Culture refers to believes, values, behaviors, and material objects

Answerer the following using the provided case study of William Thompson

A description of the three multicultural identities( African American, Male, and Veterans) describe the characteristics, life circumstances, family relationships, or social influences of William Thompson, integrating information from provided case notes

An explanation of the social context for Williams multiple layers of identity

An explanation of the identity factors you, as a psychologist, need to consider when working with William, and how you might respond to those factors

An explanation of how the complexities and various layers of Williams multiple multicultural identities might affect the primary areas of assessment, diagnosis, and treatment

An explanation of the theoretical approach you would use when assessing William, establishing a clinical diagnosis (if any), and engaging in therapy

An explanation of additional questions you would ask William to further support your assessment and diagnosis of his presenting concerns

An assessment of how Williams PTSD diagnosis (including DSM IV-TR diagnosis information) might influence his identities and the potential strategies for processing his military background and subsequent experiences related to his career and family, as well as in treatment

An explanation of the role of spirituality and/or religion as they relate to Williams identities, and what impact this may have on his diagnosis, comprehensive and competent assessment, and treatment (the therapy process)

An explanation of the multicultural theories that support the therapeutic approach you would use when working with William

An explanation of the APA ethical codes as they relate to multicultural competency and professional interactions with William

An explanation of how any potential biases and/or worldview conflicts might influence your work with William and any plans for future professional development related to multicultural psychological practice

Case Study of William Thompson

Description of Multicultural Identities

Culture refers to believes, values, behaviors, and material objects which defines people’s lives. African Americans originated from different countries in African and cultures (Fleury-Steiner, 2012). Therefore, African Americans share the same background in acculturation, racial oppression, and enslavement. According to Castells (2011), the important aspect of African American culture is that the African males are believed to be superior over their female counterparts. For example, despite the love Luli had for William, he did not open up and share information concerning his health and issues that affect him. This is because the African American custom demands that a man should persevere and preserve his dignity regardless of the pain he goes through, lest he be considered to be inferior and coward. However, William did not want to affect his lovely wife emotionally. On the other hand, the veteran culture demands each person to belong to a military group or join a National Guard. Those in the military are further supposed to remain loyal, respectful, offer selfless service, and maintain personal courage (Fleury-Steiner, 2012). William adapted the veteran culture while in Iraq; a situation that influenced his behavior to a greater extent. For instance, since he returned from the war, he remained silent and avoided conversation that reminded him of the situation surrounding the war in Iraq. People from different cultures interact through intermarriage and war. Luli (Korean/American) married William (African American) and as such, expanded the cross-cultural territory to include sister-in-law from Columbia. Overall, intermarriages often enhance the primary and the secondary culture processes which are important in intercultural communication. For instance, William and Luli were able to stay anywhere in the world because they could easily interact with people from different cultures.

William’s Social Context of Multiple Layers of Identity

Socially constructed identity has received overwhelming attention among sociologists in the past decade. The multiple cultural identities are the core aspects of personal identity that defines the race, religion, sexual orientation, and life experience (Brodsky & Marx, 2001). William’s multiple layers identity result from intermarriage, which intensifies globalization. This means that, the societal identification and behavior is shaped by the interaction between different cultural groups. Therefore, it offers William varied opportunities such as improving economic migration. For instance, William is an African America, but worked in Iraq and New York. Moreover, social constructivism influences a person to develop adaptive mechanism. Brodsky & Marx (2001) cite that this help a person to become multicultural and promote interrelations.

