Reference Counseling Across Cultures 7th Edition by Paul Pederse.docx

Reference Counseling Across Cultures 7
th
Edition by Paul Pedersen SAGE Publications
Each case response must be 1 page in length, with an APA
Cover and Reference page.
Case Study of Donna Little - Chapter 5
Donna Little is a 39-year-old Indian woman who has a history
of substance misuse and has struggled with reunification with
her adolescent children over the last 6 years. She was in
residential school from the age of 6 to 16 years old. She has a
history of domestic violence in her previous relationships.
Donna was the youngest of four children in her family. Her
parents, siblings, and herself were raised in the same small
northern reservation. Both her parents had gone to residential
school in the early 1950s, as did her grandfathers and
grandmothers on both sides of her family system in the late
1910s. Donna was raised in an environment of violence and
mayhem in her early childhood, which she has talked about
quite extensively in counseling. Although her parents abused
alcohol, she emphasizes repeatedly that her family was quite
ceremonial and participated in the big drum feast and singing
within the community. When Donna was 6, an Indian agent
wearing a red, white, and black checkered jacket gave her candy
and took her to the residential school. She never had the
opportunity to say good-bye to her mom and dad, who died of
tuberculosis while she was in the residential school. Donna
reflects on her residential school experience with a despondent
look. While in the residential school, she had only one friend
she could count on. Her siblings, who were also at the school,
were older and thus not allowed to play with her or sleep near
her at the residence dorms. This created an incredible loneliness
that Donna did not know how to fill, and often she would use
alcohol to help numb that pain. She did not like to drink, but it

helped her to stop her thinking badly about the past. Donna was
a victim of sexual abuse in the residential school, primarily by
the Roman Catholic priest who was in charge. The first time she
was assaulted she was 7; the last assault occurred right before
she ran away at age 16. When Donna had attempted to tell the
head nun in charge of her dorm what was happening to her, she
was beaten severely, to the point of unconsciousness. Donna
recalls it was her friend, Sue, who nursed her back to health.
Donna describes her life as difficult. She went home to her
community, only to find a partner who turned out to be as
violent toward her as her father was to her mother. She loves
her children and cares for them deeply. She breast-fed her three
children and still today can feel that connection to them. When
her children were taken from her home after the last time her
husband beat her, she spiraled out of control. Donna has had
long periods of abstinence, has a home in her community that is
well cared for, and now has a partner who loves her deeply.
Donna is on welfare but hunts and fishes to help with
sustenance. Donna and her partner have been together for 10
years, however, they both misuse alcohol on occasion. Donna’s
present partner is nonviolent and a former residential school
survivor as well.
Counseling Across Cultures (Kindle Locations 3850-3871).
SAGE Publications. Kindle Edition.
What is the culturally relevant history a therapist needs to
understand when working with a client such as Donna?
What are some of the culturally relevant techniques a therapist
can use when working with Native-American clients who have
been abused by people in positions of power?
How might Donna’s therapist help her to reconnect with her
family in a manner that promotes wellness for everyone?
Case Study of Simon Ho – Chapter 6
Simon Ho is a 19-year-old Chinese American sophomore
attending a midwestern university. He has a good academic

record, with a 3.25 grade point average, but he is having
difficulty understanding various concepts in his advanced
chemistry class. With a big exam approaching, Simon is not
only increasingly worried but also experiencing headaches and
stomach troubles. Fearing the possibility of failing the exam
and disappointing his family, Simon decides to seek assistance
from his chemistry professor. Upon approaching the professor,
he is greeted happily and courteously. His professor spends
more than an hour with him, reviewing some of the material for
the exam. After this review, Simon feels a bit more confident
about his understanding of the concepts. Unfortunately, Simon
receives a D on the exam. Disappointed by his poor
performance, he begins to skip class to avoid his professor and
never seeks his professor’s assistance again.
Why does Simon not ask his professor for further assistance or
guidance?
How might Simon’s cultural context help to explain his
headaches and stomach troubles?
What other cultural factors could also account for Simon’s
experience?
Case Study of Liliana – Chapter 8
Liliana, who is 24 years old, is voluntarily seeking counseling
for “relationship issues.” She has lived in California’s San
Francisco Bay Area for most of the time since her family
emigrated with undocumented status from Mexico. Recently
married, Liliana currently lives within a few miles of her
mother and sisters. Liliana’s family of origin is economically
poor. She has met but does not have ongoing contact with her
biological father, who is “somewhere in Mexico.” Her mother
and two older sisters are deeply committed to the Apostolic
Christian Church, but Liliana does not attend services regularly.
Liliana speaks reverently of her grandmother, although relations

