The Implications of a Multicultural Psychotherapy Treatment Plan Essay
This report summarizes the implementation of a Multicultural Psychotherapy treatment plan with Precious Jones, an eighteen year old African-American single mother of two. Precious was referred by the Student Counseling Center at a community college in Harlem, New York which she attends. The client’s presenting problems were struggling to adjust to a new college environment and opening up to her boyfriend about her past for fear of losing him.
The client indicated she had FS predominant styles on the BOLS and FI predominant styles on the Preferred Cognitive Styles Observation Checklist. As for Precious’ cultural styles she is modern on the FAS (score of negative two) but traditional on Cultural Style Observation Checklist and the TMI (score of negative three). We identified cultural and cognitive style goals. The cognitive goal was to shift towards a bicognitive perspective and become more comfortable with both FI and FS learning and communication styles.
The cultural goal was to discuss with Antonio the truth about the client’s past in a way that appealed to his bicultural values. Over the course of five sessions, Hali and I implemented script-writing, role playing, use of an ally, bibliotherapy and a diversity challenge to help Precious become more comfortable using FI and FS cognitive styles. We also used script writing, role playing and the empty chair approach when dealing with the mismatched cultural values the client shares with her boyfriend. Therapy proved successful with improvement on the cognitive and cultural goals.
For the Preferred Cognitive Styles Observation Checklist the client shifted from FI dominate preferred style to bicognitive as well as on the BOLS the client shifted from FS dominate preferred style to a bicognitive perspective. Culturally, on the FAS the client stayed modern; however she shifted to biculturalism in regard to the TMI and Cultural Observation Styles Checklist. Working with Precious helped me understand the effects of abuse in childhood as well as realize the importance of educators facilitating bicognitive learning styles in school.
The client’s assets towards developing a better multicultural functioning and identity include actively pursuing therapy, attending college in a ethnically and racially diverse environment, having a relationship with a Mexican-American man and being eager to learn more about the Cultural and Cognitive Flex. However, her limitations include her past which caused damage to her self esteem and self image, the interracial warfare and conflict she encountered growing up and her therapists being Caucasian women.
As for alternative therapy approaches, Humanistic, Cognitive Behavioral or the Cross and Helms model could be beneficial to use for treatment with the client. At termination, we offered Precious more sessions, which she agreed and we are looking forward to continuing our therapy with her. Implementation of Treatment Plan: Claireece Precious Jones Recap of Client About the Client Claireece Precious Jones is an eighteen year old African-American female who appeared to be about five feet and nine inches tall and rather overweight.
She is a single mother of two and is currently working as a janitor and attending a small community college in Harlem, New York. During the initial contact session Precious arrived on time dressed in black tights, a yellow shirt and a grey sweater, wearing little to no make-up. When Hali and I came to introduce ourselves, Precious stood up, gave us a shy yet hopeful smile and followed us into our office. Precious spoke in Ebonics and seemed eager to begin, but Hali and I could sense she was still slightly reserved.
She listened carefully to what we had to say and signed the consent form, beginning the therapist-client relationship. The Student Counseling Center at Precious’ college referred her to our practice because she admitted to having problems adjusting to the new college environment as well as dealing with a strained relationship with her new Mexican-American boyfriend, Antonio. Origins of Presenting Problems
1. Difficulty adjusting to college life because of lack of flexibility in learning styles and lack of experience with diversity. 2. This is likely related to being raised in a dysfunctional family environment and neighborhood in which she was sexually, physically and emotionally abused. 3. Specifically, Precious’ mother was physically abusive and her father molested her during the period from early to middle childhood. 4. Throughout adolescence, the client was teased by her peers for being overweight and illiterate. Precious was also surrounded by interracial warfare and conflict in her neighborhood. 5. As a result of the sexual abuse from Precious’ father, the client became pregnant at age twelve with her first child and again at age fifteen with her second child. 6. After the client gives birth to her son, she decided to move out of her dysfunctional home and into a shelter for women with her son.
Precious then obtains her GED at age eighteen and begins college courses. Presenting Problems Precious explained that she was having a difficult time opening up to Antonio about her past and the two children she had out of wedlock for fear of losing him.
