Theoretical Orientation with a Case Study

Table of Content

She as been married to Richard for nine years, and regularly attends a Christian-based community church. Richard is a 30 year-old African American male who presents with a casual appearance. He is a high school graduate who has been in the work force for 10 years as a cable television installer. Richard comes from a single parent household. He was raised by his mother, and has two older brothers. Richards father has never participated in his upbringing. He has been married for nine years, and attends church every Sunday with his wife.

Presenting Problem The couple was referred by a friend after learning that progress had stalled with heir previous therapist. The couple initiated and entered therapy to navigate the challenges of their relationship. After two months of weekly sessions, the couple abandoned therapy due to what they deemed “a lack of results”. During the telephone intake and subsequent intake session, Danville and Richard report that they have been experiencing an inability to communicate without conflict, having difficulty agreeing on financial issues, and have declined in both verbal and physical intimacy.

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Danville reports that her marriage is deteriorating rapidly. She is no longer blew to communicate with Richard without it ending in an argument or having him walk away in frustration. She wants him to understand her concerns about their financial future and his inability to advance at work. She relates a lack of ambition and effort to get ahead on his part and believes he does Just enough to get by. She wants Richard to “step up and be the kind of provider she is used to. ” Danville reports that Richard is too dependent on his mother and brothers, and says that he prefers to spend time with them over her.

In addition, she says she is “sick and tired f his family knowing all their business,” and doesn’t trust him anymore with their “secrets. ” Richard claims Danville is turning into her mother. “She has something to say about everything. ” He reports that she is constantly nagging and criticizing him, and is only concerned about him making money and getting promotions so they can look good. Richard says Danville is unsupported and often disrespectful. He states that “she needs to recognize that she has a good man or someone else will. ” Richard relates that Danville is no longer interested in sex and has become cold.

Richard ascribes his mother and brothers as an “outlet” for the pressures at home and word He is loyal to his family, sees nothing wrong with their relationship, and relates that they are “grateful” to have him around. Psychosocial History Danville comes from an intact family. Her parents are still married and live locally. Her father is a dominant personality whose main roles include provider, problem- solver and motivator. Danville claims her feelings of security always came from her father. He is college educated, has been self-employed for 20 years, and has strong values rooted in hard work and traditional gender roles.

Daniels mother is also college educated. She is a retired elementary school teacher who Danville describes as having balanced family responsibilities with active social affiliations. Her mother conforms to traditional gender roles and takes pride in her family’s dynamic as well as their financial success and social standing. Daniels childhood was unremarkable. She reports to having a “normal childhood” compared to many of her friends. She describes her home environment as very stable. As an only child, “she has always felt older than her years. ” The rules in the home were made by her father ND gently carried out by her mother.

Danville reports that education was a priority and high performance in general was expected. She did very well academically, graduating with honors from high school and college. Danville says that accomplishments were regularly rewarded to her and her mother with “tokens of love” from her father. The client says she is “comfortable using the word ‘indulgent’ t describe her family’s lifestyle. Danville claims to be well-respected in her work environment, and spends most of her social time with a few close friends from college. Richard portrays his childhood as loving, but complicated. He describes his mother as strict but nurturing.

Richard says that her role was multidimensional including sole provider, emotional caregiver and confidant. He reports that she always worked two Jobs, and consequently, he and his brothers managed household responsibilities and routine decision-making. His relationship with his brothers has always been solid. Richard reports that the family had ongoing financial struggles. H recalls being very aware of money matters and knowing “exactly when the rent was due. ” The client describes a general feeling of “uncertainty’ during his youth due to he “unwanted and random” appearances of his father and the emotional strains of “doing without”.

Richard claims to have been an average student. Education was emphasized in the home, but financial pressures compelled him to seek employment directly out of high school. Richard reports to being very involved with his mother and brothers as well as a large extended family that includes relatives and lifelong friends from his childhood community. The couple met through mutual friends and was married less than two years later. Prior to getting married, Danville had one long-standing relationship that ended unpleasantly. Richard describes several previous relationships he characterizes as casual.

The Client Perspective Danville and Richard Johnson are of African descent, yet living in America. In this, is a constant struggle, sometimes consciously, to address both components of one’s self. The African mind is one of community and interdependence, spirituality, divination, and harmony which conflicts with the Resurrection podium placing independence, social mobility, and mastery at its pinnacle. The external world causes stresses upon the African American individual that tends to infuse the African American family unit, which can ultimately result in a familial crisis.

This crisis is best explicated when understanding the tug of war that both the African American male and their African American counterpart engage in during their daily life, and the tension created once that is brought home and inappropriately displaced upon one another. The tension of not knowing one’s self, not knowing the values to abide to or heed, and not knowing how to initially act or consequently react in society wholly, is feeding into the unhealthy marriage that the couple is experiencing. Addressing Cultural Issues

When diagnosing strictly from a Western psychology perspective, the couple might be diagnosed as having a V-code pertaining to “Partner Relational Problems”. The therapist would then employ an intervention that focuses on aiding their basic communication pitfalls. Our therapist is utilizing these skills as simply an initial symptom relief, helping them to truly listen to one another instead of merely hearing. Yet, when looking at our couple in particular, and realizing the external pressures which are creating the disengagement between the two, it becomes important to look at the bigger picture.