between the two were tense for a time. Liliana and her
grandmother were not speaking to each other because of her
grandmother’s rejection of Liliana’s younger sister. According
to Liliana, her grandmother could not accept that her sister’s
biological father was African American. Despite a very difficult
time in public school, Liliana was able to succeed at a small
private high school, and she was accepted by an Ivy League
university. She left the university after her sophomore year to
raise her own family. She is currently working for a successful
technology firm as she completes her degree. Liliana’s sense of
humor engages young people and adults, her penetrating
insights guide conversations, and she is well liked by those who
know her well. She continues to defy authority when she feels
that it is unjustifiably imposed, is occasionally impatient with
what she perceives to be the irrelevance of other people’s
emotions or reasoning, and sometimes balks at what she sees as
unnecessary or unimportant work. How might the framework
described in this chapter be useful to a counselor’s efforts to
improve Liliana’s mental health? The framework does not
provide a script that Liliana’s counselor might follow. In fact,
the framework is designed to discourage a search for solutions,
pointing instead to better questions to guide a counselor’s
practice. Some of these guiding questions might become actual
questions that the counselor could ask Liliana. Others could
guide the counselor’s attention during their meetings, helping
the counselor discern those important ecological factors,
identify the particulars of Liliana’s orientation to the counseling
situation, and design and cocreate a safe physical and social
space. The discussion questions that follow provide a limited
example of guiding questions, organized according to the broad
categories of variables described in our framework.
What sorts of experiences, if any, has Liliana had with racism
and other kinds of discrimination? How have these contributed

to the way Liliana sees herself and her lived world? How do
race, language, class, gender, and so on matter to Liliana’s
beliefs?
How, if at all, does the ethnic, racial, linguistic, or economic
background of the counselor matter to Liliana’s orientation to
the counseling situation?
Given what the counselor is learning about Liliana’s
environment and orientation, what roles might the counselor
take on to best meet Liliana’s needs? And under what conditions
might such roles usefully vary?
Case Study of Sawsan – Chapter 9
Sawsan, a 17-year-old girl, was brought by her father to
counseling because she had withdrawn herself from family
meetings and activities during the past 2 months, instead
spending most of her time listening to music in her bedroom.
Lately, she had complained about headaches that lasted all day
with no relief, despite the use of painkillers. The family’s
medical doctor had told Sawsan’s parents that she may be
passing through a stressful period and referred them to
counseling. At the initial intake meeting with Sawsan and her
father, the father dominated the conversation, and Sawsan
displayed approval of his views. The father described her as a
perfect girl who always met her parents’ expectations in school
and in social behavior. The change in her behavior made her
seem to him as “not her.” He tried to attribute this change to
“bad friends” or “bad readings.” He also denied that Sawsan
was experiencing any stress and emphasized how much the
family loves Sawsan and cares for her needs. He said, “Nothing
is missing in her life. We’ve bought her everything she wants.
She couldn’t be passing through any stress.” Knowing that most
Arab girls find it very difficult to express their feelings in front
of their fathers (or both parents), after listening to the father the
counselor asked to be allowed to have a private conversation
with Sawsan, and the father agreed. At the beginning of this

conversation, Sawsan continued to go along with her father’s
views, describing how much her parents love and support her
and denying any stress. Only after the counselor validated to her
that she indeed has good parents was she ready to reveal a
conflict that had been raised recently concerning her desire to
study at a university located far from her village, which would
necessitate her living in the student dorms. Her father rejected
the idea of his daughter living away from the house, far away
from his immediate control. In an attempt to compensate for
this, he bought her a new computer and suggested that she study
at a nearby college. She insisted that she wanted to study at the
university and tried to push until her father became angry,
claiming that she was imitating “bad girls” who sleep away
from their homes. As she described this conflict, she continued
to remove any accusation from her father, saying, “He did this
because he is worried about my future,” and “He is right and I
should understand this.” The counseling process lasted for five
sessions, during which the counselor met with only the father
three times in order to establish a positive “joining” with his
position and worries. The counselor then revealed to the father
some contradictions within his belief system regarding the
importance of education, as described in culturanalysis. After
that, the counselor met with both father and daughter and
encouraged Sawsan to explain to her father why she felt she
needed to study at the university and to express her commitment
to her family values. The counselor also encouraged the father
to express his care and worry to Sawsan and then to discuss a
compromise that may be accepted by both of them. He agreed to
allow his daughter to study at another university, in a city
where she could live with her uncle’s family. In a follow-up
meeting, Sawsan and her father expressed satisfaction. Sawsan
had returned to normal interaction with the family and no longer
complained of headaches.

