736-client presentation_gv
TRANSCRIPT
APRIL MARTIN CHARTRAND,Presenter
The Case of
Gabriel Velez
Norman Meshriy, Instructor| COUN 736 [05] San Francisco State University May 4, 2015 Graphic: April Martin Chartrand – Copyright 2009
Graphics: Google.com and April Martin Chartrand, copyright 2015 2
English
DEMOGRAPHICS & DESCRIPTION
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42 yrs. old vs Cognitive Age | Disability
Single Het. Male
English
Hispanic Cuban Dark-Skin
3rd gen,3rd born
East Bay | Low SES
Supported Living Services
Student: Laney College & SFSU | Unemployed
Finish 18 GE = AS Degree
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Presentation Notes
39 yrs. old | Single heterosexual male | English speaker Dark complexion Hispanic Puerto Rican, 3rd generation, 3rd born male (1st born bother, 2nd born sister) | Born to a Single teenaged mother with an addiction history Developmentally Delayed | Diabetic | Recovering alcoholic Low SES | Lives in the East Bay with the help of Supported Living Services & a case worker Unemployed life-long student @ CCSF & SFSU Certificate in Keyboarding from CCSF – Honor Society Goal: Finish 18 GE units & obtain an AS degree from CCSF then transfer to SFSU Demographics & client description (major, pre-college academic history) (A) Demographics & Client Description I met Gabriel Velez (GV), during my first week in my capacity as a counseling intern and assistant teacher in Mr. Robert Clark’s Psychology 23 class that GV was enrolled in in the Fall of 2014 at City College of San Francisco. Due multiple absences he took an incomplete grade he is repeating the same class for Spring 2015. GV is a single heterosexual male, biological age is 39 yrs. old however due to his difference-in- abilities, at most times has the executive functioning of a 15-20 yrs. old – [my non-scientific observations], is differently abled and has a diagnosis of Developmentally Delayed. As a result of his cognitive challenges, was bullied by family and class mates, and he struggled academically through school in his early years. He has attended two other colleges (did not finish) in the East Bay prior to attending CCSF but was expelled from one of the previous colleges for four years due to engaging in unauthorized student behavior, and. However, he was able to join the honors society once he found several academic mentors and signed up for supportive academic services for students with disabilities at college. GV lives alone in the East Bay with the help of Supported Living Services and a case worker), unemployed life-long student, has a dark complexion, 3rd generation multi-ethnic Hispanic-Puerto Rican, 3rd born male (1st born bother, 2nd born sister), English speaker, lives in the East Bay in a lower-class stratified economic East Bay neighborhood (mainly Hispanic and Latinos), raised by a low-income teenaged single mother (she died in 2003 who had dysfunctional coping mechanisms, drug addiction and went to drug rehabilitation in her later years). GV explained that he grew up in a Catholic household he was very assimilated to the dominate cultures values and social expectations except that he was very intra-extra racist against Latinos (he calls them “illegals” and used the “N-word” a great deal. GV reminded me that he received a certificate in keyboarding, qualified for the Honor’s Society, and aspires to be a rehabilitation counselor. We reviewed his general education plan and GV is currently attempting to complete the remaining 18 units of his City College of San Francisco’s General Education Associates Degree requirements so he can transfer to SFSU and pursue his BA degree in rehabilitation counseling. Outstanding Features: GV spoke honestly about his struggles with being a recovering racist/intra-racist but is unable to fully understand the adverse impact that holding these worldviews has on his over-all cognitive and social maturation.
