Cultural Diversity within Counseling

Anita M. is a 26‐year‐old, first‐year law student at a university located in the Midwest. Born and raised in New York City, Anita is an excellent student whose academic performance throughout elementary school, high school, and college was consistently outstanding. After graduating from college, Anita worked on the campaign of a congressional candidate and, after the candidate was elected to office, joined the congresswoman’s staff in Washington, DC. There Anita worked in constituent relations and developed her passion for public interest law. Anita applied to several law schools and chose the university she currently attends due to the full scholarship she was awarded and the fact that her extended family resides in the area.Anita identifies as biracial (her mother is African American and her father is White), although phenotypically presents as White, with a light skin tone and green eyes. Anita is frequently told that she could pass for White, and many peers and adults are surprised to learn that Anita’s mother is African American. She is the first female member of her family to attend college and law school. As a result of her identities, Anita feels a great responsibility to succeed in law school and impress her family, her peers, and the faculty. The summer before moving to the Midwest and starting law school, Anita came out to her friends as a lesbian and briefly dated a White female colleague working in the office of another congressperson. For Anita, her first experience of dating a woman was generally positive; however, her experiences within predominantly White lesbian, gay, bisexual, and transgendered (LGBT) social circles resulted infeelings of discomfort and isolation. As Anita explored the LGBT community of Washington, she became keenly aware of the racial segregation within the community and her girlfriend’s unspoken preference to socialize with White lesbians. Moreover, Anita noticed that some straight friends of color reacted some- what negatively to her girlfriend, and Anita wondered to what extent their reaction was affected by race or homophobia. Over time, Anita’s girlfriend expressed disappointment that Anita was not out to her family, and she increasingly pressured Anita to disclose their relationship. Feeling reluctant to discuss her sexuality with her family and feeling anxious about moving away from Washington and starting law school, Anita decided to end the relationship.For a time, Anita was excited by the move to the Midwest and the start of her legal studies. However, she became concerned by several developments over the course of the first semester. By the end of the October, Anita noticed she was having difficulty sleeping, was easily distracted and inattentive, frequently felt fatigued, and was increasingly disinterested in her studies. Moreover, her mood was low, and she was having a difficult time making friends. After confiding in a faculty member about these struggles, Anita was referred to the Student Health Center on campus to explore counseling services.At the Student Health Center, Anita requested a counselor who identified as lesbian and a woman of color. The current staff did not include a lesbian of color; moreover, the counseling staff was predominantly composed of White women who identified as heterosexual. In an effort to accommodate her request, Anita was assigned to a White, gay male therapist, Dr. Anderson. During the intake session, Anita minimized her concerns as well as her symptomatology, explaining, “I am okay. I think I’m just trying to adjust.” When pressed to talk about her adjustment to law school, the campus, and the midwestern environment, Anita explained, “It’s different, but I can manage.” Anita then attributed her sleep problems, as well as her low energy and low mood, to the new demands of law school. Dr. Anderson attempted to normalize the adjustment by explaining “Everyone has a hard time their first semester. It sounds like you’ve been a successful student, and I’m sure that your work will improve.” At the end of the intake, Dr. Anderson recommended that Anita join a law student support group that gathered once a week in the law library and meet for a follow‐up appointment in one month to “reevaluate the situation.” In Anita’s file, Dr. Anderson recorded an “Adjustment Disorder, Depressed Mood” diagnosis and described the treatment plan as: “Referral to law student support group, follow‐up appointment in one month.”Anita did not join the law student support group, and in the month that followed, her condition worsened. By December, Anita was frequently absent from classes and socially withdrawn. Her mood was generally depressed with frequent episodes of anxiety related to academic or social stressors. Family members living in the vicinity made efforts to reach out to Anita, but she declined their invitations. Anita’s alcohol consumption increased significantly, and she increasingly worried that her decision to attend law school was a mistake. She missed her friends in Washington and her family in New York City. When she considered the impending final exams, her breathing became labored and she felt a tightness in her chest.Reluctantly, Anita returned for her follow‐up appointment with Dr. Anderson and explained that she was thinking of dropping out of law school. She reported that she had not attended the law student support group because she was no longer certain she wanted to remain in law school, and she believed her time would be better spent studying or evaluating other options. Dr. Anderson expressed disappointment in Anita’s “rejection of help” and asked Anita if she had made efforts to get support in other ways. Specifically, Dr. Anderson asked Anita if she had attended law school mixers or other graduate student organization events. Anita reported that she has “not been feeling up to those kinds of things.”  Dr. Anderson continued: “Anita, I also wonder if this is about your breakup over the summer and the fact that you are not out to your family.” At this, Anita became tearful and explained, “I don’t think you have any idea what this is about.”Prompt In an APA-formatted (7th ed.) paper, respond to the questions below. The length of your paper should be no less than three pages (excluding cover page and reference page) and no more than five pages.  You must reference the AAMFT’s Code of Ethics (2015) in your paper and include the appropriate citation on your references page.Questions1. What are your clinical impressions of Anita? How would you characterize her presenting problem, and what do you think is an appropriate diagnosis for her? Contrast your impressions with Dr. Anderson’s diagnosis and treatment recommendation. 2. What are your reactions to Dr. Anderson’s efforts, during the intake interview, to normalize Anita’s difficulty adjusting? How might these efforts demonstrate a lack of cultural competency? 3. How might Dr. Anderson’s racial and gender identities impact his interactions with Anita? How might these identities shape his counter-transference reactions? 4. How might Anita’s racial and gender identities impact her interactions with Dr. Anderson? How might these identities shape her transference reactions? 5. In the follow‐up appointment, Dr. Anderson described Anita’s decision not to join the law student support group as “rejection of help.” What do you believe led Dr. Anderson to make this judgment? 6. What are your impressions of Anita’s behaviors between the intake and the follow‐up appointment? How do you understand her decision not to join the law student support group or participate in mixers or other student organizations on campus? 7. The conclusion of the case study involves an exchange between Dr. Anderson and Anita. In your opinion, what assumptions were Dr. Anderson working from in offering his intervention? What reactions did this invoke in Anita, and why? 8. What approach would you take in working with Anita? How would you conduct the intake appointment? What treatment recommendations would you have made, and how would you have followed up on these?

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