Arab Muslim parents tend to attribute bad behavior to external
entities such as “bad friends” or “bad readings” or, in some
cases, bad spirits. Discuss why or why not this is this something
that the counselor may want to address with the parents?
It is often difficult for Arab children to criticize their parents in
conversations with foreigners, such as Western counselors, and
they typically feel the need to emphasize that the intentions of
their parents are good. How should the counselor approach
discussing the client’s parents with the client?
Therapy with Arab and Muslim families should not seek to
change or confront the family culture or the family structure;
rather, it should be aimed at finding better solutions within the
fabric of that culture. Explain how the counselor might use a
family’s internal resources and strengths to change this
situation for the better.
Case Study of Nikki – Chapter 10
Nikki is a 17-year-old male-to-female transgender client. She
was sent to counseling by her parents because of their concern
that she has become more withdrawn in the past few months.
They noticed that she spends much of her time alone in her
room and sometimes does not go to school. They are fearful that
she will not be able to graduate and go on to college. Nikki
disclosed to the counselor that she began to be bullied by her
classmates after she asked a friend to the Sadie Hawkins dance.
Since then, her classmates have shunned her and she has not felt
safe going to school. She mentioned that she would prefer to be
homeschooled or to drop out of school. During the course of
therapy, the counselor spent time validating Nikki’s
experiences, providing psychoeducation to her parents about the
effects of bullying, and advocating with school administrators
to provide a safe learning environment for her. Nikki eventually
was allowed to pursue independent studies while taking select
classes with supportive educators who were able to provide her
a safe space on campus so that she could work steadily toward

graduating with honors.
How might you create space for Nikki to explore her gender
identity and expressions?
Given your experiences of power, privilege and oppression,
what types of countertransference might you have when working
with Nikki?
How might you better incorporate issues of gender and privilege
in your counseling work with Nikki?
Case Study of Sean – Chapter 11
Sean, a 15-year-old multiracial (Native American, White, and
Black) male, initiated services of his own accord to manage
symptoms of depression, including suicidal ideation. Sean was
academically advanced for his age and excelled as an artist and
skateboarder. He prided himself most on his academic success,
and he aimed to graduate from high school early and attend
college. Sean had poor self-esteem and lacked a strong cultural
identity. In the state where Sean resided, he could consent to
treatment. He did so, stating that his father, who was his legal
guardian, would not consent. The counselor developed a strong
rapport with Sean. Sean was raised in a single-parent household.
Sean’s father had a severe and chronic mental illness for which
he received sporadic treatment, and he was currently stable.
According to Sean, during his childhood he was placed in state
custody for a year due to his father’s alcoholism and physical
abuse toward him. Sean also spent a year living in a homeless
shelter with his father. During this time, he was required to
attend therapy, which he found unhelpful to his family. Sean’s
father believed it was yet another example of the “White man

trying to destroy the Indian.” Sean’s siblings were all
incarcerated. His grandparents experienced relocation, boarding
school abuse, and slavery. Sean’s immediate family was
relatively isolated because of his father’s outrageous behavior.
Sean reported that his father would often denigrate him. One
day, Sean was limping when he arrived for a therapy session.
When asked what had happened, he stated that his father had
been angry with him for not doing well in his Native language
class and had taken a belt to his legs and then shoved him
through the screen door, breaking it. Sean further reported that
his father’s fits of rage were a rare occurrence (every few
months) and Sean had learned to manage them by accepting the
abuse. The counselor reminded Sean of his duty to report child
abuse or neglect. Sean then attempted to downplay the story,
reporting that he had fallen through the door himself. Sean
asked that the counselor not report the incident because he
feared being taken away from his father again; Sean felt that his
father depended on his care. He was also concerned that any
type of investigation would disrupt his schooling and cause his
grades to suffer. The counselor was conflicted about whether to
report. He considered the following points: (a) client safety,
including assessment of the severity, frequency, and impact of
the abuse and the vulnerability of the client; (b) obligation to
report given the state laws around child abuse and neglect; (c)
psychological benefit versus harm to the client as a consequence
of reporting, including betraying the client’s trust, potential
family fragmentation, and loss of stability, predictability, and
family social supports in the client’s environment; (d) client
level of independence and maturity; and (e) concern regarding
the client, family, and community perceptions of social services
as a systemic enactment of violence on families. Sean’s family
had experienced generations of marginalization and
victimization enacted through systems meant to uphold social
policies. The counselor consulted with several colleagues. In
addition to emphasizing the legal and ethical obligations of the
profession, one colleague asked, “What if something more

