Case Study
Patient Demographic:  Initial Intake: Age: 14 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Hawaiian American Relationship Status: Single Counseling Setting: School-based mental health counseling Type of Counseling: Individual
Mental Status Exam: Malik presents as well groomed, good hygiene and behavior within normal limits. She is highly anxious, evidenced by limited eye contact, tense expressions and fidgeting with her hands. Malik admits to having suicidal thoughts and has self-harmed by cutting herself in the past. She reluctantly shares that she had a traumatic event in Hawaii right before leaving but is unwilling to discuss it and begins crying. She then changes the subject and tells you moving out of Hawaii has been painful because “everything is different here, including how they do school and how people talk about each other.” She adds that she experiences at least one nightmare a week since moving.
Presenting Problem: Diagnosis: Major depressive disorder, single episode, unspecified (F32.9), Anxiety disorder, unspecified (F41.9)
 

Malik, a 14-year-old girl entering High School is referred to you for mental health counseling by her school counselor for reports of her leaving the classroom in tears and because of calls received by her mother stating that she has crying spells at home. After speaking with Malik’s mother, you learn her mother, stepfather and sisters have recently moved with her to the mainland states from the Hawaiian Islands and that she has been missing her father, friends, school, and other family members left behind. Malik spends most of her time in her room, appears depressed often, gets upset easily and is constantly on her phone. Her mother asks that you meet with her during school hours and help her understand what is going on. She says Malik has been crying since just before leaving Hawaii.
Other Contexts: Family History:
Malik’s parents divorced while she was young but had always lived in Hawaii, making it easy for her to see both sides of her family at will. Malik has several siblings, cousins, and all her grandparents are still alive. Malik has a strained relationship with her father and stepmother and feels heavily influenced by her father’s opinion of her, stating “he just wants what is best for me, but he’s really harsh about it and it sometimes hurts my feelings and stresses me out.” She is struggling to connect with her mother now because she is working full-time, and she feels “doesn’t have time for her anymore.” Malik is also forced to do most of the household chores and care for her younger siblings on top of managing her schoolwork. All of this has made her feel overwhelmed.

Question: Which of the following is the least appropriate way to demonstrate cultural sensitivity to Malik?
(A): Ask her to tell you more about her heritage and its importance to her.
(B): Discuss with her the similarities and differences about Hawaiian and mainland culture.
(C): Share with her your extensive knowledge of Hawaii and how you loved vacationing there.
(D): Conduct interventions that increase her self-esteem in her heritage.

Correct Answer: Share with her your extensive knowledge of Hawaii and how you loved vacationing there.
Explanation: Personal anecdotes about your connection to her culture that do not adequately reflect or support your client's concerns are not useful in counseling. It is also insensitive to present yourself as "expert" in the topic of their heritage. As a counselor it is your responsibility to help your client feel safe and secure so they can share about themselves and how their thoughts, beliefs, cultural attitudes, and experiences shape and affect their moods, behaviors, and reactions to different situations. Not everyone from the same culture feels and thinks the same way about their acculturation stress, so working with Malik to learn more about how she specifically feels is paramount in understanding how to help her. Interventions b, c and d are all effective and positive ways of addressing her heritage, learning more about her feelings, and helping her overcome her anxiety. Therefore, the correct answer is (A)
Competency: core counseling attributes