Counselling

11 November 2018

    A counselling case study which considers sociocultural issues.
    This essay is going to be looking at a fictional case study of a client, who is struggling with fear and sadness, from a counsellor’s perspective. The case study will focus on sociocultural issues such as culture, gender, race and sexuality and then I will consider how these sociocultural issues may be part of the reason for the client’s distress and how important it is to address these issues in order to help the client overcome the fear and sadness they are experiencing. The core sociocultural issues this case study focuses on are gender, sexuality and race and culture. The main counselling approach used is the person-centred therapy and the case study is based on 22-year-old woman who is transgender who is mixed raced and suffering with major anxiety and panic attacks.
    Joanne is a 22-year-old mixed race woman living in Manchester, she moved to Manchester with her parents when she was 16, she previously lived in Sussex when her father received a promotion which meant them moving to a new city. Joanne is from an upper-class family and she works in the family business of lawyers working as an assistant training to become a lawyer.
    When Joanne was 18 years old she realised that she was not comfortable in her own body, previously a male named joseph, Joanne always felt like she was a woman trapped inside a man’s body. After a lot of research on the internet and talking to people in the LGBT community for advice Joanne decided that becoming transgender was the right decision for her, she started taking hormone therapy just before her 19th birthday and is due to undergo the surgery in a few months.
    Joanne said her parents (Father English, Mother African) were surprisingly supportive of her decision and her mother even said she knew from an early age she was different as she use to dress up in her mother’s clothes and wear makeup. None of the family follow a religion and Joanne’s parents accepted her as a female and have helped her through the transition.
    Joanne came to therapy by self-referral as she was struggling with major anxiety and trouble leaving the house which resulted in panic attacks. She said people stare at her when she goes out and some people shout things at her because she is transgender which makes her paranoid and anxious. Joanne feels that things wouldn’t be as bad if she was white but due to being mixed race transgender she feels like an outsider and people are very stereotypical towards her. Joanne has said she doesn’t feel like she fits in anywhere not even at her family business and has attended therapy to seek help for this anxiety and insecurity. The approach used when working with Joanne was the person-centred therapy and she was happy to try this as it was a lot more open minded and client focuses than other approaches (Barker, 2010).
    In our society there are attitudes towards gender, sexuality, race, class and much more to what is normal and what is ‘other’. For example, you wouldn’t expect to hear someone asking a man why he is working whilst his wife stays home to care for the children but you would expect to hear it if it was the other way around (Barker, 2010). You are considered ‘normal’ and have more authority if you are white, male, straight, cisgender, able-bodied, middle/upper-class but anything else is considered to be out of the ‘norm’. Barker (2010) states that if we are part of the normal category we tend to forget that part of our identity but when we are in the ‘other’ group we may be a lot more aware of it.
    We live in world where stereotyping isn’t uncommon and certain sociocultural issues are expected to be met if we are to be accepted and treated as an equal, this is obviously not as easy as it may sound and is not possible for everyone to achieve. It has been argued by multicultural, feminists and LGBT affirmative therapists that ‘normal’ categories are incorporated into mainstream therapy and many major theories came from white, western, heterosexual men (Barker, 2010), it has also been pointed out that the majority of counsellors are white, heterosexual, middle/upper-class women. When someone out of the norm attends a counselling session how easy is it to treat the client as an equal and to see past the sociocultural issues? Although it can be argued that there are still multicultural, LGBT and feminist style therapies these aren’t easy to come by and clients still do not feel like they’re getting the help they need because they are not in the ‘normal’ category (Barker, 2010).
    For example, a transgender, such as Joanne, will get asked questions about her decision and why she chose to switch genders where as a Cisgender wouldn’t get asked such questions. Or a lesbian/gay people will get asked questions about their sexuality but it wouldn’t be expected for a straight person.
    With Joanne being mixed-race she was discriminated for her skin colour from both white and black people, this was a key issue she had growing up and with it being from both sides this made her feel even more isolated, upset and excluded. it has been proven that black and minority ethic people are more likely to suffer from severe mental health problems as opposed to white people (barker, 2010). Just like in excerpt 15 of the D240 module material where Mrisi tells us the new people that he meets always expect him to be troubled and a “bad boy” because of his skin colour and he thinks there is a big problem with racism (The Open University, 2017). Growing up mixed-race has been known to be difficult and there are studies relating to depression and skin colour, there has been said to be little to no support for individuals in the mixed-race community which will, of course, make it difficult to confide in someone especially a stranger about their struggles as they will feel no one fully understands.