If basic communication were addressed solely, this couple would again return to this place of bickering and misunderstandings, and if a repetitive cycle is induced a divorce is likely to transpire. Thus, the question of why our clients do not understand one another must be asked so that the real therapy can begin. The therapist will use a modified Western orientation of Cognitive Behavioral Therapy to encompass an African-centered foundation.

A completely conventional treatment would not address the cultural background of our couple and their unconventional needs. A culturally specific treatment would not value the fact hat our couple lives and deals with a pervasive, Resurrection world that is presented to them day by day from the time they wake up until they lay their heads on their pillows at night. Thus, the cognitive behavioral theory will work to change the maladaptive thinking patterns that are causing the negative emotions in their marriage.

Through homework and validity testing the couple will be able to recognize that most of their troubles are not with each other specifically, and begin to work on their displacement of feeling and how it affects their emotional state when with thee spouse. Both orientations resolve with cognitive restructuring whereby CAB seeks to replace their maladaptive thoughts that are distressing them in their marriage by understanding their true origin, and African-centered which helps them move outside of themselves and explore the reasons why these external pressures are so debilitating for them.

Alternative Conceptualizations of Distress It must be understood that distress can be culturally defined. In a Resurrection view, dependency upon others is irrefutably the downfall of man. Man is to rise up and create a sense of independent self, stand on their own two feet, control nature, be operate, strive for individual rights, and master the world in order to defer distress. In the Afro-centric view, dependency is the epitome of what makes man. Man is to rise up toward a higher being, be interconnected, heed nature, strive for communality, and balance the world in order to defer distress.

Thus, when conceptualizing our clients we must understand that their association with both of these worlds is likely the cause of their distress. The same can be stated of their gender roles. In the Resurrection worldview gender is generally a biological sex typing hereby females are generally described as emotional and weak and yet, African American women are described as less emotional with more power motives than their Caucasian counterparts. The opposite is described of males, the Caucasian male is domineering and driven, and the African American male is lazy and reckless.

Therefore, the therapist, being able to understand the client’s background, and taking their culture into consideration will more readily make them able to validly assess them. For our couple, the distress in their marriage generally breaks down to communication problems. This even differs amongst cultures. African Americans are high context speakers which are relying a great deal on non-verbal gestures, facial expressions, body language, and symbolic speech in order to communicate.

Often, non-verbal communication can be misconstrued and create argumentative behavior that was not intended. In short, the distress of the couple must be evaluated both externally and internally regarding the relationship realizing that there is no solitary way to analyze the distress they are having. Modification of Treatment Conventional treatments such as Humanistic, Existentialism, Behavioral, Cognitive, Psychoanalytic, Systemic, etc. Al hold a very valid place in contemporary psychology.

They have all been irrefutably utilized as a method of treatment, and all have proponents that testify to their worth and efficiency. Yet, these models do not necessarily reflect contemporary society wholly. Society is composed of persons descending from all parts of Europe, Africa, Asia, Latin America and many people directly reflect more than one of these areas in their heritage. The cultural background is necessary to heed in order to effectively implement therapy because people’s ideals, belief systems, experiences, and therefore understandings are impressed upon by their cultural makeup.

These theories do not take those facts into account, and therefore to be effective, especially when working with a population from the out-group, or minority population, a different construction must be created Cognitive Behavioral Therapy was chosen to address the client’s need for a rapid change in their marital environment, to work in the present, to recognize and confront their cognitions about society, and for its belief in the strength of the therapeutic relationship.

The African-centered therapy will serve them by realizing he strengths in themselves and each other, to address their definition and expectations of marriage, gender roles, to further empower themselves so that they can become aware of their displacement and its ill-fated transition on their spouse, and to combine the psyche with the spirit as it was done in their ancestry. Benefits Modifying the treatment opens up many doors of progress for the client. The client is no longer put into a box to question themselves in one light.

This combined orientation allows them to come to terms with how their marriage is affecting them ND how they can use their marriage as a comforting mechanism, instead of another oppressor. Obstacles and Limitations Implementing this theory can also be somewhat difficult. Some obstacles may include a client who rejects their blackness and is completely withdrawn from their black heritage and experience. This may be countered by being an active listener and listening not only to what is being said, but also what is not being said.

The treatment itself should begin to function as a way to help the clients understand the confusion in their lives, and find what they believe to be the attribution. It is not plausible that every African American can be helped with African-centered techniques. Yet, it is also important to be aware of the client’s need to feel acculturated to the point of having no roots or ties to Africa and to see how that may be playing into their psychological and emotional state, as well as their disengagement with their spouse.

Another client may feel that the spiritual undertone of the African-centered is overbearing, whereby they may not understand the distinction between spirituality and religiosity, may not be willing to undertake spirituality in their lives, or may not ay not see the connection that the theory draws between the spirit and the psyche, as well as the physical self. The African-centered foundation of Cognitive Behavioral Therapy will be able to help the couple identify the residual values from Africa within their personality and provide a sense of strength and resiliency in the face of external pressures.

This requires the couple to “begin at the beginning” and to accept wisdom from their ancestors, elders, and community. The African-centered orientation functions as a framework in order to best address their cultural background, one of the most essential aspects being its spiritual element. The Africans sense of self is the union between the physical, mental, and spiritual. It is expected that if their spiritual self is not fully addressed, they will experience hardship in both their physical and mental selves because they are no longer balanced.

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Theoretical Orientation with a Case Study. (2018, Feb 06). Retrieved from

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