PRESENTING ISSUES & HISTORY
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1) ‘Counseling Bubbles’ Intervention
2) FLU & Hospital3) Dean of Students
4) DroppingClass
5) 2015 SummerSchool
6) ACA Code of Ethics – A.10.f Receiving Gifts
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Presentation Notes
(b) Presenting issues and history (why did they come to see you?) ‘Counseling Bubbles’ Intervention - empathetic confrontation intervention Serious bronchitis | Kaiser Hospital with dangerously high blood sugar (hyperglycemia) with a Hypertensive urgency Dean of Students dropped the ball on his 2014 complaint Dropping the TAB class at SFSU Intra-Racism: 2015 Summer class at CCSF on Latino/Hispanic History 2015 Summer (B) Presenting Issues & History GV a student at City College of San Francisco (CCSF) and an articulated student at San Francisco State University (SFSU). GV came in to talk to me about six things: (1) First, GV thanked me for helping him with the Counseling Bubbles Intervention - empathetic confrontation intervention (he said that he wrote about me in his academic journal and said that I have been a positive role-model and have taught him a lot of good things that are helping him function socially; (2) Second, GV had been out of school for a month with serious bronchitis (he was still suffering and loss a lot of energy and was not able to keep food down.). Additionally, in January GV ended up at Kaiser Hospital with dangerously high blood sugar (hyperglycemia) with a Hypertensive urgency (Blood pressure was over 250; he was informed that his condition could have led to a diabetic coma, stroke and or worse). GV wanted to know why he keeps going forward in school and then 10 steps backwards; he was concerned that he was “cursed” and that his educational process is taking so long; (3) GV informed me that the Dean of Students dropped the ball on his 2014 complaint against the counselor who yelled at him during the initial 2014 alleged event and then the counselor allegedly threatened him “Snitched need Stiches” when he came into the counseling office in 2015. GV indicated that he felt let-down by CCSF and felt that he had been wronged but was not going to pursue the complaint at a legal level because he is physically and emotionally unable to do so and wanted to focus on his pressing and chronic health issues. He brushed it off and said it was ok (I could tell it was not) and asked him how he really felt about it; (4) Because of his back-to back-illnesses and other emotional difficulties, he is dropping the Tabulation Articulation Bridge class at SFSU and is arranging for an incomplete grade so he can repeat the class next Fall; we looked on SFSU’s website to determine if he would be able to take an incomplete or not; SFSU’s academic policies states he can and GV will contact his instructor to make arrangements; (5) He also informed me that he is attempting to work on his intra-racists attitudes and decided to take a 2015 Summer class at CCSF on Latino/Hispanic History so he gain knowledge, could better understand his biases and confront his ethic miseducation. However, shortly after saying that to me, GV started using the “N-word,” “N-word with an “ish” on the end, and GV came up with a newly reconstituted racial epithet “Blackish.” In his world view, Blackish is a new way of referring to himself and others in a disparaging way. GV explained that this meant = loud talking, low-class, ignorant, and ghetto black person. I engaged in empathic confrontation with him on this matter by asking him, “Why are you making “Blackish” a term that is used to denote ethnic pride, and making it into to a racial slur. Remember the assignment you did in our Ethic Relations Class on the etymologies of racial slurs and on stopping the usage of racial slurs?” He dismissed my question and made up some excuse and changed the subject; (6) GV asked me about the department’s policy on gift-giving (American Counseling Association (ACA) Code of Ethics – A.10.f Receiving Gifts). GV wanted to express his appreciation for my counseling help for the year and said he was going to miss my counseling support when the semester was over. He wanted to know if I would accept a $20- thank you gift certificate from Starbucks at the end of the semester. According to the ACA’s Code of Ethics, it states, from a cultural perspective, that I must ask the client what is the meaning of gift, determine our department has a policy against small gifts of appreciation, if it is culturally appropriate, and if it does not cause undue financial burden on the client. I discussed all of the above items and he appeared to be genuine in his wanting to express some type of appreciation at the end of the semester.
