This assignment will first look at a fictional case of counselling a client with issues relating to fear and sadness. Yet, as Barker (2010) indicates traditional psychotherapies may not consider sociocultural issues like culture, gender and sexuality as important. Consequently, this assignment will evaluate any individual problems and sociocultural issues that might arise within the context of this case. Thus, a fictional example using a CBT/Mindfulness approach to a client’s therapy will be offered for study. Concluding, with some remarks into why this approach was taken.
Suong le thi is a 54-year-old woman born in Vietnam and raised mainly within Vietnamese culture in Lewisham, London. She is now living and studying in Plymouth. She comes from a close-knit family who were immigrants at the end of the Vietnam war. She has one older sister, with her family being staunch catholic, adhering to all religious celebrations. Suong presented to her General practitioner with feelings of sadness and depression. She finds living in Plymouth lonely, having no family, no friends and no support network. She finds the university where she studies unfriendly. This is a change from the happy family-oriented person when at home in London, where she has plenty of support not only from her family and friends but also the wider Vietnamese community. She hasn’t had any romantic or sexual relationships since moving in 2015 and has no children of her own. She now has no contact with anyone sharing the same cultural background and in her first session of counselling said, “I feel so low now, well really since I moved and left London and although I have taken antidepressants my doctor prescribed, I hardly have the energy to do anything, people down here do not seem to understand my culture, with my accent and skin tone setting me apart from others. My age also makes a difference, as most students at the university are much younger so it’s hard to fit in, I feel so sad and anxious.”
Moreover, Barker, (2010) indicates that counsellors and therapists should bear in mind any views they may have about race, culture, gender, age and class and be aware that any such views they bring to a counselling session, might impact on how they provide therapy to their client and affect how the client might perceive them. Furthermore, most theories around counselling and therapy, have
emerged from concepts proposed by men from a white western background, who had little knowledge or background of other cultures or beliefs, this being the social norm at the time. (Barker, 2010) Nevertheless, it has also been noted that most sociocultural issues are today viewed in an either/or (dichotomous) way. Thus, a person may be described as ‘white or black’ with people often being measured against the ‘norm,’ of what society decides is normal, table 10.1 (Barker, 2010, p.214). for example, in Vietnam it is well known that women having a lighter skin tone are treated more advantageously in society. With Barker, (2010) indicating clients of black minority ethnicity (BME) are more likely to be diagnosed with mental illness than their ‘white’ counterparts. With Suongs culture being an important aspect of therapy. With, Suong indicating that her cultural identity, especially one important aspect, being unmarried and having no children and not staying home caring for parents, may bring strong feelings of shame and sadness, as Vietnamese culture looks down on this aspect of Suongs life, this being an important factor of her case, that could be seen to conflict with her British values, exerting powerful feelings of sadness and anxiety. As hers can be observed to be a collectivist culture, with great emphasise placed on family and community rather than individuals (Barker, 2010).Thus, one-to-one therapies focusing on individuality and individual goals like CBT may seem strange to Suong, with Marshall, (2004) cited in (Barker, 2010, p. 219) also indicating a high rate of BME patients drop out from therapy and therapists must take these factors into account.
Accordingly, Suongs experience is one that many people of BME may experience and therefore feelings of fear and sadness may be seen where people experience such problems as prejudice and exclusion, (Barker, 2010). This may account for her perceived experiences at university where she reports feeling isolated. Yet, she hasn’t given details of any actions she has taken to build new friendships or whether this isolation reflects trauma of being separated from family and culture and maybe, even loss of her own sense of belonging. For example, The Open University. (2017a). Thus, people of BME may be thought to have specific needs, but it must not be assumed, that they have the same background, sharing the same experiences and would therefore need the exact same treatment. (Barker, 2010). Thus, therapists should be aware that being part of a different culture may affect clients differently For example, moving to a new city or town, can impact and engender feelings of fear at moving and sadness at leaving the old and this may be true for all, yet for people of different cultures this could have a huge impact, especially losing touch with close family support. Thus, in examining Suongs situation, her feelings of fear and sadness may be exacerbated by the fact she is
unmarried, has no children and has left close family, friends and community, to attend university with other students of younger age and is therefore anxious about being ignored or unaccepted within this youth culture. For example, Barker (2010) suggests there might be a sense of grief or sadness for being old. Thus, feelings like sadness are often emotions felt in relation to other people and when people grapple with such feelings they may also develop both relationship and family problems’ (Beach,2003; Brown and Harris, 1978,) cited in (Vossler, 2010, p. 204).