violent or lethal were to happen to this child and you did not
report? Would you be able to live with that?” The counselor
decided that he could not. He talked with Sean about the need to
report, encouraging Sean to report with him, but ultimately the
counselor made the call. The counselor had plans to work
closely with the family if the case was investigated, to ensure
that the caseworker considered the family’s context and culture.
He also hoped to help the adolescent develop a safety plan and
build broader networks of social and cultural support while also
continuing to support him in his academic strengths. However,
after the counselor reported the abuse, Sean did not return to
counseling.
What are the different contexts of marginalization that may
have been at play in this situation? How might your experiences
of marginalization influence your perspective and choice to
report?
How well did the therapist behave in accordance with: (a) the
legal standards, (b) the ethical standards of conduct in
psychology, (c) the ethical standards of conduct with
racial/ethnic minorities and marginalized groups, and (d)
personal ethics? Where do the standards conflict or align in
regard to this case?
How do you think the therapist’s choice to report affected the
client’s marginalization and other issues for which he sought
help in counseling? How do you think the client might have
been affected if the counselor had not reported?
Case Study of Ling and Mohammed – Chapter 12
Given the information on Ling provided in this chapter, as
Ling’s therapist, how would you attempt to strengthen the
working alliance by helping her to surface some of her “culture

teachers” (Pedersen et al., 2008) and their influences on her
decisions and experiences?
Given the information on Mohammed provided in this chapter,
what hypotheses do you make regarding his reluctance to focus
on his home country? What do these hypotheses imply about the
similarities or differences between your worldview and
Mohammed’s?
What ethical responsibilities do counselors have for addressing
racism and other forms of oppression directed toward
international students?
Case Study of Eduardo – Chapter 13
Laura is a counselor at a small, private, progressive, and
predominantly White university in the northeastern United
States. Laura is a White, straight, U.S.-born cisgender woman
of Dutch descent who graduated from an Ivy League university.
She has been a mental health practitioner for the past 8 years
and considers herself to be an effective and competent clinician.
For the past 2 months, Laura has been working with Eduardo, a
19-year-old cisgender man, a freshman at the university, who
initially presented with a depressed mood, inability to
concentrate, and general anhedonia. Eduardo is an immigrant
from the Dominican Republic; he was 5 years old when he
arrived in the United States with his family. He grew up in the
Southeast, which he considers home and where his family still
lives. He is the eldest of four siblings (María, Carmen, and
Lissette are 14, 12, and 6, respectively) and the first one in his
family to go to college. Eduardo’s parents, who are extremely
proud of their “college boy,” worked multiple jobs while he was
growing up and now own a small neighborhood restaurant.
Eduardo works there during school breaks and is studying
business so that he can take over the management of the
restaurant and allow his parents to retire. In the course of
treatment, Eduardo discloses that for the past 6 months he has
been having erotic encounters with men. He discounts these

encounters as “just playing” and, after a recollection of every
encounter, he tells Laura about his plans to get married to a
woman and to have a large family. He tells Laura that he is not
gay, because he is “very masculine” (un tigre) and always the
“top” during sex, which he considers comparable to having sex
with a woman. Lately, Eduardo has been talking a lot about one
particular young man, Clive, with a lot of tenderness and
affection. Eduardo talks about Clive wanting to go on “real
dates” and finds these requests “ridiculous,” as he does not date
men. At the same time, Laura notes Eduardo’s worsening mood
and apathy turning into passive suicidal ideation. She is familiar
with research linking closeted homosexuality with negative
psychological consequences. Since coming out is empirically
correlated with improved mental and general health functioning,
Laura is convinced that Eduardo’s worsening mental health is
related to his inability to come out and decides that she will
assist Eduardo with this process. Laura’s therapeutic goals are
not easy to implement, however. No matter how gently she
brings it up, Eduardo becomes angry and, at times, leaves
sessions prematurely. At one point, Laura shares her experience
of being the only nonlegacy student among her friends at her
Ivy League university in order to show Eduardo that she knows
what it means to feel different and not always accepted. She
also shares the story of her gay cousin, who came out about 10
years ago. She states that she knows how hard it is to come out,
but she imagines that things must be so much easier for gay
people now than they were for her cousin. Laura’s disclosure is
met with a blank stare from Eduardo. One day, Laura looks
around her office and notices that none of the books or
pamphlets she has available relate to “gay issues.” She makes
an effort and brings in pamphlets advertising the university’s
Gay, Lesbian, Bisexual, and Queer Student Union. At Eduardo’s
next session, she asks him if he would be willing to go with her
to the organization’s open house the next week. Eduardo’s eyes
well up with tears. He says, “I cannot believe you. You have no
idea who I really am.” He storms out of the room and does not