Identity Factor

There is a continuous motivation among psychologists to absorb and understand the ethnicity and cultural factors to deliver appropriate services to clients. Moreover, the understanding of identity factors among diverse population enhances the ability to incorporate cultural diversity, beliefs, and values in health care system. However, before identifying the factors, the psychologists require a social framework that considers the interactional style, values, and people’s lifestyle (Castells, 2011). Therefore, as a psychologist, identity factors such as interest and hobbies, language, genders, professional experience, family and country of origin should be considered during the psychological processes. Once the identity factors have been noted, the next process should include a comprehensive framework on how to respond to those issues. For example, in William’s case, it is important to explain for him some aspects such as economic capabilities so that he would understand who he is and the value he has to the community. Other information should include a brief presentation of his interest, hobbies, and social setup. Moreover, persuading William to share some of his experiences such as the Iraq war would offer him an opportunity to face realities of life. As such, he would forget the past memories thereby enabling him an opportunity to relax. Juhnke, & Hagedorn, (2013) affirm that the development of personal identity and personality often shapes the nature of people’s behavior in the future. Therefore, it is important to make a person recognize his/her potential and change their perception and attitude about life as well as other aspects of life. Despite William’s multiple layer of identity, the family should be the defining factor and the strong foundation for personal growth and encouragement especially the wife.

How Multiple Multicultural Identities affect Assessment, Diagnosis, and Treatment

Overall, culture controls the behavior and belief of a person and determines his/her expectation. Therefore, any person offering assessment, diagnosis, and treatment should be sensitive to different cultural aspects and orientations such as believes, lifestyles, and values held by people from such cultures. As such, the psychologist needs to develop cultural skills, knowledge, and attitude (Alarco, 2009). However, multicultural identity pose a challenge during the assessment because if the psychologist is unfamiliar with all the cultural values, believes, and customs, frame and references made may be incorrect. According to Purnell (2013), different people show different behaviors and experience when reacting to situations. For instance, the multicultural nature of William is a challenge because his abusive drinking, avoiding conversation, and being angered at all times may be related to a given cultural defense mechanism as applied by some people. Although behavioral models might assist in the diagnosis and treatment of individuals with disordered behavioral symptoms, it has proved difficult to diagnosis and treatment for multicultural patient like Williams (Kaplan, Sadock & Sadock, 2007). This is because the biopsychosocial model assumes that patient’s psychological makeup, biological state, and environment affect the treatment and illness presentation. Therefore, in the case of William, it is hard to determine what type of treatment and therapy would be suitable because he has lived in California, New Jersey and Ira; these places where William has lived in have different cultures and might have influenced him differently. As such, a psychologist cannot exactly identify William’s cultural background although he is an African American. Sometimes, there are symptoms which are of cultural importance and require appropriate intimacy with the psychologist. As such, it would be challenging if there were cultural communication barrier.

Theoretical Approach in Assessing and Clinical Diagnosis of William

Theory approach in a psychotherapy process act as a road map in understanding the client’s problem and providing the required solution (Kaplan et al., 2007). In William’s case, behavioral theory would be useful in assessing him. The behavioral theory state that, people’s behaviors are determined and acquired through conditioning. In other words, continuous reinforcement of response activity produces stimulus, which causes a negative reaction from an individual. Nonetheless, before the war in Iraq, William was a member of the Catholic Church, participated in various activities in the church, and received sufficient sleep. However, after the war, his behaviors changed and any scenario (conditional reflex) that reminded him of war caused conditional responses; these included abusive drinking, traumatic stress, and staying awake for a long time. Therefore, this theory would assist in assessing the extent of impact of the war on William’s brain and behavior. The clinical diagnosis methods have experienced uneven reception and implementation because of cultural differences among mental health workers. Therefore, the use of clinical DSM-V during diagnosis would enable psychologists to understand the complex information regarding symptoms, emotional correlated issues, behavior, and culture (Hinton & Fenandez-Lewis (2010). Alarco (2009) cites that clinical DSM-IV aims at providing comprehensive information about the patient’s experience and offers appropriate treatment. William’s multicultural identity layers require such type of diagnosis such that the psychologist would understand the cultural diffusion and behavioral changes that emerged after William leaving the Iraq war and losing his job. The post-traumatic stress disorder (PTSD) shown by William requires therapy from a psychotherapist who would employ practical techniques to eliminate negative thinking and depression. For instance, improving a good relationship between William and Luli, setting health boundaries, and educating him how to handle life’s problems. Kaplan et al., (2007) cite that the therapy session would reduce isolation and provide good feedback mechanism in a relationship.

