Psychotherapy

Psychotherapy

1. Explain why it is very important for a therapist to be informed about the practices and values of the different cultures, genders, or ethnicities.

Recognition of the client’s practices and values is beneficial in different ways. First, it helps the client understand the behaviors and the different inclinations of the client, which increases the effectiveness of therapeutic interventions. Here, the therapist can develop treatment plans that are tailored to the different needs of the client (cultural, ethnic, and personal needs) and simultaneously effective. Secondly, it reduces the trap of racial microaggression through actions such as color blindness, assumption of criminal status, and pathologizing cultural values or communication styles (Sue 282). Color blindness occurs when the therapist attempts to show the client that he/she does not consider the client’s unique cultural practices and beliefs. In essence, the therapist should show genuine concern to the client’s belief system.

Lack of information about the client’s culture and ethnicity may result in a misdiagnosis that is based on certain inherent behaviors and practices that are not amenable to psychological treatment. For instance, awareness of some of the practices of African Americans may reduce the risk of overemphasis on symptoms such as paranoia and substance abuse. Thirdly, the knowledge of the cultural diversity of clients is associated with the effective delivery of services through the creation of therapeutic relationships that fosters trust and openness (Sue 271). Such an environment is conducive to the recovery process of the client.

2. Explain why therapists should carefully examine their own values and world views. This does not imply that the therapist should reveal their values and worldviews explicitly to their client.

Therapists should strive to remain mindful of their values as these may predispose them to racial microaggression through the practice of prejudice and biases. These types of racial microaggression may occur in unconscious, unintentional, indirect, and subtle ways (dilemma 2: invisibility), which makes them more difficult to identify and to change (Sue 277). Therapists who are unaware of their values and world views may discriminate against specific clients unknowingly and place their clients in a tough position (dilemma 4: the catch-22) (Sue 279). On confrontation, the therapists may defend themselves vehemently since they strongly believe that their actions are justified. In the long run, the microaggressions end up inflicting psychological harm to the client in different ways. Some of the consequences include angering the client, lowering their self-esteem, reducing the level of therapist-client trust, and ultimately destroying the therapeutic relationship. An awareness of personal values and world views also helps in avoiding transference and countertransference that may further strain the therapeutic relationship between the clinician and the client.

3. Explain why the therapist should recognize that particular behaviors, values, or attitudes might have different meanings in different cultural contexts. Give an example of a value, behavior, or attitude that has a different meaning in different cultures or subgroups.

First, failure to appreciate the diversity of clients’ behaviors, values, and attitudes, increases the risk of pathologizing such cultural inclinations in different cultural groups. As such, the therapist might make the wrong diagnosis based on a value that they think is a shared value in all cultural groups. For instance, Latinos or Asian American clients have strong family values that are centered on being highly responsible. Such a practice might predispose them to increased family expectations that may make them overwhelmed and stressed. For a therapist to advice, such a client to abandon the collective responsibilities of the family in favor of individualistic practices would be ignorance of the diversity of culture and ethnic views. Moreover, although Asian Americans and Latinos are considered to be calm and quiet, Black Americans are generally animated and loud (Sue 282). Failure to recognize these differences may result in racial microaggressions, such as pathologizing of the communication style and cultural values of different clients.

4. Explain what is wrong with the following statement: “As long as the therapist treats all others the same and pays no attention to race or ethnicity, it is likely that a good outcome will result.”

The above statement is misleading and is a threat to the success of the therapeutic process. First, the therapist can’t treat every client in the same way. This is because every individual has a unique set of unique values, beliefs, and attitudes. These cultural and ethnic inclinations are instrumental in understanding, diagnosing, and treating the client effectively. Secondly, treating all clients equally predisposes the therapist to microaggression such as color blindness, alienation of the client, assumption of criminal status, the myth of meritocracy, pathologizing cultural values, and defining clients as second-class citizens. These microaggressions may make clients feel invalidated and misunderstood, thus creating a hostile therapist-client relationship and destroying the therapeutic alliance.

