Multicultural Considerations with a Substance Abuse Client Van is a 26-year-old multi heritage male.

Multicultural Considerations with a Substance Abuse Client

Van is a 26-year-old multi heritage male. Over the past 6
months, Van’s use of alcohol and marijuana has increased significantly. His
usage has coincided with his disclosure to his parents that he is gay, which
conflicts with their beliefs and values. He thinks he has let his parents down
and feels depressed and isolated. Van has been attending counseling for the
past month. In this session, the discussion focused on understanding substance
use and cultural expectations.

Counselor: Van, we’ve been talking the last several sessions
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Multicultural Considerations with a Substance Abuse Client

Van is a 26-year-old multi heritage male. Over the past 6
months, Van’s use of alcohol and marijuana has increased significantly. His
usage has coincided with his disclosure to his parents that he is gay, which
conflicts with their beliefs and values. He thinks he has let his parents down
and feels depressed and isolated. Van has been attending counseling for the
past month. In this session, the discussion focused on understanding substance
use and cultural expectations.

Counselor: Van, we’ve been talking the last several sessions
about your coming out process and how this has devastated your parents. You
knew telling your parents that you’re gay was going to be hard, but you didn’t
think it was going to be this painful. They are very angry and disappointed.

Van: I didn’t want to disappoint them, but I couldn’t keep
living this lie. They were pressuring me to settle down, get married, and have
a family. They believe I’m making a choice to be gay as an act of defying them.
The weight of their anger and disappointment sits heavy in my heart.

Counselor: I’m sensing your pain as we talk and the heavy
toll it’s taking on you. Tell me more about your parents’ cultural beliefs
about being gay.

Van: In my culture, being gay has always been viewed as some
sort of defect and has been looked down on. My parents don’t support this
lifestyle and believe it’s sinful. They made it clear that they would never
accept this lifestyle in any of their children. I was always fearful because I
knew I was gay for a long time.

Counselor: You knew deep down that identifying as gay meant
you’d never be accepted by your parents so you turned to alcohol and drugs as a
way to numb the pain.

Van: Well, it’s a lot easier to drink and get high to take
away the pain than to feel it. Yet I still feel it and sometimes it only
magnifies the feelings. Maybe I should just give them what they want because I
see how much it is hurting them and me. It’s so confusing and I don’t know what
to do.

Counselor: You’re questioning yourself and thinking giving
them what they want will make everything better. (Van looks dejected, like he
is feeling lost and confused. It is clear he is struggling with his truth
versus family and cultural expectations.)

Van: Yeah.

Counselor: (Using an advanced empathic statement to make the
implicit message explicit.) Van, as we’ve been talking today and over the last
several sessions, might it be that you can’t accept yourself as a gay man
unless your parents can also accept you in that way? That you have struggled for
a long time with the realization that being true to who you are means
alienating your family? Knowing that you’re disappointing them has led to
alcohol and drugs as a way to numb the pain. Yet the pain never goes away.

Van: (Van sits for several minutes in silence reflecting on
the counselor’s response.) I just wanted the pain to stop, but how can it as
long as I keep denying who I am. I can’t control how they see me, but I can
control how I see myself and how I want to live my life. I’m really tired of feeling
like I have to be something I’m not. I need to find other ways of dealing with
this problem, and I realize using alcohol and drugs is not solving this
problem.

Counselor: You want to be true to yourself and find
healthier ways of dealing with the pain. We can use our time together to
explore what cultural expectations and messages you want to embrace while
finding healthier ways to deal with painful emotions.

A multi culturally competent counselor examines any value
conflicts and biases that arise as the client is telling his story and
addresses them. The counselor also attempts to see the presenting problem from
the client’s worldview. Strategies for change will likely require exploration
and resolution of conflicting cultural messages and healthier ways of coping as
the client moves toward embracing his identity.

Discussion Questions

1. What other strategies for change should be integrated
into the work with Van?

2. How should the counselor go about dealing with the
substance abuse concerns?

3. What other cultural issues do you believe should be
considered and why?

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