODNEY K. FORD: Yeah. That's right.

LUIS: You know, that's interesting. Because here I am thinking, be a nice guy, be a good husband. But maybe too nice?

DR. RODNEY K. FORD: Well being a nice guy is a general state of affairs. But sometimes people get angry. And they don't have to suppress it 100% of the time. That's unnatural.

LUIS: Hm.

DR. RODNEY K. FORD: If I had that to do over I would have said, sometimes people get hurt and they don't have to hide that all of the time. I think that would have been more on the mark.

DR. NINA NABORS: A little subtle difference.

DR. RODNEY K. FORD: But it's probably closer to what he's feeling, I suspect.

DR. NINA NABORS: OK.

DR. RODNEY K. FORD: See, he's not hiding his anger from her. He's hiding his hurt from her.

DR. NINA NABORS: His pain. OK. Although it seems to be evidently coming out as he's interacting with you. Have you noticed a shift in his body language?

DR. RODNEY K. FORD: Yeah.

DR. NINA NABORS: Yeah.

DR. RODNEY K. FORD: Therefore the prescription is that you should probably talk with her about this stuff and let her know how it feels. Not just what you think about it, and not just that you're angry. I gather, you're telling me, that you've become somewhat depressed about it. And it hurts. And does she know that?

LUIS: I don't think she knows it, because in my family the default emotion is humor. Something is sad, you bust a joke, make a crack. My grandfather's funeral, even while my uncles had their tears streaming down their face, they're making jokes. It's how you deal with stuff.

DR. RODNEY K. FORD: Yeah. There's another issue here, too. And that is that we don't show our hurt. It's not just a matter of him suppressing because he's modifying his role. It's also probably somewhat cultural.

He's not going to demonstrate-- he's already told us that he feels like he's weak because he's got to come and talk about it. He probably would feel weakened-- and I'm not probably, at the moment I'm talking to him about that, fully appreciative of it.

Looking back at this session right now, it seems to me that he probably is ashamed of being hurt. And it's just within himself. And to tell her that makes him even a little bit weaker. So this is actually a tougher problem than I'm giving it credit for at the moment, I think.

DR. NINA NABORS: And so again, a more deeper interpretation, culturally, of what he's experiencing.

DR. RODNEY K. FORD: So you're not giving her sufficient feedback to even consider adjusting her own behavior. She has no way of gauging her impact.

LUIS: Well she knows that I don't like what she's saying about the family. I mean, she knows it because I've told her.

DR. RODNEY K. FORD: Well the reason I bring up this hurt business is that sometimes people will take that a little bit more seriously when they really realize. She's not being just simply irritating. She's being hurtful.

LUIS: OK. I mean, I've told her I don't like what she's said. But I haven't said that I'm sad, or that she's hurting my feelings. But I mean, I would think she would get that I'm ticked off.

DR. RODNEY K. FORD: But you're working at preventing her from getting it, from what you're telling me. If you're just getting angry, or cracking jokes, or being sarcastic, she doesn't have any way of reading underneath that.

LUIS: You're making too much sense here, Doc.

DR. NINA NABORS: Did you make a connection there? It sounds like you did.

DR. RODNEY K. FORD: Well, that was a pretty straightforward, rational thing to say. Is If he's not giving her the information, how on earth could she know how hurtful she's being?

DR. NINA NABORS: And he certainly seems to agree with that.

DR. RODNEY K. FORD: Well, so the bottom line is it gives you a course of action that you can take home. And you can work on it. And it's a rather immediate thing you can begin doing. This stuff can be communicated in no short order.

LUIS: Yeah, I guess.

DR. RODNEY K. FORD: She knows you're coming to see me?

LUIS: I haven't exactly told her.

DR. RODNEY K. FORD: Because?

LUIS: Because then she would say, see, you've got problems. This is your problem, you know? You're seeing a shrink because you're sick, you know? You've got problems.

See, your whole family's got problems. And I hate to say it, you're the only one man enough to go and do something about it. Yes, continue seeing him. No, I don't want to hear that.