come back for his next three scheduled appointments.
What assumptions does Laura appear to be making about the
etiology of Eduardo’s symptoms?
What are some of the important intersectional issues (in terms
of gender, sexuality, and ethnocultural background) at play for
Eduardo? What are some of the important intersectional issues
at play for Laura?
What sexual orientation microaggressions can you identify in
Laura’s interactions with Eduardo?
Case Study of “The Team”– Chapter 16
As a member of a team of Native American mental health
professionals and traditional spiritual leaders (hereafter called
“the Team”), I have had the opportunity to respond to
community crises in Native communities. Often these responses
have come after communities have experienced clusters of youth
suicides. The following is a description of one of those
responses. The health director of a remote tribal community of
approximately 2,500 contacted and met with the Team leaders
(one of the community’s traditional spiritual/cultural leaders
and me, a clinical psychologist). She described the occurrence
of 17 youth suicides in the community, all by hanging, over a 2-
month period. Most members of the community had been
affected directly in some way, and some families had lost more
than one child. Service providers and first responders in the
community were overwhelmed and exhausted as suicide
attempts were continuing almost every day. Community leaders
had sent the health director to request that the Team respond as
soon as possible to help stop the suicide attempts and help the
community begin a healing process. Team Activities The Team
prepared itself through spiritual ceremony and then traveled to
the community within 3 days. The following are some of the

activities of the Team over the next several weeks. Meeting
with first-line service providers (FLSPs). The Team spent the
first day meeting with a group of service providers and first
responders from the community, providing training on the
effects of traumatic stress and using talking circles to give the
FLSPs a chance to talk about the ways they had been affected
by the suicides. The FLSPs became the lead group for all the
following work and worked closely with the Team for the
remainder of the visit. Community meeting. The Team
conducted an open community meeting to hear the perceptions
and ideas of community members about what had been
happening. Meeting with tribal government. The Team met with
the tribal government to ensure that community members
recognized that the Team had been authorized to be in the
community, and to present a report and recommendations to
tribal leaders at the end of the visit. The Team maintained
contact with tribal leaders as recommendations were
implemented over the next several years. Meeting with spiritual
leaders. Traditional Native spiritual leaders and church leaders
had never met together before but were able to come together to
provide united spiritual support to community members.
Working with schools. All of the schools serving the reservation
children (public, church-based, tribal) were visited. This was
facilitated by school counselors who were part of the FLSP
group. Team members working with members of the FLSP group
held talking circles with children in every grade, all teachers,
and all administrators to educate (in grade-appropriate formats)
about the effects of traumatic stress and to identify high-risk
children. Meeting with affected families and relatives. Team
members traveled to families’ homes or met them in places they
felt comfortable. In some cases, families had not yet reentered
the homes where their children had died. Spiritual leader
members of the Team conducted the appropriate ceremonies that
would allow them to go into their homes or enter their
children’s rooms. Mental health members of the Team worked
with the children, adults, and families to help them express their

grief, honor their loved ones, and support one another. Meeting
with representatives of the judicial system. Some children
whose siblings had died were afraid to return to school because
they were afraid someone else in their families would die. The
schools had started to press charges against the parents for
truancy. Team members met with representatives of the judicial
system and were able to work out solutions that included in-
home schooling for affected children. Building a context.
Meetings with the tribal health director over a 2-week period
revealed a broader context that included 4 years of massive
flooding on the reservation, basements that held 3–4 feet of
standing water, increases in respiratory illnesses, deaths of
elders, occurrence of hantavirus, and washed-out roads
requiring school buses to detour 70 miles (resulting in children
going to school in the dark and not returning until dark). Many
families had moved to the central district of the reservation,
where services and schools were centered, but a severe housing
shortage required them to live with friends or relatives.
Families were separated, with members scattered among
multiple households and their possessions somewhere else.
Federal funding cuts meant that service providers were
overwhelmed. Overcrowded living conditions led to increases in
substance abuse, domestic violence, and gambling. Preexisting
racial tensions between the reservation residents and people
living in the nearby town were exacerbated. There was a single
half-time mental health professional for the reservation, and
when the suicide attempts started, young people who attempted
to harm themselves were sent off the reservation to hospitals
more than 100 miles away for evaluation. Often, their families
did not have access to transportation and could not go with
them. When the young people returned, their families were not
informed about diagnoses, medications, or warning signs, and
there was no aftercare in the community. This was the case for
many of the young people who had died. People started to
believe that when their children were “sent away,” they were
put on medicine that contributed to them killing themselves, so

