The Case of Maria: Therapeutic Approach
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Introduction
This report aims to determine the best course of treatment for patient Maria. A woman of a Caribbean background, Maria is married to an African American man, and has lived in different cultural settings. These factors qualify her case for a multicultural counseling approach. Through this method, Maria’s deepest, most internal issues will be explored from the perspective of how cultural background influences personal expectations, social norms, and the view of our environments.
Theoretical Approach
Multicultural Counseling: Origin of Theory
The multicultural therapy approach works with the client, taking into consideration the complexities of culture. In this approach, the term “culture” encompasses the client’s race and ethnicity, but it does not limit itself to these two dimensions alone. Other considerations include physical or mental disability, socioeconomic background, spiritual background, and sexual preferences, among many other variables that make individuals unique. The idea is to understand the client’s view of the world from the personal perspective that is created from these elements. Each component alone can drive the client to see the world differently. For this reason, it is imperative that the clinician understands the cultural background of the client in each of those cultural dimensions. (Ponterotto, Casas, Suzuki, Alexander, 2001)
Views of Human Nature
Multicultural therapy operates from the philosophical tenets of Multicultural Counseling and Theory (MCT), developed by D.W. Sue in 2001. MCT refers to any therapeutic method that is used to help clients from a cultural perspective. The key tenet of the theory is that all clients are different and, as such, should be treated based on their unique traits. Another tenet is that culture affects the way we perceive our immediate environment. Both of these tenets entail that the therapist needs to respect the views of the client, understanding that they are likely to be quite diverse from the therapist’s own view. (Sue, 2001)
Theories of Change
Unlike traditional therapy, in multicultural therapy the client’s views cannot be just deflected with a treatment plan. They have to be looked at deeply through the cultural paradigms that the client has been born and raised with. Understanding the culture itself can lead to developing an effective action plan. These action plans are relevant because they are created with the prior knowledge, or schema, that the client brings from his or her personal background. In the end, this approach will prove more effective because it makes more sense to the client at a personal level. (Ivey, Ivey, D’Andrea, Morgan, 2002)
View of Psychopathology
In MCT, the view of psychopathology is similar to other cognitive and behavioral theories. Clients react to their environment according to the ideals and expectations bestowed upon them by themselves or others. Clients will respond to therapy if it is relevant and important to them. Also, when given a better alternative, clients will be likely to change behaviors if the right combination of feedback and positive reinforcement is present. It is essentially the same idea, except that culture is the single most factor to consider during the profiling of the client. The point is not to label the client or predispose the therapist. The idea is to understand what is considered right, wrong, good, bad, acceptable and unacceptable in the mind of the client based on their background. (Sue, 2001)
The Role of the Counselor
One additional important tenet of MCT is the admission that most of the current theories of cognition and behavior were originally developed using either male, white, or middle-class individuals as subjects. (Sue, 2001) This underlying recognition leads to consider that the established parameters that are cited in many therapeutic models would be effective with demographics of that nature. When clients are drastically different from the subjects used during the empirical validation of a theory, it is up to the therapist to extrapolate the unique traits of the client.
This said, the roles of the counselor are to listen for the client’s idiosyncratic view of the world, correlate how these views are connected to the unique cultural background of the client, and determine an action plan based on psychodynamic or psychoanalytic theories that can help the client move away from a place of negativism and thrive on. (Ivey, Ivey Morgan, 2002).
Research Evidence, Validity and Effectiveness in Diverse Populations
In the book Multicultural Therapy Over Time, by Dr. Melba J.T. Vasquez (2016), the author mentions that the field of multicultural research has grown since the year 2000, when the U.S. Census showed that the minority populations in the United States were not only growing, but in need of services, such as education and counseling, that would help them increase their quality of life. The result is an ongoing tendency to explore the needs of diverse groups. (Vasquez, 2016)
The need for a model of action, the growing number of minorities, and the necessity to diversify the field are the factors that make this model so important to work with a changing society. Moreover, its effectiveness will be based on how relevant and organic the therapy process will be for a client who is culturally understood. This will bring on the validity of the study since it will show over time whether it is working or not. This is how research has been building over time, as the needs change and the demand for services becomes more evident.
In my opinion, multicultural theory is 18 years too late, but it is better to be late than never in terms of looking out for what clients really need. Multicultural societies have existed since the times of the old metropolis, but it is clear that established psychotherapy, as a field, is only over 100 years old, at most. (Hazler, 2016) That said, we can see why it has taken so long to bind the two, culturalism and psychotherapy, together. To me it is imperative to know a background before starting any therapeutic session. What is important to a Westerner may or may not make sense to an Easterner. Knowing the difference may take therapy from basic to better.
Therapeutic Approach
The Case of Maria
Maria is clearly not a happy woman. We still do not have information from her file that states what exactly is triggering these feelings of anger toward her husband. Judging by her and her husband’s roles in the community, it is possible that Maria is holding back essential and personal information that may indicate to us what is happening in the marriage. Being that both Maria and her husband are socially active, it is possible that she is not telling us about bad husbandly behaviors that are making her angry to avoid staining his social reputation.
Cultural Considerations
As a Hispanic woman, namely, as a Puerto Rican woman, the role of the counselor is to determine what are the accepted boundaries that couples are typically allowed to cross, or expected to break, during the time of the marriage according to the way she was raised. If Maria believes that her husband has cheated, and that she needs to accept his behavior only because he is her husband, chances are that she will remain quiet at his misbehavior. As a result, she will exteriorize her emotions, almost uncontrollably, through those bouts of violent anger that even hint at revenge for “something.” If she feels so mad that she could kill him, she is obviously looking to punish him for something. The question will remain to see exactly what he did to deserve those thoughts from her.