    As well as race another sociocultural issue that is related to Joanne is her gender. Joanne felt trapped inside a man’s body and she felt as if something was stopping her from being herself, Joanne decided the transition from male to female including hormone therapy and having the operation was the only option for her. Unfortunately, society still believes it is wrong to be a transgender and you are born with your given gender that you must accept and live with for the rest of your life, this however is not how everyone thinks and there are many individuals that accept and understand the transgender community but a big part of humanity isn’t as understanding and are what is known as transphobic. Many people feel that they do not belong to just one gender and they will show both feminine and masculine qualities, for example, not all women want to wear pink flowery dresses they may feel more comfortable in jeans and a t-shirt which challengers the extent of what is femininity and masculinity and where is the line supposed to be drawn (Barker, 2010).People may also question age in relation to gender for example, Joanne only being 22 is told that she is going through a phase that she will grow out of, this is not always the case. When working with a client who questions their gender it is always a good idea to keep this thought in mind and consider how, in some ways, we all have transgender mannerisms. It is also appropriate to not assume the client is at therapy because they are transgender but it is useful to be aware of it and contemplate the problems they may have because of gender related matters (Barker, 2010).
    Although Joanne does not identify herself as gay people do question her sexuality because of her gender. We live in a very ‘heteronormative’ world where being heterosexual is normal and expected where as being anything other than heterosexual, gay, lesbian, bisexual or even A-sexual for example, is seen to be wrong and in some countries, it is thought to be a criminal act and the death penalty is acceptable for such activities (Barker, 2010). People automatically assume a transgender is homosexual which is not always the case, Joanne identifies herself as straight because she likes men, this may be confusing to some people because she was previously male but now that she has become women she is essentially attracted to the opposite gender. When working with such a client it is important to keep an open mind and understand the clients point of view.
    I would put Joanne’s interests first and give her one of two options in which way and what setting we could work with, the first being a one to one setting where I would work directly with Joanne and only her. The second option would be after two or three one to one sessions to get explore Joanne’s main concerns to work with Joanne in a group setting which would involve a mixture of men and women who are facing similar issues to Joanne. A group setting would be ideal for this client because she will know she is not alone and there are others like her that are with her to support and be familiar with how she is feeling. Although a group setting is the desired approach Joanne may feel unnerved with this option and may decide to stay with the one to one sessions which is completely fine because I want her to feel comfortable and trust me as a therapist and later on in the sessions she may feel willing trying a group setting.
    Whichever option Joanne chose I would use the person-centred approach when working with her, this will ensure that as a therapist I am non-judgmental and human, rather than being the ‘expert’ I would show the client that I am willing learn and grow with them (Dykes, 2010). Instead of working with a set technique the person-centred approach is about learning new techniques and working with the present, this will allow Joanne to explore herself and accept who she is as a person, whilst the therapist, myself, is completely transparent and open minded to her situation. I would start by building a rapport and allowing Joanne time to gain my trust and to get to know her better. I would ask her questions such as “what brings you here today?”, “what goals would you like to achieve throughout therapy sessions?” and a brief explanation of what her daily routines involve and things she avoids because of her fear and sadness, which will give me an understanding of what areas we need to work on. I would let Joanne know in our first session which approach I will be using and explain how and why this approach will be suitable for her.
    The Humanistic approaches draw from the ideas and values of ‘humanistic psychology’ which is also known as the ‘third force’ because of how it developed as a reaction against two mid-twentieth century psychologies, behaviourism and psychoanalysis, and their theories of seeing humans as machines and in the grasp of unconscious urges (Dykes, 2010). Using the person-centred approach will allow Joanne to see me as an equal rather than a professional which will grant a strong relationship and effective results when working with her.
    In conclusion, this assignment has provided a fictional case study on a 22-year-old mixed-race, transgender woman and has outlined how sociocultural issues have affected her and how she lives life because of the. It was believed that the person-centred approach would be best suited for a client of this description because of its understanding nature and the way it treats everyone as an equal rather than an outsider which is how Joanne has felt for all her life so this would be a refreshing change for her. This also gave me room to think about the social context of the client and the relevant sociocultural issues related to them. We have reflected on how sociocultural issues can relate to a client and how it affects their personal life and how to be mindful of these issues whilst working with the client which is an important aspect to consider when working with any client.
    References
    Barker, M. (2010) ‘Sociocultural issues’ in Barker, M. Vossler, A. and Langdridge, D. (eds) Understanding counselling and psychotherapy, Milton Keynes, The Open University. PP. 211-233.
    Dykes, B. F. (2010) ‘Humanistic approaches’ in Barker, M. Vossler, A. and Langdridge, D. (eds) Understanding counselling and psychotherapy, Milton Keynes, The Open University.
    The Open University (2017) ‘Sociocultural counselling in action (part 1)’

    D240 Counselling: exploring fear and sadness. Available at https://learn2.open.ac.uk/mod/oucontent/view.php?id=1053402;section=1.3 (Accessed 27/02/2018)
    Self-reflection
    In this assignment I found it interesting to explore how sociocultural issues effect people in everyday situations and how these issues affect mental health. I found deciding which approach to use difficult because I wanted to make sure it was the best suited for the client in question. (48)

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