Cultural Issues, Family Issues

In case we have not made our biases and values clear, consider this: Even with respect to diagnosis and treatment planning, mental health work is about human relationships. If, in the process of diagnosing or formulating, planning, and goal setting, we lose contact with our clients as unique human beings, we risk missing their real needs and causing damage. If, in this same process, we lose contact with ourselves as unique, complex human beings as well as professionals, we diminish our work and the potential of our profession.

300 Structuring and AssessmentDiagnosis and Treatment Planning Cultural Issues in Treatment Planning: A Case Example Often, client cultural issues take center stage in treatment planning. The following very brief example is adapted and summarized from “The Case of Dolores” .

Dolores, a 43 year old American Indian woman, came to counseling because she was suffering from sadness, inability to concentrate, insomnia, and anhedonia. These depressive symptoms were associated with two major concerns. First, Dolores was very upset because her husband of 23 years, Gabe, was suffering from a serious gambling addiction but was refusing to go to treatment. Second, Dolores was worried that, because of her diminished functioning and her husband’s gambling, she might lose custody of her adopted daughter, Sage.

Even with the minimal information provided in this example, several cultural issues rise to the fore. Speci?cally, because Dolores’s major concerns center around family issues, it is important to explore the onset and duration of her concerns in the context of familism-as Dolores’s symptoms might be more directly associated with her family identity than with her “self.” Additionally, it could be that the decision to come to counseling was producing nearly as much stress as her family situation because some American Indian tribes consider it disloyal to say negative things about other family members. Consequently, Dolores’s feelings about counseling and what it says about her Indian identity may be a major focus of treatment-especially if she is seeing a counselor from the dominant culture.