Precious has never had a positive male role model in her life and she assumed that once Antonio learns of her traumatic past he will reject and abandon her. Moreover, she also was struggling to adjust to her new learning environment and to her culturally diverse peers enrolled in some of her courses. Finally, Precious stated her problems adjusting to independent life as a single mother and all the struggles and stressors that come with young motherhood.
Initial Assessment Results Cognitive Assessment Findings According to the Client Preferred Cognitive Styles Observation Checklist, the client’s predominate style was Field Independent (FI). It appeared that Precious thought of the relationship with the therapists, Hali and I, to be secondary and she wanted to focus solely on the problems that were to be addressed in therapy. As for the Bicognitive Orientation to Life Scale (BOLS) Precious was Field Sensitive (FS) in regard to motivational styles. The client is extremely motivated to achieve for her children and she possesses a strong interest in art and social sciences.
Cultural Assessment Findings On the Cultural Styles Observation Checklist the client was predominately traditional (t), she expected Hali and I to do most of the talking and appeared shy and reserved. Specifically, Precious strongly identified with the traditional values regarding abortion and gender roles in the home, however Precious is shifting to preferred modern values as demonstrated by achieving independence from her mother. The client also expressed a preference for future time orientation for her children and herself. Goals for Treatment Plan Cognitive
Precious, Hali and I discussed and collaborated on certain goals Precious wanted to accomplish by the end of therapy. 1. Precious thought her interactions with her peers and professors at the college were lacking, and she expressed a strong desire to learn more effective ways of communication. 2. We decided it would be beneficial to assist the client in shifting towards a bicognitive perspective and to become more comfortable with using both FI and FS learning and communication styles. Cultural Hali and I discussed the cultural mismatches between Precious and Antonio to the client and she appeared to be discouraged.
The client then explained how fearful she actually felt in regard to the possibility of losing Antonio once he learns of her past. Precious was worried that their cultural mismatches will serve as a barrier for when she does disclose her past to him. 1. We all decided that for the cultural goal, we would construct a script for Precious to discuss with Antonio the truth about her past in a way that appeals to his bicultural values. Session One (Contact Session) Explanation For the first session, Hali and I explained to Precious her assessment findings in terms of the Cultural and Cognitive Flex Model.
We also explained the mismatched cultural values she shares with Antonio. Moreover, Hali and I made sure to foster unconditional positive regard with the client and we explained that neither FI nor FS or traditional or modern preferred values are better than their counterpart. We described the differences between FI and FS preferred cognitive styles as well as traditional and modern preferred cultural styles. Finally, we clarified that every person is uniquely unique which is good. During the explanation period, Precious listened carefully and seemed interested.
She appeared slightly reluctant to ask for clarification on points of confusion she may have had regarding her assessment findings, but when given time and patience she eventually began asking questions. The client expressed some confusion about the domains of her preferred cognitive styles, but when provided with direct examples she quickly accepted and understood. Specifically, we explained when the client is in class she reported enjoying individual competition, appearing impersonal or formal (hard to get to know) and a preference to work alone. These domains are regarding FI cognitive styles.
Moreover, we described the FS cognitive styles by explaining that she reported to feeling unpredictable in interpersonal conflict and is also motivated to achieve for children. Precious was concerned that her cultural mismatch with Antonio would hinder their relationship causing him to leave her. Hali and I discussed these areas of concern and then collaborated on the therapy goals to aim for. We told Precious that it is natural and normal for people to encounter others who have different cultural or cognitive styles than their own and sometimes when mismatched, conflict may occur.
However, a goal of multicultural psychotherapy is to overcome the mismatch syndrome and then recognize and accept the unique self. It is then that the client can achieve the cultural and cognitive flex that is needed to empower themselves as multicultural human beings. Precious appeared excited to learn more about FI and FS cognitive styles and showed even more excitement knowing that becoming comfortable with both FI and FS styles could help her academically and socially.
The client admitted to feeling like there were some barriers between Antonio and she because of the differing cultural values and seemed eager to address these barriers. Referrals After establishing an atmosphere of nonjudgmental acceptance and providing a safe environment for the client, Hali and I reported a few referrals that we thought would be beneficial for Precious. We wanted to send the client to a psychiatrist to receive evaluation and medication for her Depression and panic attacks, as well as possible PTSD symptoms, which is common in young women who were victims of sexual abuse.