5. Her loneliness associated with her fear of developing friendships with others.

The first step is to educate the client, Beth, on the meaning of automatic thoughts and maladaptive automatic thoughts and how to identify the two. Automatic thoughts are those thoughts that occur spontaneously in an individual’s daily interactions with other people or with events is (Beck and Weishaar 28). These thoughts connect the individual’s experiences and interactions to emotions, which lead to the respective behaviors. The situation-thought-feeling triad can be instrumental in offering client education. On the other hand, maladaptive assumptions are the rules, causes, or reasons that people attribute to an automatic thought. Magnification and maximization are forms of cognitive distortion that refer to either seeing something as more significant or less significant than how it is (Beck and Weishaar 24).         In the case study, Betty’s automatic thought is that she had no life (meaning her social life was poor and deficient), and she was unpopular in her workplace. The maladaptive assumption is that if she formed friendships, they would only be temporary (Yalom 100). These automatic thoughts and maladaptive assumptions come from previous experiences where she would lose friends immediately after forming relationships because most people considered her unattractive ad pitied her physique. They also act as a minimalization, since she sees no essence in forming new friendships. These factors made her fearful of making new friends, thus leading to loneliness.

After identifying the automatic thoughts and maladaptive assumptions, the therapist should strive to develop treatment goals with Betty. An example of a goal is: to improve the level of social interaction, friendships, and the length of relationships. The therapist should also employ strategies such as collaborative empiricism and guided discovery, which help in developing a client-centered intervention plan (Beck and Weishaar 30). Next, the therapist should address the maladaptive assumptions by assisting Betty to code the thoughts correctly. In essence, nothing lasts forever, and friendships are of great benefit, regardless of the time the friendship lasts. After this, the therapist should encourage the client to test the new thoughts by making friends. This helps to strengthen the new cognitions and to augment behavioral change.

6. Her fear of losing weight despite her morbid obesity

            The automatic thought in Betty, in the case study, was that she likes she is fat and obese. The maladaptive assumption is was that if she lost weight, she would get cancer and die (Yalom 102). The source of the maladaptive assumption is that Betty had witnessed her father, who was also obese, grow thinner and thinner by the day and finally die from cancer. Consequently, Betty viewed food as a form of gratification and an escape from life’s anxieties. After identifying the above aspects, the therapist, together with Betty, should establish goals for the therapy. The main goal is to reduce the amount of food intake and to develop healthy eating habits. The therapist should employ strategies such as collaborative empiricism and guided discovery, which help in developing a client-centered intervention plan (Beck and Weishaar 30).

After this, the therapist should help Betty to understand that losing weight is synonymous with good health. The therapist can also address the source of the maladaptive assumption. Here, the therapist should explain that Betty’s dad did not die because of weight loss but due to the effects of his illness. Next, the therapist should help the client develop an action plan, which Betty will start to execute. Successful implementation of the action plan for healthy eating helps to augment the change in behavior and cognition.

7. Can we consider Betty to be subject to microaggressions, invalidations, and assaults due to her obesity? Is there any evidence in the case that supports this idea?

From the start, Betty’s therapist exhibited negative beliefs and attitudes towards fat women, which was a source of bias and microaggression towards Betty. These inclinations were shaped by an interplay of cultural attributes and life experiences (such as family experiences and professional experiences). Moreover, the therapist also cited that he had a similar intolerant and de-humanistic feelings for all obese clients (Yalom 99). This acts as an invalidation to Betty’s life and experiences since she is also an obese lady. The therapist also makes the mistake of suggesting other options for some of Betty’s social problems (e.g., the Overeaters Anonymous and the Sierra Club) (Yalom 94). Such an action is a form of microaggression and assault (a myth of meritocracy) since it paints Betty as a mediocre and that she needs to put more effort in her social skills. During the initial sessions, the therapist was in the habit of looking at the clock frequently (Yalom 99). This was a sign that the client was boring, which is a form of microaggression to the client. However, with time, the therapist changes this behavior.