now there were many more suicide attempts that went
unreported. The young people who had died were actually seen
as the youth leaders in the community. Sharing the context. The
Team worked with the health director and tribal governance to
build the context for the current crisis situation. The tribal
chairperson called a mandatory meeting of all community
members so that the Team could share the context with
community members. People in the community had not
connected the long-term stress brought on by the flooding to the
suicides. The tribe did not think of the flooding as a “disaster”
because it was a part of the natural world (there actually is no
word for disaster in the tribal language). Team members had
also been working with the young people, developing a new set
of youth leaders. These youth shared their grief, feelings of
loss, and need for adult guidance at the community meeting.
Sharing this context allowed community members to get a “big-
picture” view of what had been happening and allowed them to
come together and mobilize community resources to support
each other and begin a healing process. Developing a
community crisis team. The Team worked with the FLSP group
to develop a community crisis team with an emergency plan and
connection to needed resources. The Team had discovered a
pattern of suicide attempts, and planning was done for the
community crisis team to use time periods when no suicide
attempts were happening to do community education and
outreach. Engaging in advocacy. The Team was able to advocate
with FEMA to get needed resources to the community.
Acknowledging the relationship. The Team maintained contact
with the community and its leaders. Follow-up visits focused on
further development of the crisis team, the youth leadership,
community education, and advocacy for resources. It was
important for the Team to acknowledge that its relationship with
the community did not end at the end of the crisis. Engaging in
self-care. The Team met at the end of every day so that
members could debrief and check in with each other. Even when
the Team worked late into the night, this meeting was important

to make sure that everyone remained healthy. In a situation
where children have died and everyone in the community has
been affected, it is difficult for helpers not to be overwhelmed
as well. Throughout this intervention and the several years that
followed, the Team maintained a supportive presence, stayed in
the background, and empowered community leaders and service
providers to shape and implement their plans. Community
members who had felt helpless in the beginning became active
leaders for change in their own community. The suicide
attempts stopped, the youth leadership asked for representation
in tribal governance, and needed resources (including mental
health professionals) were received in the community.
What are some of the reactions to traumatic stress seen in the
community described above? Would you describe the
community above as resilient? Why or why not?
How did culture play a role in the crisis that occurred in this
community?
How do the IASC guidelines apply in this setting? How do they
serve to protect a community during a crisis response?
Case Study of Jeanette - Chapter 17
Jeanette, a 54-year-old married African American woman,
presented at a community mental health center in rural Georgia
with symptoms of depression (weight gain, irritability, social
isolation, crying spells). Jeanette’s husband is an independent
contractor, but construction jobs have been few and far between
with the economic downturn, and Jeanette herself is currently
unemployed. Jeanette has one adult daughter with whom she
describes a “distant” relationship because her daughter
identifies as a lesbian and lives in Atlanta with her girlfriend.
Jeanette states that she garners the majority of her social
support through her women’s group at church, though she notes
feeling “guarded” around friends who “don’t know too much”

about her past. As a child, Jeanette experienced severe physical
and psychological abuse from her mother and sexual abuse from
her older brother. Despite having been raised in the 1960s,
Jeanette grew up in a childhood home that had no indoor
plumbing or heat, and she states that she was too embarrassed to
make friends for fear they would find out about her poverty.
She dropped out of high school in the 10th grade in order to get
a full-time job as a line cook that enabled her to move away
from her abusers and support herself. Jeanette entered therapy
at the prompting of her husband, who claims that she “overeats
away her pain” rather than facing her past trauma. Jeanette has
a history of severe drug abuse, but she indicates that due to
Narcotics Anonymous, raising her daughter, and her Baptist
faith, she has been able to remain substance-free for 17 years
and has instead shifted her coping method to food. Since her
daughter moved away and came out as lesbian, Jeanette reports
feeling that she has lost her identity as a mother and
homemaker. Jeanette completed her GED after her daughter was
born and has since enrolled in a few classes at the community
college, but she has little desire to earn her associate degree. To
pass the time, she is currently seeking employment, but because
of her past involvement with narcotics, she has a criminal
record and has been unsuccessful in securing even a minimum-
wage position. Jeanette indicates that she would like to work on
her anger toward her family of origin, her feelings of
helplessness, and her lack of a sense of purpose. In sessions,
she explores the context of her traumatic experiences. Growing
up in the rural and racially segregated South, she felt as though
she could not report her abuse or rely on law enforcement for
support or intervention. Moreover, as a Black woman, she
describes feeling pressure not to bring negative attention to her
family and community by reporting these assaults. Through
therapy she begins to process how these early traumatic
experiences may have contributed to her feelings of
hopelessness and disempowerment, which eventually led to
substance abuse and overeating. Jeanette feels “trapped” and

