SOCW-6060 & 6443-W11-Discussions

Multicultural and Contextual Considerations Case Study: Marisol Multicultural and Contextual Considerations Case Study: Marisol Program Transcript [MUSIC PLAYING] NARRATOR: Professional counselors consider all facets of a client's pers\ onal background and history to provide informed ethical care. As such, indivi\ duals belonging to special or minority populations require additional consider\ ation on the part of the counselor to ensure appropriate care is given. In the ca\ se that you're about to view, Marisol—the client—presents with special eth\ nographic needs.

As the client is introduced, consider possible areas in which the client\ requires a treatment approach that incorporates culturally sensitive considerations\ . Think of ways to align specific addiction and mental health concerns with cultura\ l considerations. How should this client be assessed? What alternative approaches should the counselor employ to address multicultural barriers\ ?

Marisol is a 25-year-old Latina living in a traditional home on the south side of San Antonio, Texas. Marisol has lived in the United States for most of her life and has extended family in Mexico and in San Antonio. She is the middle chil\ d of six.

Her family and friends are pressuring her to get married. Her grandmothe\ r, mother, and married friends consistently bring up the subject of marriage. Marisol worries about her ability to be a good wife and mother and sees her sibl\ ings struggle to lead a good life as much as she does.

Marisol is fluent bilingual. However, English is Marisol's second langua\ ge.

Although she wanted to succeed in her studies, 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 worries that\ she will 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 her psychiatrist, Dr. Dan, for treatment of her addictions. Dr. Dan is a Caucasian master's level c\ ounselor who has received specialized training in addictions counseling.

During the past two counseling sessions, Marisol appeared reluctant to e\ ngage in communicating with her psychiatrist as evidenced by her limited verba\ lizations.

1 Multicultural and Contextual Considerations Case Study: Marisol information beyond yes and no responses. Her responses have sometimes appeared to be insincere or evasi ve.

MARISOL: I met with my doctor two times. Dr. Dan wants me to tell him wh\ at 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 so\ meone 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 fro\ m me, and I don't want to trouble him.

I like Dr. Dan. He seems nice and all that, but I really don't feel like he can understand my problems. First, I don't think he's ever had addiction him\ self. If he hasn't had an addiction, how can he possibly understand what I'm going through?

He's also a white man. The issues I face as a Latina woman are very diff\ erent tha n 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 years old, and I've be\ en using drugs for the past 10 years. I only really started using drugs to help w\ ith my anxiety. [ SPEAKING SPANISH]. Sometimes, when I get nervous, I forget to talk in English.

Anyway, I've been nervous for as long as I can remember. I've just—I've had some bad stuff happen, stuff that I don't want 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 things. But I c\ an't bring myself to talk about them with an educated man like this. I mean, I trie\ d to start telling him, but he was like in a hurry or something. He started writing a prescription for me.

You must know what I mean. And—I don't know, maybe I shouldn't talk s\ o 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 mothe\ r. 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 santa. 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 to up and leave. Like I was\ saying, my mother worked 14 hours a day. She worked two jobs.

2 Multicultural and Contextual Considerations Case Study: Marisol And she left us kids—there 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 brot\ her, Juan, has spent most of his life in and out of prison. He joined up with MA, s\ o he's all tough and gang banger now. My sisters are in abusive relationships. I don't think they know how to keep their men happy.

And my youngest brother, my youngest brother, he's had the hardest becau\ se he saw too much too early. We used to party sometimes together, you know? B\ ut he's worked so much. These days, he parties just as hard as he works. I \ think he's stuck on [INAUDIBLE].

Things have been hard for us all. My poor mother—I try to keep it tog\ ether 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. I used alcohol first. It was\ a way to help me relax and forget about my problems. Plus, I mean, Tia Alejandra 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 r\ eally liked the way that made me feel.

I didn't feel the anxiety as much. I could get out of the house, go make\ friends, and everything. But then I started needing more and more, and that scare\ d me.

I've had friends who overdose, and others get sick from that stuff. I thought, \ I'll just cut back. I even had an attack the day I tried to not take it. It—it felt like if 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, t\ hough. It usually just makes me feel more anxious. I know it sounds stupid, but so\ metimes I feel like if the cocaine gets me too up, I'll be too up to even care a\ bout being anxious. Yeah, you know, it's like I can take it.

Anyway, I can talk to people and not feel so stupid all the time, you kn\ ow? 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 are very wrong for me. But I just do\ n't want to feel anxious every day. I don't want to feel anxious every day.

I—I haven't been in a relationship in over three years. And I'm afrai\ d that I can't trust anyone. What kind of 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?

3 Multicultural and Contextual Considerations Case Study: Marisol It's all too much. So like, I can't tell Dr. Dan any of this stuff. I'll\ be so ashamed. I mean, he is the doctor, right? He'll want to lock me up or tell me that it's my mother's fault.

She's a good woman. She's worked so much. I wish I could be like that, y\ ou know? What if she found out? It would kill her. I don't—I just think I won't go back.

I can't stand the judgment. Dr. Dan. He can't even pronounce my name right.

"Mare-ah-saul". It's "Mar-ie-sole." I just might not come back. I can't stand the judgment.

Maybe my anxiety isn't so bad. Maybe I could just cut back on the Xanax \ and maybe only do coke like in the weekends or something. I think I'm wasting his time.

Multicultural and Contextual Considerations Case Study: Marisol Additional Content Attribution Creative Support Services Los Angeles, CA Dimension Sound Effects Library Newnan, GA Narrator Tracks Music Library Stevens Point, WI Signature Music, Inc.