Procedure and Goals
Regardless of whether Maria discloses what really makes her angry or not, my role will be to understand from the context of our discourse what are some of the triggering factors that lead her to such intense emotions. This, I can discover through our therapy sessions, especially as I ask her to share more about herself, who she is, and what makes her react to her environment.
Session One: Goals
Meanwhile, I still need to establish goals. The first is to look into the traits of Maria’s personality, as well as the behaviors, that make her strong. This way, I can help her recognize her strengths so that she can take control of her emotions. Moreover, a counselor serves both as a mirror and a safety net. Maria can tell me her life story and use me as her primary support system. I could encourage her by pointing out the strengths that I see in her as a therapist and ask her how she feels about them. (Hazler, 2016)
Second Session
As a secondary step, I would ask her to expand upon those strengths we talk about by talking a bit more about her family. I particularly want to ask about how the women in her family tended to act toward their husbands when they felt mad. This may show me if her reactions were learned from her family after seeing it so much from an early age, or if this is “all her.” Through asking more about her and her family, I may start discovering how she ranks herself in terms of her role in her family, as a wife, and as independent person.
I would ask her whether she thinks she got the strength from in her family. I would ask her to draw a parallel between herself and someone in her family who may have a similar temper or situation. By comparing herself to her kin, she may realize that maybe she is repeating behaviors that can be deflected or avoided.
Third Session
I would then help her build a map of herself as far as her personality traits goes. If I can put Maria in a place where she feels in complete control, she may even feel compelled to disclose whatever injustice is being done to her in the marriage. She may then accept a plan of action that includes self-control, counting to 10, counting backwards, analyzing the bouts of anger. In a position of power, Maria may even decide whether she is willing to forgive her husband, or work on her own independently.
Whatever she decides to do with the marriage is not a primary goal in these sessions. As a person-centered multicultural model, Maria is the most important factor to consider. (Rogers, 1951) Her well-being and strengths of character are the focal points of the sessions. These factors will be the data points that I will want to go over during future sessions to bring out a version of Maria that is sure of herself and willing to change her mindset.
Conclusion: Strengths and Limitations of Multicultural Therapy
Strengths of using MCT with Maria
The primary strength of using MCT with Maria is that she will know ahead of time that I understand where she comes from, and her cultural implications. If I explain that I am aware of most expectations that families from Puerto Rico bestow upon wives, she may feel compelled to talk more about it. This way I can see how she sees her role within her marriage. (Vasquez, 2016)
The secondary strength is that I can compare Maria to other people of her same culture. I can determine from there if her behaviors are actually deviant from the norm of Puerto Ricans, or if she is “breaking the mold.” Comparing will not give me a clear description of Maria, but it can offer me a chance to see if she feels that she needs to act in a certain way to fit in a specific expectation. (Vasquez, 2016)
One final strength is that, as a counselor, having an understanding of the culture of the client takes away from time trying to figure out mannerisms, tones of voice, and other empirical data that therapists use to determine the mindset of the client. For example, understanding the demeanor of a typical Puerto Rican female during a regular conversation will help me determine whether Maria is comfortable with me or not. Moreover, I would be able to avoid making comments or setting up goals that go against what she believes to be her role within the marriage as a woman and as a wife.
Limitations
In the case of MCT, the limitation is the counselor. If bias is present, the danger is imminent, and the process will be immediately eschewed. In other words, studying a culture with bias is worse than not studying a culture at all. If the counselor is someone who simply adjudicates traits to people, that is, that labels on the basis of country, religion, or skin color, then the therapy session will not work.
Another issue is that, regardless of experience, education, or reputation, the counselor may be ignorant to the in-depth needs and emotions of clients who deviate from the theoretical constructs discussed in this report, which were all developed in their majority from participants who were neither females, nor Puerto Rican. This takes an extra effort from the counselor to truly make a correlation between the traditional framework of counseling and how it would apply to someone like Maria. The counselor must be willing to engage with the culture, get to know it at a deep level, and develop some empathy for it (Vasquez, 2016). Not having these basic elements of humanity will make it close to impossible to understand clients from different backgrounds. It may lead to further misunderstandings, not to mention to the possibility of insulting a client based on stereotyping statements.
The solution is for counselors to love the job they do. If they are knowledgeable of what it takes to support fellow human beings, it will be second nature to them to explore cultures and understand their idiosyncrasies. If, in turn, a counselor is too busy labeling and judging a client based on mere articles read in journals of multicultural theory, it will be a waste of time, money and resources in trying to help Maria to no avail. What Maria needs is someone who is willing to go above and beyond what is required to understand her immediate situation, and build ways to make her life better.
References
Ivey, A. E., D’Andrea, M., Ivey, M. B. and Morgan, L. S. (2002). Theories of counseling
and psychotherapy:A multicultural perspective, 5th ed. Boston: Allyn & Bacon
Hazler, R. (2016) Counseling and Psychotherapy Theories and Interventions, 6th Ed. \
Alexandria: American Counseling Association (ACA)
Ponterotto, J. G., Casas, J. M., Suzuki, L. A., & Alexander, C. M. (2001). Handbook on
multicultural counseling III. Thousand Oaks: Sage.
Rogers, C (1951).Client-Centered Therapy. Cambridge: Riverside Press
Sue, D.W., (2001) Counseling the Culturally Diverse: Theory and Practice, 5th edition
Boston: McMillan
Vasquez, M. (2016) Multicultural Therapy Over TimeAmherst: Research Gate