Reason for Referral
Jennifer Wise initiated contact with this psychologist because she had concerns regarding her former student’s withdrawal from others and his assertion that he felt depressed. Miss Wise noted that her former student had expressed feeling left behind and did not have role models who would help guide him through life.
Consultee Summary and Background
Following a discussion with Miss Wise regarding the client’s background, it became apparent that the client was born and raised in a multigenerational setting in Haiti. His parents and younger brother are alive and well. The client moved to the United States and chose to settle in Dartmouth, MA, given that they already had extended family in the area. The client moved to the United States with his biological mother, whom the client describes as always nervous and mistrusting.
The client’s high school experience was challenging due to the language barrier and the culturally diverse environment. The aforementioned challenges notwithstanding, Miss Wise noted that he was able to graduate. He has been working on improving his English diction since leaving high school.
Miss Wise describes the client’s family as highly emotional, with some elements of substance abuse. Miss Wise highlights her client’s beliefs in his Haitian heritage as well as elements such as voodoo. She noted that her client does not, however, believe in Western medicine or religion.
He lives a largely secluded life, with limited friendships and no meaningful role models to provide guidance. Miss Wise notes that her client has no significant medical or surgical history. It is vital to note that he feels depressed, given that he has no real career transition plan.
Consultation Framework
The multicultural consulting approach is the best fit for adequately addressing the client’s problems as presented by Miss Wise. Multicultural consultation, rather than being a distinct technique in and of itself, might be regarded as a lens for conceptualizing the influence of culture on consultation (Ingraham, 2000). Multicultural consultation alters the conceptualization of issues throughout the consultation process, introduces the consultant to alternative approaches to problems within a cultural context, and proposes various avenues for further empirical investigation (Ingraham, 2000). There is evidence that mental health consulting can be a beneficial strategy for reducing problem behaviors and enhancing staff’s ability to cope with associated difficulties (Perry et al., 2008). The cultural lens reveals consultation issues and methods, as well as the views, cultural backgrounds, perspectives, and unique characteristics of each participant in the consultation system.
The proper implementation of the multicultural consultation framework depends on specific factors. Ingraham (2000) emphasizes the importance of understanding one’s own culture, recognizing its impact on others, and embracing and appreciating diverse cultures. It is also important to recognize individual differences within cultural groups as well as the variety of cultural identities that characterize specific individuals (Ingraham, 2000).
Practitioners must focus on cross-cultural communication and multicultural consulting strategies to establish and sustain rapport. When examining the cultural context for consultation, it is essential to understand cultural saliency and how to bridge cultural divisions (Ingraham, 2000). Ultimately, it is crucial to ensure that multicultural consultations and interventions are tailored to the needs of consultees and clients.
School/Agency Culture
Some school cultural practices are likely to have an impact on the therapeutic process. The primary concern is certainly the dominance of English in communication. Certain notions may be lost in translation because the client’s native language is not English. This may severely impede his capacity to express specific views appropriately. It is also worth mentioning that the client’s communal attitude to hardships, as stressed in Haitian culture, is likely to clash with the individualistic tendency of Western nations. The client’s multigenerational upbringing is likely to influence his perception of the obstacles he confronts in his new setting.
Consultation Plan
The purpose of the consultation process is to strengthen Miss Wise’s capacity to assist her client in enhancing his self-esteem regarding his ability to succeed in a new, culturally diverse context. The consultation will proceed in the following phases as outlined. The first step will be the entry phase, during which efforts will be focused on investigating the presenting problem.
The problem exploration stage follows, during which the core issue and its impact on the client are identified. The third phase is the problem description stage, which involves describing and operationalizing the identified problem. The fourth step is implementation, in which an intervention is chosen, and its methods are detailed.
Consultation and Goals Stage
Entry Stage
The goal was to establish the nature and bounds of the client’s problem. Miss Wise noted that the client revealed that he felt depressed because he felt his life had no direction. Miss Wise also pointed out that the feeling was aggravated by the fact that the client’s peers seemed to be progressing in life while he felt stuck. The psychologist then discussed the terms of the consultation, and Miss Wise agreed to implement all the proposals that would be suggested during the process, given that she was determined to ensure the client’s condition improved. This stage was successful, given that the nature of the client’s problem was established.
Problem Exploration
After a comprehensive discussion of the client’s current behavior, Miss Wise identified her client’s withdrawal and depression as her chief concerns. Miss Wise opined that, while she believed her client possessed the necessary skills to succeed in a new environment, she had reservations, given that he tended to avoid contact with his peers. She was concerned that he did not think his English was good enough to succeed in America.
In addition, Miss Wise pointed out that the client missed his father, who was in Haiti, and that family arguments and substance use negatively affected his worldview. This psychologist and Miss Wise discussed the need to clarify the client’s current emotional and mental state. Miss Wise agreed to evaluate the client’s emotional and mental state by conducting two weekly meetings over the next two weeks. The objective was to identify whether the client exhibited any of the classical signs of depression and whether he was determined to continue interacting with his peers.
Problem Definition
Miss Wise completed her meetings with the client, and the psychologist facilitated a session to analyze the data, establish goals, and design an appropriate intervention. The baseline data revealed that the client exhibited symptoms of depression as evidenced by his withdrawal from social activities and his preference for isolation. It was also evident that he had low self-esteem, given that he did not believe he was capable of succeeding in America, particularly since English was his second language. Miss Wise noted that her client had the capacity to achieve his objectives, given that he had performed well in his English as a Second Language (ESL) classes. She also emphasized that her client required treatment to achieve his objectives.