DR. RODNEY K. FORD: Well that leads me to think that you could discuss that a bit further and give her a better understanding of what you're feeling and why you're here. And if she doesn't understand that or appreciate that, that tells me all the more that maybe we need to talk with her, as well. Because there's more going on here, in terms of this relationship than simply--

LUIS: I agree with you. I do. I really don't see her coming in to see you or anybody else. I don't know. She might talk to her preacher.

I'm sorry to say. It's just, I don't go to her church.

DR. RODNEY K. FORD: Mm.

DR. NINA NABORS: You said, mm.

DR. RODNEY K. FORD: Well when I heard that, I just heard more distance between them. And it just struck me. I mean, yes, people do go to different churches. But it is a separation. And for whatever reasons, it does have the potential to create some conflict. And that's what I was reacting to.

DR. NINA NABORS: OK, why don't we stop it there. We have a really good sense now of what the session was like. And this has been very helpful to talk to you about it.

Could you give us a sense of, now that you've watched yourself and how the session went, what your overall impression was of the session, how you think it went. And now looking back, is there anything you would have done differently? And where do you think you'll go from here with this client?

DR. RODNEY K. FORD: Well in some ways, I view this as a continuation of assessment as much as it is a therapy session. Because it helps me consolidate my conceptualization of what he's experiencing, and how he's thinking about it, and how some of his thinking is resulting in incomplete communication between them and the dysphoric feelings that he's having.

And some of this we can see, as we've discussed, is connected to this whole machismo business. And his conflict about that is he's trying to change roles and the way he performs them. And in doing in that, he's suppressing some of his feelings. Because he believes if he doesn't suppress them-- and this is a belief issue. If I don't suppress these things, I'll blow up and I'll end up ruining my family like my father ruined his family.

Of course, he's a different human being. And there are other options and other ways of thinking about this. And we would get to this as we went along in therapy. And I'd become more explicit in my conceptualization of the underlying thoughts that are driving his suppression of his emotions, which in turn lead to incomplete communication between him and his wife, and his dysphoric mood.

DR. NINA NABORS: So you'd continue with that focus?

DR. RODNEY K. FORD: I think I would continue with that focus. There is another thing as I observe him a second time this way. I do think that he is more depressed than he is letting on here. And if we were to push him in the direction of couples, I would keep him as an individual client and probably have both of those things operating at the same time. I think he needs support. And I think it would be very valuable to him for us to lay out some of the conflict that he experiences and an awful lot of the thinking that is underlying all of that.

DR. NINA NABORS: OK. Do you think he's even more depressed than he knows?

DR. RODNEY K. FORD: I think so. I suspect it.

DR. NINA NABORS: Overall you're a cognitive behavioral therapist. Certainly you utilize CBT techniques, right? And what's your overall feeling about working with clients of color using CBT? What are your thoughts about that?

DR. RODNEY K. FORD: Well, it's a system of examining the thoughts that people have that lead to the emotional experiences they have. Cultural variation is going to create different thoughts and different priorities. But the methodology of examining those and pulling those out is going to be relatively the same.

But it is a matter of understanding what some of those differences are so that you know where to do your drilling for the underlying thinking. You might go in a different direction, you might have different hypotheses about what to explore, in terms of his thoughts if you were from a different culture. But in this case, we keep coming back to this machismo business, and the role of the Latin father, and all of that business. It's there It's involved in the conflict between him and his wife and his inability to play the role in a way that works.

DR. NINA NABORS: So certainly, having knowledge about his culture makes it a lot easier to utilize techniques.

DR. RODNEY K. FORD: Yeah. Well now, one thing to keep in mind about this is that there's great variations within cultures. And it's not a sure thing that those are issues. But you see as we talk, he begins to produce this material for us. He confirms these hypotheses that I have. And so I think I'm on pretty safe ground in my thinking about this.

DR. NINA NABORS: It certainly seems that way, it certainly seems that way.

All right. Well this was great. And it certainly looks like you're doing a great job with the client. I appreciate you allowing us to enter your head, if you will, to get out some of your perceptions.

DR. RODNEY K. FORD: Well thank you for the opportunity to do that. That was kind of fun.

DR. NINA NABORS: OK. Take care.