discouraged by her inability to find employment and notes that
her present disempowerment is triggering her to relive past
trauma. At the end of her fourth session, Jeanette expresses the
desire to set concrete goals for reestablishing her sense of
personal mastery while allowing for a more healthy release of
anger toward her mother and brother. Jeanette also notes that
she would like to work on her relationship with her daughter but
feels “stuck” because of her spiritual beliefs that same-gender
romantic relationships are immoral. She fears that if her friends
in the Baptist women’s group find out that her daughter is a
lesbian, she and her husband will be marginalized by their
community, and they might also lose the sporadic economic
support they receive from religious leaders and food banks run
by faith-based organizations.
Jeanette’s presenting concerns emerge at the nexus of several
poverty- and racism-related factors. How would you describe
the influence of these systemic forms of oppression in her life
and in her presenting concerns?
A primary element within Jeanette’s history is the childhood
abuse that appears to have triggered a pattern of withdrawal,
depression, and avoidance of emotions via substance abuse.
How has the impact of the trauma been exacerbated by the
poverty that Jeanette’s family faces?
To supplement her husband’s sporadic wages, Jeanette and her
husband receive support from their church—though this faith-
based support feels tenuous, as Jeanette worries that it may be
revoked if word of her daughter’s sexual orientation reaches
members of the conservative church leadership. How do
oppression-related issues intersect in this element of Jeannette’s
story? How do they contribute to Jeanette’s lack of connection
to others?
Case Study of 17-year old student - Chapter 18
Imagine that you are a school counselor in an urban center. A

concerned teacher at your school has referred a 17-year-old
female student to you because her behavior has become
withdrawn and her grades have been consistently dropping over
the past few months. The referring teacher, who leads the
school orchestra, had noticed that the student, a second-
generation immigrant from a Middle Eastern background, did
not attend orchestra practice for 3 consecutive weeks and asked
the other students if anyone knew the reason for her absence. In
private, one of her friends disclosed that the young woman has
been having family problems because her parents found out that
some of her classmates were dating boys from another school
and that as a group they had all been spending time together.
Although the girl herself is not in a relationship, after finding
out that she was unsupervised in the company of young men, her
parents have stopped allowing her to go to extracurricular
activities and outings with her friends. They also now drop her
off at school and pick her up every day, and they will not let her
answer phone calls from her friends. This situation is obviously
negatively affecting the student’s well-being as well as her
school performance.
In the contextual domain, what elements of the broader social
setting and the specific school setting do you think are
influencing the situation?
In the relational domain, how would you identify who should be
part of the counseling process? Should friends, family members,
or others be involved? Who should make the decisions
regarding whom to include or exclude, and how will these
choices affect the sessions?
In the individual domain, what identities, personality attributes,
and personal characteristics are pertinent to the situation?
Case Study of Martinez Family - Chapter 21
A family therapy research program focusing on drug abuse in a

large metropolitan city on the West Coast included 41 families,
16 of which were Latino. The clients were affected by a variety
of psychological disorders, and all had histories of drug abuse.
The Latino families in the program came from a wide range of
Latin American countries. The research program entailed 10
sessions of family intergenerational therapy that was manual
based and conducted in a bilingual format. The Latino
participants were all second-generation immigrants (i.e., the
children of immigrants to the United States). During the course
of the therapy, a number of issues came up, as illustrated by the
material presented here. Most of the Latino families were
struggling with challenges related to immigration, family roles,
and separation from the nuclear and extended family, in
addition to the challenges of drug abuse. Nearly all of the
Latino families were facing issues that often emerge in family
counseling and therapy with linguistically and culturally
different clients. As an example, we present the case of the
Martinez family. Identifying details of this family have been
altered to protect anonymity. The Martinez family consisted of
Victor, the 33-year-old “identified patient,” and the family
members with whom Victor lived: his 57-year-old mother and
his 36-year-old sister, both divorced; a 10-year-old nephew; and
a great aunt, 84 years old. Victor’s extended family included an
older brother (age 40) and the brother’s wife and children.
Victor had a history of heroin abuse since adolescence. At the
moment of entering the family therapy treatment, he was in a
methadone maintenance program, yet he admitted to continued
casual use of heroin. He was disconnected or cut off from his
father. Victor’s older sister, Patricia, was the breadwinner of
the family; Victor did not finish high school and could not hold
a job for more than a few weeks. Victor’s mother received
Social Security benefits and helped support Victor, which
included giving him money for his drug use. She was worried
about the shame that would come to her family if Victor were
arrested for a crime and convicted, so she preferred to give him
money to prevent his committing a crime. Later it became clear