Referring Precious to an expert in anxiety disorders would also be helpful, as well as sending her to a therapist or support group that specializes in incest rape victims. Finally, Hali and I agreed on sending Precious to Humanistic or Cognitive-Behavioral therapy for the years of physical and emotional abuse from her mother. Identification As for the mismatches between therapist and client, I matched the client on the BOLS but mismatched her on the FAS and TMI, I am more modern than Precious. Hali on the other hand matched Precious on every assessment.
We felt this to be a positive finding because when Precious needs to practice encounters with people of matched values Hali can administer and direct whereas when Precious needs to work on interacting with people of mismatched values, I can step in and provide guidance. Apart from the therapist and client’s cultural/cognitive mismatches, Precious and Hali and I are mismatched in other ways. The client grew up in a predominately African-American neighborhood surrounded by violence and poverty. Hali and I, on the other hand, are both Caucasian and we were not subjected to violence or poverty during our childhood.
These mismatches could stand as a barrier to effective therapy with Hali and I standing as the therapists. Our plan is to foster a great amount of trust and respect with the client and work for her acceptance. Strategy During session one Hali and I provided an atmosphere of acceptance, finalized therapy goals, and then we matched the client’s preferred cultural and cognitive styles. For the bulk of this session we talked about specific incidences where Precious felt a miscommunication between her and Antonio had occurred. The client recalled a minor argument between her and Antonio about caring for one’s parents at an old age.
The two of them were eating a casual dinner when Antonio expressed that he was feeling worried about his mother’s health. Antonio then suggested that if his mother were sick, or rather if either one of his parents was to become ill, he would insist on them living with him. Precious reported feeling shocked and surprised that Antonio possessed such dedication and commitment to his parents. Being that the client is modern in this domain, Precious regards the nuclear family (she and her children) as more important than responsibility to her parents.
The client described the mismatch with Antonio as discouraging because she did not want him to think that she was cold hearted or aloof, but simultaneously she didn’t know how to rectify the conversation and instead simply stayed silent. We decided to use the empty chair approach and explained to Precious her mismatched cultural styles with Antonio. We helped her understand that even though Antonio is bicultural, he comes from a traditional and closely-knit Mexican-American family. Hali and I told the client that in order to grow multiculturally we must recognize and acknowledge the matches and mismatches in our lives.
Moreover, we asked the client to think about the reasons why she, specifically, would not want to care for her parents. Most likely due to the abuse she endured while living with her mother and father. We had Precious look at an empty chair and play Antonio in their previous conversation. Hali and I instructed the client to think about why Antonio feels such a dedication to his parents. After Precious acted her boyfriend, she played herself in which she decided to change how she reacted to Antonio and became more understanding.
At the end of the session Precious reported to feeling like the differences between her and Antonio’s cultural values lead to some of their misunderstandings and she is looking forward to correcting these. Finally, Hali and I wanted to identify an ally for Precious and the three of us decided upon Maya Angelou. Maya Angelou is FI in regard to learning and teaching styles and FS in communication styles which is important because Precious mismatches Maya in these areas and having Maya as her ally may help her develop a better cognitive flex.
We wanted to give Precious something concrete to take away at the end of the session as well as drive home the concept of understanding and then appealing to Antonio’s mismatched cultural values, i. e. the empty chair approach. We also wanted to briefly touch on familiarizing Precious with both FI and FS communication styles, hence the decision to have Maya Angelou as an ally. Homework For the first homework, we assigned the literary work written by Maya Angelou, specifically the poem, “Still I Rise.”
Maya Angelou does a great job of incorporating FI and FS cognitive styles in her writing that Precious will be able to read and observe. In addition, this poem emulates how Maya Angelou has overcome racism, sexism, criticism and her own personal obstacles throughout her life. Maya Angelou and the client have endured some of the same experiences growing up and this may help Precious develop a higher level of trust towards Maya Angelou as her ally. Moreover, being that the client is FS on the BOLS she possesses a strong interest in art and poetry.