CURRENT LEVEL OF FUNCTIONING
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Extended Illness
HighlandHospital
Cognitive Impediments
Disabled Student
Honor Society
Laney class ‘C’ grade SFSU ‘D’ grade
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(c) Current level of functioning (how are they dealing with their current situation? – this does not have to be considered from DSM standards) Been out of school for a month with serious bronchitis | low energy | not keeping food down | diabetic complications Kaiser Hospital with dangerously high blood sugar (hyperglycemia) with Hypertensive urgency Legally disabled (developmentally delayed), has a fiscal custodian Registered with the DSPS at City College of San Francisco Honor Society but has Falling grades ‘C’ grade on his midterm in Phycology 23 asked to drop the SFSU TAB class ‘D’ grade and ask for an incomplete grade and retake it in the Fall (C) Current Level of Functioning & Risk Factors GV had been out of school for a month with serious bronchitis (he was still suffering and has loss a lot of energy, his has a hard time talking, and was not able to keep food down. Additionally, in January GV ended up at Kaiser Hospital with dangerously high blood sugar (hyperglycemia) with Hypertensive urgency (blood pressure was over 250); GV was informed that his condition could have led to a heart attack, diabetic coma or a stroke. GV is legally disabled (developmentally delayed), has a fiscal custodian, has a social service case manager and is register with a Supported Living Services (SLS) organization which offers SLS to people who choose to live in their own home within the community, yet require increased support systems to reach their potential for independence. GV is registered with the DSPS at City College of San Francisco. GV reported that he is still recovering from the emotional fall-out from 2014 legal issues which were brought on by Latin neighbors who accused him of harassment (charges dropped). As a result of the situation he began view all Latinos in a very negative way. He indicated that his world view was tainted by the past legal encounter and recognizes the error in his thinking process, yet has to put more work into his emotional recovery. He received a C grade on his midterm in Phycology 23 and has been asked to drop the SFSU TAB Classs and get an incomplete current grade is a D.
MULTICULTURAL CONSIDERATIONS
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Hispanic Macho Male Ideology
RecoveringSubstance Abuse
Intra-Racism
HighCrime &Gang Activity
Social Trauma PTSD | Depression
Hip Hop/Rap& Hard Rock
Apple Technology AgeResilience
2010 RIP Mother
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6d) Multicultural Considerations (important cultural markers – also consider how they may differ from your own lived experience) Traditional Hispanic macho male ideology| recovering alcoholic Shadism/colorism | Racism | We are recipients of Americans structural racism and social hierarchies Low SES, high crime, prolific gang activity is a key factor, violence, and safety issues Police harassment of Brown and Black men in his City Disability Social trauma can impact the neurological processing Age difference = age of technology, hip hop, SF Giants Fan vs my Royal Electric Typewriters and classical music, Girls Scouts and knitting lessons STRENGTHS: I admire his resilience and his ability to tap into and find the support and systems that keep him functioning and positively contributing to his self-esteem. I love that he made the Honor Society a few semester’s back. ) (D) Multicultural Considerations: GV is a recovering alcoholic and has found his “higher power” and still appreciates his Catholic religious background, maintains a traditional macho male ideology, is a recovering bigot and intra-cultural bigot who views Latinos (South American) as illegals and was very judgmental (shadism/colorism), raised by single teenaged mother who supported him the best she could and was not a bigot. GV struggles with the 2003 passing his mother, misses her (sees her spirit in his home and talks to her all the time), struggles with mental demons, and was an older teenager when the technology boom started and now he is an I-phone fan and a bit fan of the SF Giants. On the other hand, I grew up with manual typewriters and cell phones had not been invented yet. In many ways as a women of color, single-mom (poor) household, as a recipient of the American structural and social racism which includes American Apartheid aka Slavery/Jim Crow systems, dangerous Klu Klux Klan experiences, Microagression (overt/covert), I can related to the structural racism mindset that is engrained in GV’s lived experience. These lived experiences are an impediment in overcoming his challenges due to the continued onslaught of racism and the targeting of Brown of Black men in USA and also in the town that he lives in. Additionally, gang violence is a key factor in his neighborhood and town. I am of Native American (Cherokee), Irish, and Bantu-African heritage, I can directly relate to GV’s home life given that my home life was dysfunctional, low-income, violent, and experienced severe parental neglect. I also understand that these social trauma can impact the neurological processing of the brain in negative patterns are become fixed in the firing mechanisms if not challenged and replaced with positive ways of functioning. However, I have found the narrative/sociocultural approach is effective in supporting and uplifting my client during his recovery phase so that he can stay in school (many teachers have allowed him to take an incomplete and or reinstated him so he could continue). I do admire his resilience and his ability to tap into and find the support and systems that keep him functioning and positively contributing to his self-esteem.