Consequently, with changes in Suongs circumstances, it could be proposed that her normal coping tactics are not helping her through the changes she is experiencing. Hence, she could become confused about who she is, whilst experiencing problematic thoughts about losing touch with her support network. Thus, she may be more susceptible to the impact of feeling prejudice and marginalisation, which can result in feelings of fear and sadness and may result in isolation.(The Open University, 2017b) Therefore, the cognitive theory of emotion proposes that it is not about events or situations, which may result in having emotional responses, but it is the meaning of these that happens to the person concerned. So, if the meaning is negative then the emotional response will be the same and this being true for positive meanings (Beck, 1976; Beck et al, 1979) cited in Salkovskis, (2010, p.147). Therefore, this may trap clients like Suong in a vicious cycle of for example anxiety, in Table 7.1 (Salkovskis, 2010, p148).
Therefore, I would use CBT/Mindfulness approach with Suong, building a rapport with her by obtaining a history, asking questions such as “in your own words please tell me what you see as the main problem” and going on with other questions depending on the answers given and to also use simple scales in question form such as “if I asked you to rate how anxious you feel about this on a scale of zero to 100 when zero is not anxious to 100 the most anxious” with such information expanding my knowledge of her problem, allowing a more empathic response. (The Open university, 2017c). I would also be open and talk with her about her culture to gain an insight of her background whilst not assuming, that she is only attending therapy because of problems with her culture, gender, age, class or sexual orientation. because like all people Suong is an individual who has developed through complex interactions of biopsychosocial influences (Macagnino, 2018).
Accordingly, I would use an educative method, acting as 'teacher' providing her with tools to better manage her life, remembering that both therapist and client are seen, as experts. Thus, I would use a
collaborative approach, determining what problems she has and work with her using a mixture of dialogue, information gathering and behavioural experiments, to develop a shared understanding with Suong and to ascertain why her problems such as fear or sadness, continues persisting, helping her to recognize and then overcome obstacles which may hinder her thinking, working from this to progress to a point where she chooses to change (Salkovskis, 2010). Thus, CBT works according to specific rules and as her therapist, I would assign her homework, for example, listing her positive and negative experiences and using graphic interpretations for her to see. I would also structure a plan for each session, ending with a summary of what has been accomplished. Whilst also negotiating short, medium and long-term goals for her. (Salkovskis, 2010). This should then help Suong become aware of her thoughts and help when any negative feelings intrude, because the cognitive theory indicates that theses abnormal emotional responses can become disorders, which affects the way a person responds in everyday life, causing, distress, sadness or fear. For example, Dora’s case of panic disorder with agoraphobia, (Salkovskis, 2010.) illustrating that repeated experiences of panic attacks can lead to agoraphobia. Hence, by undertaking such a collaborative partnership, building a shared experience I would help Suong to re-engage and challenge her negative beliefs by exploring alternate ways of making sense of situations, which she finds emotionally disturbing. Thereby. helping her understand how she thinks and views her internal and external world and helping her decide to alter her situation. (Salkovskis, 2010). With the aim of this therapy to teach her to apply skills learnt during treatment to her daily life. I would also integrate ‘Mindfulness’ techniques such as teaching or even engaging with her in co-meditating on bodily sensations or focusing on breathing, helping her to be ‘mindful’ of what is happening from moment to moment and not thinking about the past or future and to use such techniques in her day to day life. (The Open University, 2017d).
Thus, CBT is an evolving psychological approach helping clients who have challenging feelings and behaviours This should help provide a framework for Suong to manage her problems and stop them having a negative impact on her life, even after treatment finishes. However, it should be noted that one to one therapies may not always be appropriate as a response to feelings of fear and sadness and maybe other therapies could be explored such as systemic family therapy, (The Open University, 2017e) or a Humanistic person-centred approach for example, (The Open University,2017f). as a sense of not belonging can be central to our existence and relate to family, age and culture. Yet, in Suongs case, these are not suitable due to the distance involved from family and her wanting a one
to one face to face therapy. And I must take this into account.
In conclusion, this essay has supplied a fictional account of a case study of an individual made up of an amalgam of people and no information will infringe on anyone’s identity or break any data protection legislation. Therefore, this case study provides details of the presenting concerns of this client, relating to emotions of fear or sadness within a sociocultural context. The decision made on taking a cognitive behavioural/mindfulness approach instead of the many other approaches to her problem was taken due to the effectiveness of this form of therapy and how it deals with such problems as fear and sadness alongside the importance of considering any sociocultural perspectives, helping a client, and to show her how to change her unhelpful thoughts. However, it must also be noted that due to word constraints that a more in-depth discussion of her treatment was unable to be provided