Important Questions to ask during Assessment and Diagnosis

Assessment and diagnosis processes require a complete physical examination of the body and historical background of the patient. This is because the information received would provide clear background for treatment. In the case of William, the following questions would be important in the diagnosis and assessment: What is the ethnic background, what is the language preference, what is the medical background, and what is the preferred service location (place of treatment). According to American Psychological Association (2011), the questions would help the health professionals to discharge better treatment to the patients from the ethno-cultural groups. For instance, information about ethnic background often assists psychologists to become cultural sensitive and provide a wide spectrum for treatment. During the assessment, language background is often important because there are symptoms, which can be explained best in cultural language (Juhnke, & Hagedorn, 2013). Nonetheless, the patient should decide where to receive treatment and medical attention. For example, the treatment could be administered in hospital premises, home or any convenient place chosen by the patient. This is would be essential because treating a patient in some places and facilities sometimes rekindles the past memories which could increase the level of depression. Many medical problems are intra-cellular intra-psychic. Therefore, knowledge on the patient’s medical background would provide a clue on the related treatment that should be provided. Purnell (2013) asserts that a transcultural mental health care professional often emphasize the medical background to discover the roots and cultural heritage associated with the symptoms. As such, a standardized treatment which incorporates all aspects of medical dimension should be provided.

Assessment of how PTSD Diagnosis Influences Identities

DSM-IV-TR PTSD diagnosis is a process applied to traumatized people from diverse cultural groups and affiliations. PTSD occurs when a person has been exposed to events or activities that threaten his or her life and/or physical integrity. According to Hinton & Fenandez-Lewis (2010), DSM-IV-TR PTSD diagnosis assist the doctors to determine the range or intense of psychological damage. As such, this diagnosis would help the doctors to ascertain why William often avoids people and engage in abusive alcohol drinking. Research found that PTSD diagnosis display how an individual’s genes are related to the environment and cultural preferences (Kaplan et al., 2007). In other words, members from a given cultural background tend to display similar symptoms. Therefore, DSM-IV-TR PTSD diagnosis would assist in determining the cross-cultural boundaries of Williams as well as affirm the extent of traumatic effect he is exposed to. Moreover, studies reveal that the ethnic minority in America (African American) shows a link between PTSD severity and trauma (Hinton & Fenandez-Lewis, 2010). In other words, people exhibiting multicultural layers tend to show traumatic symptoms whenever they are exposed to activities that threaten their life. This explains why William developed a great depression and trauma during the war in Iraq as well as spent several days without having adequate sleep. Ironically, William was a trained lawyer and not a military officer. Therefore, after encountering numerous negative events in war and at work place, William developed PTSD, which affected even his relationship with the family members. As such, the PTSD diagnosis would provide a basis through which the symptoms would call for treatment and therapy that encourages recalling of events (Purnell, 2013). In addition, it would encourage emotional sensation hence act as an outlet for emotions, which accumulated in mind for a long time.

Role of Spirituality in Identity, Assessment, and Treatment

William was an active, healthy, and strong member of the Catholic Church before joining the military in Iraq. People believe that God created them in His own likeness and image. Therefore, people believe that they originated from one place, which describe their identity as people of the same origin. Owing to such relationship, people often find themselves going to church to worship their creator, God, together. Religiosity and spirituality defines people’s believes, life, faith, and relationship with God. Therefore, Juhnke & Hadedorn (2013) propose that the use of biopsychosocialspiritual model would incorporate biological, psychological, social, and spiritual domain that assist in assessing and treating patients. The absence of similar religious practices poses a challenge to caregivers because doctors require holistic information in order to provide treatment. In some circumstances, patients believe that God has the ability to heal, therefore, denying doctors the opportunity to carry assessment, diagnosis and treat them. Nonetheless, religious leaders sometimes require counseling before the doctor commences assessment. For example, a pastor would want to share with William some of his past life experiences that altered his behaviors and give him hope of living a normal life again.

