Pick one of the following two clinical vignettes to focus on. Each vignette comes with its own set of questions. Put which vignette you chose as your paper title (i.e., “Vignette 1” or “Vignette 2”). Again, there is no right answer, but please address each question listed. Your writeup should be between 3 to 5 double-spaced pages. Requirements: Using the material provided regarding specific patient populations, answer the questions associated with the clinical vignette profile you’ve chosen. Double-spaced; minimum of 3 pages, maximum of 5. Vignette 1: When Dexter first came to therapy, he was 26 years old, single, and described himself as a third-generation, Black, Christian minister. He lived with his mother and did not disclose his sexual orientation. Both his father and grandfather were preachers, as were two of his uncles. Dexter came to therapy upon referral from his uncle, the senior pastor at his church, who was concerned that Dexter was suffering from “delayed grief.” Dexter was very skeptical of therapy, feeling that if God abandoned him, how could anyone else help him? He reluctantly agreed to therapy because his uncle told him that he would keep him on the church payroll only if he sought help. The church was paying for treatment and wanted monthly updates that Dexter is coming to therapy—they did not require updates on therapy content or progress. Dexter arrived to his first session with his hair in braids, wearing jeans and an oversize T-shirt and jewelry. His left earlobe was pierced; he had rings and bracelets on both hands and a huge silver necklace around his neck. Dexter grew up in the Christian church. His activities were strictly monitored, and he had very restricted habits. As a child he went to religious school and spent most of his “free” time singing in church, practicing his music, and in Bible study and prayer groups. You notice that Dexter is very bright, articulate, and a passionate public speaker; he was being groomed to become senior pastor at his grandfather’s church. His peers led similar lives. Currently he is on leave from the church, where he served as the minister of music and led several youth groups. Both his father and grandfather were deceased; however, both had been very active in advocating civil and human rights for African Americans. Thus, Dexter had been reared with a very strong racial-ethnic identity and envisions himself as an activist minister. Dexter’s father died when he was 15 from a long-term illness. After about 8 sessions, discussing the story of his father’s death, he began to address his “real problem.” Dexter reported that he is “same-gender loving,” that he has had several same-sex experiences, and that he thinks he is “in love” with another man. He expressed some confusion about how to integrate his sexual identity with his strong ethnic identity and deeply held religious faith. Upon the suggestion of the therapist, Dexter had begun working at a community agency doing outreach with HIV-positive Black men. He reported that this work gave him a chance to engage in important social activism work while getting to experiment with his same-sex identity. Although he reported that he was comfortable with his sexual identity, he experienced conflict between his identity and the strong conviction that he had been “called” to the ministry and wanted to remain a minister at his church. He reported that he had conversations with both his uncle and mother about his sexual identity, although neither of them “took me seriously.” He is balancing moving in with his “lover” versus staying with his mother, who continues to grieve about the loss of his father. Questions: What role do you think Dexter’s religious heritage has on his identity, and what is your opinion of it? What is the significance of Dexter defining himself as a same-gender-loving man, and what is your opinion of it? Given Dexter’s skepticism about the value of counseling and psychotherapy, what role might therapist self-disclosure have on establishing a strong therapeutic alliance with him? What are the primary dimensions of Dexter’s identity, and how might a culturally competent therapist begin to prioritize targets of treatment with him? How difficult might it be to address each of the major dimensions of Dexter’s identity? What role, if any, do the therapist’s multidimensional identities play in Dexter’s treatment planning? Are there any ethical issues you believe would arise in treatment? (Refer to ethics codes here if necessary) Vignette 2: Rita was a 17-year-old Cambodian American bisexual female. She was referred for counseling for getting into fights at school and was experiencing academic failure due to multiple suspensions for this behavior. Her mother, who barely escaped from the Khmer Rouge, was receiving medication for her own depression and symptoms of posttraumatic stress disorder. Her younger brother was referred for mental health treatment for his acting-out behaviors (e.g., getting into fights, petty theft, academic failure). Rita claimed that her mother was “crazy”—oftentimes displaying extreme behaviors such as emotional smothering (not allowing Rita to have her own space at home and listening in on her telephone conversations) or abandonment (throwing Rita and her possessions out of the house when she misbehaved). She often fought with her mother and reported that her father, who remarried when Rita was 5 and had other children, has not been a big part of her life. Rita would secretly fantasize that her parents would someday reunite despite not being together for more than a decade. Initial treatment sessions consisted of Rita proudly talking about how many times she had been in fights with her classmates. She also relayed that she was able to be financially independent by supporting herself as a waitress. She seemed amused when she fought with her mother and unaffected by her father’s absence. Although Rita was enthusiastic and willing to self-disclose, developing a genuine connection was initially a challenge due to her inability to recognize her contributions to the dynamics surrounding her. The focus of her treatment was delivered via individual therapy, especially since family therapy seemed to worsen her acting-out behaviors. Rita began seeing a man she met outside of school who was a year older than her. Their relationship did not sound very stable, and Rita expressed minimal interest in committing to him. In fact, she often complained about the idea of having a monogamous relationship. She had dated both men and women in the past, but only for a few months at a time. Eventually it became clear that building trust would take more time than planned. Her mother had failed at creating a trusting bond with her daughter, and this was very apparent over the course of numerous sessions. Treatment slowly challenged her to consider the consequences of her own actions. This happened over time and by using nonverbal techniques. We discussed her disappointment in her father, anger toward her mother’s inability to take care of Rita and her brother, difficulties obtaining positive attention from her peers, and reluctance to commit to a romantic relationship. We worked together for a year and a half, during which time Rita was better able to communicate with her mother without getting angry, reduced the number of fights she got into at school, and began to work toward financial independence from her family of origin. Questions: If you were Rita’s therapist, what are some assumptions you might make about her based on her background? What kinds of feelings might you have when working with someone similar to Rita? What are some of the ways in which Rita is different from the model minority myth? What are ways of reducing the barriers to treatment for someone who is underage, living with a caregiver with a mental illness, and financially insecure? What types of treatment techniques do you think should have been considered when working with someone like Rita? The therapist in this case initially had stereotypes about Rita’s mother and her parenting style. What are some assumptions you may have when considering a first-generation female refugee from Cambodia? What are some treatment techniques you could incorporate to help Rita feel safe and engage in self-exploration? Are there any ethical issues you believe would arise in treatment? (Refer to ethics codes here if necessary)
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