The present case study considers the situation of Mrs. H., who appears to have developed an adjustment disorder as a result of a series of negative events, which followed her immigration to the US. Mrs. H. lives with her husband, child, and the elderly mother of Mrs. H. The family struggles to earn money: both Mrs. H. and her husband need to work very hard, and the mother of Mrs. H. tries to take care of the child. However, the senior woman experiences difficulties in caring for the child, and she does not speak English, which makes her very dependent on Mrs. H. Recently, the husband was hit by a car, which severely distressed Mrs. H. Her complaints include headaches, insomnia, and irritability.
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Cross-Cultural Counseling Issues
According to Lee (2014), the understanding of the role of culture in human life is essential for counseling. Diversity is a fact of modern society, which means that counselors need to work with diverse populations, including those that do not share the counselor’s culture. Cultural differences presuppose discrepancies in values, and cross-cultural counseling that is undertaken without due consideration of this factor can introduce bias or even contribute to minorities’ oppression. Bias can result in misunderstandings, and a client can be subjected to the negative experience of working with a culturally insensitive counselor. Both situations prevent counseling from being effective. Therefore, Lee (2014) recommends examining cultural differences, privileges, and one’s bias and stereotypes while being willing to learn from clients about their culture by listening to them and hearing them. Lee (2014) also states that cultural differences do not have to be limited to ethnicity; the counselor of Mrs. H. needs to explore the cultural differences that are related to gender, age, socioeconomic status, and, possibly, other factors.
Adjustment Disorder Opposed to Major Depressive Disorder
Mrs. H. was diagnosed with a subtype of adjustment disorder (AD): AD with mixed anxiety, which is characterized by predominant anxiety. In the case of AD, a person exhibits significant but nonspecific and varied “symptoms of emotional distress or behavioral symptoms” that occur “in response to stressful events” within three months since experiencing these events (Black & Grant, 2014, p. 187). For AD to be diagnosed, the distress of the patient has to be non-proportional to the stressor, which corresponds to the fact that the accident with the husband of Mrs. H. was non-threatening. Also, the symptoms of AD need to disappear within six months after the removal of the stressor; otherwise, the diagnosis will have to be changed. It can be suggested that a key requirement for AD diagnosis is the existence of a stressor.
On the other hand, major depressive disorder (MDD) is not connected to stressors; Black and Grant (2014) warn against mistaking normal reactions to stressors with MDD. MDD is a serious disorder, the emotional and behavioral symptoms of which tend to be persistent and disrupt the lives of patients, including their social and job-related activities (Black & Grant, 2014). Given the recent stressful events in the life of Mrs. H. and her complaints, MDD is unlikely to apply to her case.
Responses to Stressors and Related Factors
The responses to stressors are affected by multiple factors. Anisman (2015) lists age (with youngest and oldest people being more vulnerable) and gender (with the latter supported by conflicting evidence) as two of these factors. Also, the author suggests introducing genetic factors (which can, for example, predispose a person to mental disorders) and personality specifics into the list. Finally, Anisman (2015) also mentions previous stresses, especially focusing on the event when “stress breeds stress” (p. 20). Given the fact that Mrs. H. appears to have been in stressful situations for some time (for example, the need for hard work and the difficulty of providing for the family), this factor might be of importance in her case. Also, Black and Grant (2014) point out that cultural specifics can affect a person’s response. To sum up, a response to a stressor presupposes a combination of multiple factors.
Anisman, H. (2015). Stress and your health. New York, NY: John Wiley & Sons.
Black, D., & Grant, J. (2014). Dsm-5tm guidebook. Washington, US: American Psychiatri Publishing.
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Lee, C. C. (2014). The cross–cultural encounter: Meeting the challenge of culturally competent counselling. In C.C. Lee (Ed.), Multicultural issues in counseling: New approaches to diversity (pp. 13-22). New York, NY: John Wiley & Sons.