Session Two Discussion At the beginning of the second session, we discussed the client’s homework assignment – reading “Still I Rise,” by Maya Angelou. Precious informed us that she easily identified with Maya Angelou and the message that was communicated through “Still I Rise. ” Precious appeared rather emotional when repeating a verse that seemed to deeply resonate inside her: “You may shoot me with your words, You may cut me with your eyes, You may kill me with your hatefulness, But still, like air, I’ll rise” Precious reported feeling inspired and felt like Maya Angelou was speaking to her through her words.
Both women were oppressed and faced similar rejection and abuse throughout their lives; reading Angelou’s work empowered Precious to continue her poetry and writing as well. Strategy To start, Precious, Hali and I decided to schedule the actual meeting with Maya Angelou, the client’s ally. We worked around Precious’ school and daycare schedule to find an appropriate time for Maya and Precious to meet. The client expressed her excitement about the meeting but disclosed that she was also feeling a little nervous knowing that their cognitive styles mismatched.
We explained to Precious that indeed she and Maya share mismatches but they also share many similarities including both being strong, talented, African-American female writers. She seemed to become more at ease after discussing the similarities between herself and Maya. For the bulk of this session Precious explained to us that she was experiencing some difficulty in one of her courses at the college because she cannot seem to relate to her professor. In regard to human relationship styles the client is FI and she described her professor as very personal and requires the class to do many group tasks and projects which Precious has a hard time completing.
At times the client feels uncomfortable around others and she reports being task oriented easily shutting out the social environment. Hali and I decided to work on a script writing and role playing exercise about communicating with her professor and specifically, the peers in this particular class where many group tasks are required. This was a conversation that we agreed could definitely happen in real life and in her classes.
Using primarily Precious’ ideals but also our guidance we constructed a short script using FS human relational styles and thinking/problem solving styles. We role played the script with Precious playing herself, Hali playing the professor, and me playing one of her peers. The script is as follows: Hali: Good morning class! I hope everyone had a fantastic weekend! For today’s lecture we are going to do something a little different. I want everyone to get into groups of four and you are to discuss the assigned reading and then collaboratively write a paragraph addressing the main theme of the story.
Okay go! (strong eye contact; clapping hands) Megan: (Gestures toward Precious) Hey! My name is Megan want to be our group? Precious: (strong eye contact) Yeah that’d be great! I’m Precious. (sits down with group and initiates discussion) So, what did you all think about the story? Megan: I thought it was really interesting with a lot of symbolism. Precious: I agree, I really liked it! I think one of the main themes described are that love and compassion are the most important gifts that someone can give and having grace for others really can go a long way.
Megan: Wow, Precious you are right! I think that theme is very important. Do you want to start writing? Precious: Sounds good! Where should we start? We then switched roles and afterwards we asked Precious how she felt about the script. She said it felt a little strange acting so warm and personal to others and she wasn’t used to initiating a discussion. However, in the end she enjoyed acting the part and the script gave her confidence to speak up in class. The client said that with a little more practice she would be ready to attempt the script in real life.
Homework Our second homework assignment was for Precious to actually meet with Maya Angelou. We arranged for Precious and Maya to meet at Central Park and sit by the pond, take a walk, admire some of the statues, and talk to one another. In order to structure the meeting with the client and the ally, Hali and I gave Precious a couple questions to ask Maya Angelou. 1. I have been reading quite a bit of your literary work and I am curious to know which cognitive styles you tend to use? Which styles are the most effective?
2. I understand you and I have shared some of the same experiences growing up. How have you been able to work through the trauma and see the other side? Secondly we gave Precious a Diversity Challenge in which we directed the client to join a mentoring/tutoring service in Harlem where she would have the opportunity to help counsel and tutor kids who are known to be either very FS and FI in their learning style. She would be participating in a Big/Little Sister type program and we asked the client’s permission to speak with her counselor at the college who knows of a counselor at a middle school.
The client permitted Hali and I to speak with the counselors and they ended up helping us structure this volunteer experience as a way for Precious to learn and implement the concepts taught by us in therapy regarding comfortable usages of both FI and FS learning/communication/motivational styles. Since the client has a lot of homework after this session, we have decided to space our next session two weeks from now to ensure the client can complete the homework.