that the vergüenza, or shame, would be particularly bad for the
older brother, who was a law enforcement officer. When Victor
was 5 years old, he and his mother lived with his grandmother
and Patricia in Nicaragua; his mother then migrated to
California alone before gradually bringing her children to join
her, beginning with her daughter. It took 9 years for Victor to
be reunited with the rest of his family. An examination of the
family genogram showed a three-generation pattern of losses
and separations, with women in charge of the family but without
much help from their male partners, who were involved in
alcohol abuse. Victor’s mother left Nicaragua to improve the
family’s economic situation and left the children behind under
the care of the grandmother. The women were seemingly
overinvolved and enmeshed with their children. Gradually, the
mother began to bring the children to the United States, first her
daughter and later the grandmother and Victor. One of the key
elements in family counseling is engaging the family. The
research context in this case provided a great deal of flexibility
with regard to making reminder calls to the family about
appointments or even holding sessions in the home if necessary.
The sessions with the Martinez family were conducted in both
English and Spanish. The older members of the family were
addressed in Spanish, and the younger ones spoke English.
Language can be a powerful tool for engaging the less
acculturated members of a family. Deciding which family
members to invite is also important. From an intergenerational
perspective, the ideal approach is to invite anyone who is
available and can help. These invitations are not left up to the
identified patient or any other family member. In the case of the
Martinez family, the counselor obtained the necessary contact
information and called the potential participants, inviting them
to one session. With Latino families, the value of familismo
often means that family members will show interest in being
part of at least a first session. Soon thereafter, the use of the
genogram helped to broaden the family members’ views of their
situation. An early task assigned in therapy was for all family

members to engage in the joint project of diagramming their
family tree as far back as possible. The diagram was later
discussed in a session with all members present. Discussion
This case illustrates many of the complexities involved in
counseling families. A first concern was how to handle the
integration of a serious substance abuse condition within the
psychological, family, and social contexts. Our approach was
based on a family therapy strategy that incorporates culture and
context. We used the contextual family therapy (CFT) model,
which aims to include all available individuals in its preventive
strategies (Boszormenyi-Nagy & Ulrich, 1981) for the benefit of
current and future generations. We culturally adapted the
approach as suggested by Bernal and Domenech Rodríguez
(2012). CFT views drug abuse as predominantly rooted in social
and community processes that affect the entire family. Second,
we needed to culturally adapt and contextualize notions about
high levels of interpersonal involvement among family
members, often viewed as “enmeshment” and considered
pathological and indicative of overly flexible boundaries. When
mothers become single parents, left to take care of their families
on their own, how is it possible for them not to be “overly”
involved with their children? Here we see that Victor’s mother
assumed both instrumental and affective roles. And given the
cultural context of familismo (valuing the unity of the family),
we needed to culturally adapt and contextualize the pathological
concepts of enmeshment, fusion, and undifferentiated ego mass.
A third consideration is the immigrant experience, which
includes the intergenerational conflicts that evolve from the
pressures on the younger generation to assimilate, adapt, and/or
acculturate. With migration comes the loss of social capital and
disconnection from the family of origin and the network of
relationships at home. In this case, a number of relational issues
arose. Victor’s mother migrated alone to the United States from
Nicaragua with hopes of improving the economic situation and
quality of life of the family; that by itself is a courageous
endeavor for anyone and in particular for a woman from a

context of limited resources and education. She left her children
to be raised by her mother when Victor was 5 years old. The
therapy supported Victor and his mother in talking about the
losses they had experienced and ways for the mother to give to
her son directly that did not entail paying for his drug use,
perhaps as a way to make up for having left him. At the same
time, Victor’s contribution was recognized as a sacrifice—that
is, through his addiction he seemingly remained dependent on
the family as a way to give to his mother. The effort here was to
build trust in family relationships. Could the contributions of
each member of the family be recognized, and could a plan be
devised based on an understanding of the legacy of
abandonment, limited resources, and loss? Once mother and son
exonerated each other, the focus of the therapy turned to
identifying resources and problem solving for all family
members. Finally, the genogram was a resource for exploring
the family’s history and changing contexts. From the genogram
it was clear that the family had a three-generation pattern of
women leaving children with their mothers, serious challenges
with men suffering from alcoholism and subsequently
abandoning the family, and overinvolvement of women with
their children. A broader contextual view emerged in which all
were understood to be victims of a legacy of poverty, war, and
exploitation. The question became what they could do about it
now, and the promise of therapy was that they could learn how
to transcend the generational legacy to prevent the younger
generation from further victimization.
What definition of “family” would you use in this case? How
would you describe the structure of the Martinez family and the
impact of social, historical, and cultural processes on the
family’s basic functions (e.g., instrumental, expressive, child
rearing)?
What conceptual resources or tools could help you approach a
family that is different from your own racial, ethnic, and

cultural background, given the changing social, historical, and
multicultural contexts?
What is your assessment of the Martinez family intervention?
What other culturally sensitive approach might have been
suitable for this family, and what would you have done
differently?

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