Miss Wise and this psychologist then discussed specific goals and potential interventions that would effectively address the client’s issues. Miss Wise agreed that the main goals were to alleviate her client’s depression and elevate his self-esteem. Miss Wise also agreed to a seven-week treatment plan that focused on the application of Rational Emotive Therapy to address the client’s depression and self-esteem issues. The main objective of treatment was to progressively address the client’s depression and increase his interaction with peers.
Implementation Stage
The goal of this stage, as discussed with Miss Wise, was to encourage the client to take action to address his problem. This was accomplished by identifying what might be done to reach the goal and taking specific steps to reassure the counselee that the goal is achievable. As previously stated, Rational Emotive Therapy was chosen as the intervention for this client.
The emphasis was on three primary strategies to assist the client in dealing with his depression. Problem-solving was the first strategy employed, aimed at helping the client enhance his assertiveness, social skills, problem-solving abilities, and decision-making skills (Jordana et al., 2020). The second technique was cognitive restructuring, which was intended to help the client overcome illogical views about voodoo. Reframing and rationalization strategies were employed to help the client reevaluate his perspective on reality (Jordana et al., 2020). The third strategy employed was coping techniques, designed to help the client manage the emotional implications of erroneous ideas. The client practiced specific meditation and relaxation techniques.
The 45-minute sessions were held once a week to allow the client time to practice the skills he had learned. The intervention was divided into three groups, each consisting of a total of three sessions. The categories are related to the highlighted strategies for dealing with the client’s despair. He also completed assignments and polls, which were an essential source of data that could be used to assess his advancement.
Disengagement/Termination Phase
After seven weeks of treatment, this psychologist met with Miss Wise to assess the effectiveness of the intervention and discuss the future of the consultation relationship. Miss Wise expressed her satisfaction with the outcome of the intervention, given that her client had experienced a significant change in attitude. The client reconnected with his peers and was making significant strides toward improving his English and setting meaningful career goals.
A formative assessment of the consultation process revealed that all of Miss Wise’s concerns had been effectively addressed. She revealed that her instinct regarding her client’s potential was correct, and she had learned a great deal about depression through this process. Miss Wise derived great satisfaction from monitoring her client’s progress every week as he slowly regained his self-esteem. Miss Wise noted that she would continue offering her support as a role model to her client after treatment was completed. The termination procedure was discussed, and it was agreed that the consultation process would come to an end and would be re-initiated if there was an urgent need to address a relapse or the emergence of significant concerns.
Evaluation of the Consultation
A variety of challenges marked progress toward achieving the consultation goal. The overwhelming impact of Miss Wise’s perceptions of the client’s Haitian culture and belief in voodoo affected the consultation process. Miss Wise’s concerns regarding the client’s overt distrust of Western medicine and formal institutions were particularly challenging to address.
Miss Wise’s participation in the implementation of various elements of Rational Emotive Therapy in the framework of multicultural counseling helped the client address a variety of irrational thoughts that contributed to his feelings of depression. Miss Wise played a critical role in helping the client to understand that his present condition was not the direct result of voodoo from enemies back in Haiti. He also understood that the only way to change his mindset and view of the future was to dedicate himself to achieving the goals he had set. It is worth noting that once the client’s views regarding voodoo and formal Western institutions began to change, Miss Wise reported that he started developing a more positive outlook on life.
It is essential to note that significant changes have occurred following the intervention. Miss Wise reported that the client was able to learn a variety of coping mechanisms, including meditation, which he practiced at least twice a week. Miss Wise also reported that the client was able to complete his English program and is now reasonably fluent in the language. In addition, the client now speaks with his father in Haiti twice a month and has enrolled in a mentorship program to help guide him through some of life’s challenges. The client has identified a career path and is looking forward to going to college.
Even though the consultation process was filled with challenges, I believe my performance was above average. It is important to note that learning the cultural significance of voodoo and the stigma around mental health issues in Haitian culture was both challenging and intriguing. I must contend that at the beginning of the process, I may have underestimated the significance of the aforementioned cultural elements in Miss Wise’s assessment of the client’s challenges. However, I quickly pivoted and understood the lens through which Miss Wise conceptualized her client’s challenges.
In retrospect, there are some elements that I would have handled differently. For starters, my assessment of Miss Wise’s appraisal of her client’s difficulties was flawed because I underestimated the importance of voodoo. I should have spent more time examining the effect of cultural practice on Miss Wise’s assessment of the client’s worldview.
I, however, believe that Miss Wise’s concerns were prioritized, and I feel my interpersonal skills were appropriate. I was able to communicate successfully by engaging in active listening and asking questions as necessary. I worked with other staff members to seek help if needed, and I was able to address critical cultural challenges that arose from working with diverse groups.
I also followed all of the relevant ethical requirements for conducting consultations. These included maintaining confidentiality, prioritizing the client’s dignity, and using harm-avoidance techniques (American Counseling Association, 2014). Ultimately, I was able to solve problems by conducting research, identifying contextual elements, and considering Miss Wise’s perspectives.
References
American Counseling Association. (2014). ACA code of ethics.
Ingraham, C. L. (2000). Consultation through multicultural lens: Multicultural and cross-cultural consultation in schools. School Psychology Review, 29(3), 320-343.
Jordana, A., Turner, M. J., Ramis, Y., & Torregrossa, M. (2020). A systematic mapping review on the use of Rational Emotive Behavior Therapy (REBT) with athletes. International Review of Sport and Exercise Psychology, 1–26.
Perry, D. F., Dunne, M. C., McFadden, L., Campbell, D. (2008). Reducing the risk for preschool expulsion: mental health consultation for young children with challenging behaviors. Journal of Child and Family Studies, 17, 44-54.