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Section 16
Treating Culturally Diverse Clients by 'Exploring Depression'

Question 16 | Test | Table of Contents

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In the last section, we discussed three components of counselor credibility for working with Alaska Native clients. These three components of counselor credibility were expertise, trustworthiness, and belief similarity.

In this section, we will discuss methods of counseling a culturally different client who is both depressed and angry.

As you know, due to the Psychological Sets and the Counselor Credibility issues discussed in the previous sections, many culturally different clients may feel depressed and angry. Let’s look at Lily’s case.

As we discuss this case, think of your culturally different client. What are the ethical implications of your current counseling methods?

As you have probably noticed, for culturally different clients who are trying to persuade others that their needs are legitimate, the client often appears to others to be lacking confidence, and inside they feel angry.

♦ Case Study Analysis: Lily's Anger & Depression Management
Lily, age 25 Native American, began coming to therapy sessions because of her problems with anger. Lily frequently lost her temper with her children and yelled at them. However, she convinced herself to begin counseling when she found herself raising her hand to her oldest son, David, for knocking over a glass of Kool-Aid.

Lily stated, "I don’t know what came over me! I’ve never hit my kids before! Growing up in my house, we were always afraid my dad would take a strap to us, and I don’t want my kids having that same fear. But I just lose it when I feel like people don’t listen to me. It seems like Andy, my husband, who is white, hardly knows me. Sometimes my friends are like that, too. They just don’t get me, and I end up taking it out on my kids."

After a few sessions, I realized that Lily’s anger may be rooted in her depression. I stated, "You’ve said you feel alienated from your white husband and friends because they don’t know you as well as you think they should. Could you be more direct in telling these people how they can respond to your needs?" Lily sighed and stated, "I’ve tried, but I get no results. Talking does no good."

I stated to Lily, "I agree there’s no guarantee you can force others to respond properly to your needs. But perhaps you could find more successful ways of communicating your needs to others." Lily looked doubtful and asked, "Like how? I answered, "Well, let’s find out the problem with how you currently communicate."

Have you found, as I have, that some detrimental communication patterns are too much salesmanship and justifying needs too strongly? I stated to Lily, "What I mean is, do you try too hard to persuade others that your needs are legitimate, or do you find yourself defending your position a lot?" Lily answered, "All the time. I just feel like Andy and some of my black and white friends alike don’t take me seriously when I speak."

It goes without saying that for culturally different clients who are trying to persuade others that their needs are legitimate, the client often appears to others to be lacking confidence. I explained this to Lily, stating, "The net result is they don’t seriously consider your needs, and this leaves you feeling disconnected and alone, and then angry."

Lily then asked, "So what should I do differently?"

As you probably know culturally diverse clients want tangible solid therapy, not tangential philosophical insights in the counseling environment. I have found that culturally diverse clients like Lily generally respond best to this direct approach in therapy. For this reason, I decided to give Lily straightforward advice.

I stated, "State your needs in a strict tone of voice and be succinct. If your need is invalidated or questioned, don't defend it. Just say, ‘That’s how I feel.’ As you know, engaging in a power play can create the adversarial climate that leads to strong feelings of estrangement."

♦ Exploring the Depression Technique
Lily still looked uncertain, so being aware of her need for a  tangible technique. I decided to explain the "Exploring the Depression" technique. I gave Lily the first question. "Can you think of a time when you created a gulf in a major relationship that leaves you feeling angry?" Lily thought for a moment, and then wrote down, "When Andy and I disagree about how to discipline the kids." Obviously, clients can minimize their anger and depression by taking the initiative to bridge gulfs that disrupt relationships.

I explained this to Lily, then posed the second question for her, "What adjustments could you make to more successfully address your relational needs?" Lily thought for a moment, and then wrote down, "Instead of just wishing Andy would go along with the punishments I think are right, I could explain to him why I think the punishment I’ve chosen is appropriate."

Do you have a culturally different client who, like Lily, struggles with depression and anger? Would the "Exploring the Depression" technique be appropriate for your Lily? What ethical concerns should you have in counseling a culturally different client regarding depression?

The social work Code of Ethics states, "Social workers should understand culture and its function in human behavior and society, recognizing the strengths that exist in all cultures."
 
In this section, we have discussed counseling a culturally different client who is depressed and angry.

In the next section, we will discuss Atkinson’s Minority Identity Development Model and its five stages. The five stages of the Minority Identity Development Model are the Conformity Stage, the Dissonance Stage, the Resistance and Immersion Stage, the Introspection Stage, and the Synergetic Articulation and Awareness Stage.
Reviewed 2023

Update
The Complex Relationship
Between Depression and Progression
to Incident Cognitive Impairment
Across Race and Ethnicity

- Babulal, G. M., Zhu, Y., Roe, C. M., Hudson, D. L., Williams, M. M., Murphy, S. A., Doherty, J., Johnson, A. M., & Trani, J. F. (2022). The complex relationship between depression and progression to incident cognitive impairment across race and ethnicity. Alzheimer's & dementia : the journal of the Alzheimer's Association, 18(12), 2593–2602.

Peer-Reviewed Journal Article References:
Delgadillo, J., & Gonzalez Salas Duhne, P. (2020). Targeted prescription of cognitive–behavioral therapy versus person-centered counseling for depression using a machine learning approach. Journal of Consulting and Clinical Psychology, 88(1), 14–24.

Gonzalez, V. M., Burroughs, A., & Skewes, M. C. (2020). Belief in the American Indian/Alaska Native biological vulnerability myth and drinking to cope: Does stereotype threat play a role? Cultural Diversity and Ethnic Minority Psychology. Advance online publication. 

Kaufman, C. E., Beals, J., Croy, C., Jiang, L., Novins, D. K., & The AI-SUPERPFP Team. (2013). Multilevel context of depression in two American Indian tribes. Journal of Consulting and Clinical Psychology, 81(6), 1040–1051.

O'Keefe, V. M., Cwik, M. F., Haroz, E. E., & Barlow, A. (2019). Increasing culturally responsive care and mental health equity with indigenous community mental health workers. Psychological Services. Advance online publication. 

QUESTION 16
To what kind of approach do Native American or other culturally different clients typically respond best? To select and enter your answer go to Test.