Resilienc
CLIENT CONCEPTUALIZATION
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Intra-ethic antagonism
Socialconditioning
Summerclass
Doctor’sorders
Check-in
Positive Asset Inventory
Resiliency
Infectious
Kind-hearted
Donates to those in need
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Presentation Notes
(f) Client conceptualization (speak here to how you truly understand the client’s needs and what you expect/hope to be potential outcomes) Social Justice, ethnicity, racism, intra-ethic antagonism (internalized superiority by Puerto Ricans) is a major part of GV’s social conditioning Will take a Summer class on Latin/Hispanic History - see his own intra-ethnic biases Take rest of the semester is to take care of his health, follow the and check in with his care-team CCSF counselors weekly to make sure he is doing his assignments and follow up with the administrative issues with his academic incompletes Positive Asset Inventory: Resiliency Infectious personality Kind-hearted and is very resourceful | Great Networker Ability to think deeply when he is given a challenge Donates food to those in dire need (F) Client conceptualization: Social Justice, ethnicity, racism, intra-ethic antagonism (internalized superiority by Puerto Ricans) is a major part of GV’s social conditioning. GV is taking the lead (autonomy) on his emotional and academic process in the areas of his own racial bias and his feeling of superiority because he is Puerto Rican. GV said he will take a Summer class on Latin/Hispanic History so he can see his own intra-ethnic biases. He said that his homework for the rest of the semester is to take care of his health, follow the doctors’ orders, and check in with his care-team, and the CCSF counselors weekly to make sure he is doing his assignments and follow up with the administrative issues with his academic incompletes. GV is having a tough time with his food management which adversely impacts his severe diabetic symptoms. So, he promised to follow the doctors’ orders so he does not get sick again and have to miss school. Positive asset inventory: (1) His passion for academic achievement is very impressive and his ability to continue to forge forward after many health-related setbacks is a testament to his resiliency. (2) He is function well, he responsible and follows-up with his promises by calling in and letting the instructors know if he needs support or accommodations. (3) He has an infectious personality and is very easy to talk to and is well liked with his peers. (4) He is very kind-hearted and is very resourceful and has a knack of finding where to get what he needs met and is a determined self-starter and seeks out mentors to help who help him in his academic progress. (5) GV has the ability to think deeply when he is given a challenge and given creative prompts to help his cognitive process along. (6) GV gives back to the community anonymously by donating food to those in dire need.