Multicultural Theory that Support Therapeutic Approaches

A number of multicultural theories including, but not limited to the multicultural counseling and therapy explains that patients from different ethnic and racial groups may respond to specific cultural counseling. Hays & Erford (2010) assert that multicultural counseling and therapy theory focuses on the development of multicultural environment which assist the therapists to provide adequate treatment based on cultural requirement. Therefore, William being an African America, the theory would help him identify the cultural background and therapy that can be used to treat people from the same culture.

Explanation of APA Codes

American Psychological Association (APA) represented a guideline that contains codes and ethics to be observed when providing therapeutic services. Psychologist should recognize cultural variation across religion and groups and hold positive believes and attitude when interacting with patient (APA, 2011). Therefore, during the therapy with William, he would not be discriminated based on religion, culture, or race, but receive sufficient therapy services as required by the APA code of ethics. Overall, the APA code of ethics requires psychologists to appreciate and recognize the importance of multicultural responsiveness. This knowledge enhances quick delivery of therapy and assessment thereby promoting trust and faith among different people from different cultures. Hays & Erford (2010) assert that appreciation facilitates the establishment of good relation between the patient and doctor which is healthy in health care system. According to APA (2011), psychologists are often encouraged to incorporate cultural skills required to carry out clinical practices. This is important because the process would enable doctors would to address multiculturalism and diversity, a process that is essential in the medical practice. At the same time, it would prevent racial discrimination.

Worldview Conflict and Professional Development

Culture determines people’s actions, behavior, and attitude. Therefore, as a psychologist, there is the need to establish a common ground that provides solutions to issues touching on culture. Many countries across the world attend to people differently based on religion, race, and culture (Hays & Erford, 2010). However, interpersonal and intrapersonal harmony would enable a person to understand different culture. Racial discrimination result from stereotype and negative perception about a given culture. Therefore, in order to develop professionally, health care providers should share culture and positively demonstrate trust, efficiency, and fairness when dealing with another culture. In addition, people should engage in dialogue. This would enable a person to understand cultural differences, which is crucial during medical judgment.

References

Alarco, D. (2009). Culture, cultural factors and psychiatric diagnosis: review and projection. World Psychiatry, 8(3), 131-139.

American Psychological Association (2011). Twelve critical issues for mental health professional working with ethno-culturally diverse populations. Retrieved 12, February, 2014, from, http://www.apa.org/international/pi/2011/10/critical-issues.aspxBrodsky, A. E., & Marx, C. M. (2001), Layers of identity: Multiple psychological senses of community within a community setting. Journal of Community Psychology, 29, 161–178.

Castells, M. (2011). The power of identity: The information age: Economy, society, and culture (Vol. 2). John Wiley & Sons.

Fleury-Steiner, B. (2012). Disposable heroes: The betrayal of African-American veterans. Lanham, MD: Rowman & Littlefield.

Hays, D. G., & Erford, B. T. (2010). Developing multicultural counseling competence: A systems approach. Upper Saddle River, NJ: Pearson Education, Inc.

Hinton, E., & Fenandez-Lewis, R. (2010). The cross-cultural validity of posttraumatic stress disorder: implications for DSM-5. Depression and Anxiety, 1-19.

Juhnke, A. G., & Hagedorn, B. (2013). Counseling addiction families: An integrated assessment and treatment model. New York, NY: Routledge Publisher.

Kaplan, H. I., Sadock, B. J., & Sadock, V. A. (2007). Kaplan and Sadock’s synopsis of psychiatry: Behavioral sciences, clinical psychiatry. Baltimore [etc: Wolters Kluwer Lippincott Williams & Wilkins.

Purnell, L. D. (2013). Transcultural health care: A culturally competent approach. Philadelphia, F.A: Davis.

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