TREATMENT & GOALS
SILENCE IS GOLDEN
CounselingBubblesSilence is
GoldenCommunityStar
Empathetic Intervention
IntentionalDreaming
Stay in School
HealthChallenges
Harding’s (2013) Research
EcologicalContext
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G (a) Course of treatment & goals Make sure GV stays in school and maintains his acute health routines, remains healthy emotionally, and heals Ongoing reminders of how to maintain proper social engagement boundaries with counselors and classmates Narrative and empathic confrontational interventions: “Community Star” (community genome-narrative), “Silence is Golden,” “Counseling Bubble” (empathetic intervention), and “Intentional Dreaming.” Harding (2013) Wounds Race Related Trauma intervention. Struggled with equity issues, racism, low social economic status, and disability ‘Grounding Work’ intervention (G) Course of Treatment & Goals: The overall goal is too made sure that GV stays in school and maintains his acute health challenges and remain healthy emotionally and heals. GV will benifit if from ongoing reminders of how to maintain proper social engagement boundaries with counselors and classmates. He has a tendency to engage in inappropriate conversations and actions. For example, when I was talking to him in the hall way in-between classes, he told me a story about his person life and gestured me in an offensive sexist matter “gave me the finger” and used the N-Word quite a lot. In addition the narrative and empathic confrontational interventions that I have employed such as - “Silence is Golden,” “Counseling Bubble” (empathetic intervention), and “Community Star” (community genome-narrative) interventions, I will employ a culturally relative a transpersonal intervention entitled “intentional dreaming.” GV said he wishes to talk about dream interpretation because he dreams about his mother all the time and talks to her and she is sending him messages in his dreams of her and wants to understand them more. Since I have some background in “intentional dreaming,” he asked about intentional dreams and I gave him information on intentional dreaming. Also, in consideration of how GV’s presenting issue(s) fit within social, ecological context of his life GV has surely struggled with equity issues, racism, low social economic status, and disability. Harding’s (2013) research offers new language for counselors to be aware of which consist of three race-related trauma and schemas that contribute to the unresolved and unaddressed “wounds race related trauma” are as follows: (1) Internalized devaluation = “direct byproduct of racism, inextricable linked to the deification of whiteness and demonization of non-white hues”; (2) Assaulted sense of self = “culmination of recurring experiences with internalized devaluation” (3) Internalized voicelessness – “erodes the ability to defend against a barrage of unwelcomed and unjustified negative, debilitating messages” (pp. 27-28). My suggestion to a new counselor is to employ the following techniques when working with GV who freely expresses biased or prejudiced beliefs: Acknowledge the GV’s history, their experiences. Express appreciation for GV’s short forthcomings or his world view. Take on a non-judgmental empathic connection (no 2x4 hit over the head). Take the implicit bias test first at https://implicit.harvard.edu/implicit/takeatest.html. Look deeply at your own biases after taking the implied bias test and see if you can see. yourself in GV? From this, test you might come to the conclusion that we are all. recovering from some form of microaggression, biases, and prejudices. From this develop a broad knowledge base then develop culturally specific grounded. Social cultural treatments will be employed to support the GV with his concern about his emotional health recovery, helping with new tools to combat his PTSD/depression, and support him in maintaining ties with his spiritual community and serve as an academic support system. I will employ here-and-now coping tools (mindfulness) so he can utilized them in his growing coping tool-box. One tool that I introduced to GV in our 2014/2015 session was “Grounding Work.” Grounding is the process actively noticing the here and now and being in the present moment e.g. breathing deeply, noticing any physiological responses, then ask “What time is it?, Where am I?, and notice that he is in the present moment.
COURSE OF TREATMENT & GOALS
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G (b) Course of treatment & goals Counseling Bubble
2 QUESTIONS FOR YOU!
What types of cognitive counseling interventions would you employ in working with a cognitively disabled adult?
What types of empathetic counseling interventions would you employ in working with a cognitively disabled intra-racist Hispanic male who perpetually engages in racist self-judgements and racist and sexist judgements of others?
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(h) Questions (pose 2 questions to the group that would help with your work and/or your understanding of this client and/or clinical issue) What types of cognitive counseling interventions would you employ in working with a developmentally delayed disabled adult? What types of empathetic counseling interventions would you employ in working with a developmentally disabled intra-racist Hispanic male who perpetually engages in racist self-judgements and racist and sexist judgements of others?
REFERENCES
Gardiner, H. W., & Kosmitzki, C. (2008). Lives across cultures: Cross-cultural human development (4th ed.). Boston, MA: Pearson.
Google.comHardy, K. V. (2013). Healing the hidden wounds of racial trauma.
Reclaiming Children and Youth, 22(1), 24-28.
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