Cultural Factors and Legal and Ethical Issues in Pharmacology
Responses must be 2 pages in length per case.
Entire assignment must be 6 pages plus a title and reference page.
Please do not include the prompts in the pages; the responses need to be 2 pages in lenght
Considering the indicated symptoms for all three cases below you are required to:
1. Discuss case-specific cultural factors as well as legal and ethical issues
2. Indicate the possible etiologies in a general way and the steps you would take to diagnose, treat, and manage these cases, with consideration of pharmacological intervention
3. Write from the standpoint of a clinical psychotherapist who does not prescribe medication, but coordinates care with physicians who do.
4. Include 4 references per case
Case Studies: Respond to all three (3):
1. Bob is a 47-year-old Native American man who comes to you with his wife of 15 years. He appears agitated and complains that he feels anxious. His wife reports that Bob has had a lot of trouble sitting still, frequently jumping up and pacing. While he has been this way throughout their marriage, it is getting increasingly worse. Bob tells you that he is a lot like his abusive father, who died of alcoholism. Bob feels that if he drank, he’d be able to relax, but swore he would never be like his father. The wife tells you that the children are frightened when Bob gets agitated as he has punched holes in walls. You notice the wife looks frightened when you ask her if she feels the children are safe in the home. Discuss case-specific cultural factors as well as legal and ethical issues.
2. Steven is a 7-year-old Korean American first grade student brought to treatment by his mother. He has been disruptive in class. His teacher and the school counselor are strongly urging that Steven be put on medication for ADHD, but his mother is reluctant to do so. Steven is described as exceptionally gifted and appears bored in the classroom. His mother tells you that Steven is impatient and rageful to his younger sisters at home. She is afraid Steven is taking after his abusive father, who no longer lives in the home due to domestic violence. She tells you that their father is allowed to visit the children in the home under her supervision discuss case-specific cultural factors as well as legal and ethical issues.
3. Melinda is an exceptionally bright, 17-year-old African American young woman, in her first year at a state college. Both parents accompany her to your office. When she came home for spring break, she started talking nonsense, saying that the college’s biology department is using a high-powered laser to alter the DNA in her brain. She has always been an “A” student and has never shown any sign of psychiatric disturbance prior to this. Discuss case-specific cultural factors as well as legal and ethical issues.
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Question 1
As a clinical psychotherapist working with Bob, a 47-year-old Native American man, and his wife, it is essential to consider cultural factors affecting his mental health and help-seeking behaviours. Native American culture has a unique worldview and traditional healing practices based on the interconnectedness of mind, body, and spirit (Redvers & Blondin, 2020). However, Native Americans may also have experienced historical trauma, such as forced relocation or boarding school, which can impact their sense of identity, self-worth, and trust in healthcare providers (Wiechelt et al., 2019). Therefore, it is essential to incorporate cultural sensitivity and humility in the therapeutic relationship, to respect and validate their cultural beliefs and values, and to address any barriers or disparities in accessing mental health services.
Bob presents symptoms of anxiety and restlessness, which have been present for most of his adult life and have worsened over time. He also has a history of trauma and substance use in his family, which may have contributed to his sense of inadequacy and self-blame. Bob needs a comprehensive assessment to diagnose and treat his symptoms, including a clinical interview, mental status exam, and symptom checklists. It is also essential to gather collateral information from his wife and children and assess his cultural and spiritual dimensions of health. It can help to identify any underlying mental health disorders and tailor the treatment plan accordingly.
As a non-prescribing therapist, the role is to provide evidence-based psychotherapies to help Bob address his psychological needs and improve his coping skills. Cognitive-behavioral therapy (CBT) is a practical approach for anxiety disorders, which focuses on identifying and challenging negative thoughts and beliefs and developing more adaptive coping strategies. It can also help Bob to recognize and address his cognitive distortions, such as the belief that he is like his abusive father, and improve his self-esteem and self-efficacy (Goger & Weersing, 2022). Mindfulness-based stress reduction (MBSR) is another practical approach to anxiety, which involves practicing mindfulness meditation and body awareness to reduce stress and improve well-being (Li & Bressington, 2019). MBSR can also help Bob develop a greater sense of acceptance and compassion for himself and others, enhancing his interpersonal relationships and reducing conflict.
In addition to psychotherapy, it is important to involve family members, such as Bob’s wife and children, in the treatment process to provide education and support and to address any family dynamics that may contribute to Bob’s symptoms (Goger & Weersing, 2022). The wife reports that the children are frightened when Bob gets agitated and punches holes in walls. This behavior can be intimidating and threatening to the children and may contribute to their insecurity and fear. Therefore, it is essential to address the children’s safety and well-being and provide them with age-appropriate information and coping strategies. Family therapy can also be beneficial to improving communication, resolving conflicts, and enhancing the overall functioning of the family system.
Finally, it is essential to coordinate care with physicians who can provide medication management for ADHD, anxiety, or SUD, as needed, and monitor for any potential side effects or interactions. Bob reports that he feels like drinking to relax, but he has sworn never to be like his father, who died of alcoholism. Therefore, it is essential to assess his alcohol use and any other substance use and to provide him with psychoeducation and referral to support groups or substance abuse treatment, if necessary. Monitoring for any potential interactions between medications and traditional healing practices is also essential.
Question 2
As a clinical psychotherapist working with Steven, a 7-year-old Korean American first-grade student, and his mother, it is essential to consider cultural factors that may affect his mental health and academic performance. Korean Americans, like many other Asian Americans, may have a collectivistic culture that strongly emphasizes academic achievement and respect for authority. However, they may also experience acculturation stress, discrimination, and cultural conflicts, impacting their mental health and well-being (Woo et al., 2020). Therefore, it is essential to incorporate cultural sensitivity and competence in the therapeutic relationship, to understand and respect their cultural background and beliefs, and to address any cultural barriers or biases in the educational and healthcare system.
Steven presents with inattention, hyperactivity, and impulsivity symptoms, commonly associated with attention-deficit/hyperactivity disorder (ADHD). However, it is essential to rule out any other possible causes of his disruptive behavior, such as learning disabilities, anxiety, depression, trauma, or family stressors. Steve needs a comprehensive assessment to diagnose and treat his symptoms, including a clinical interview, behavior rating scales, and academic and cognitive testing. It is also essential to gather collateral information from his teacher and school counselor and assess his cultural and family context.
As a non-prescribing therapist, the role is to provide evidence-based psychotherapies to help Steven address his behavioral and emotional needs and improve his academic engagement. Behavioral parent training (BPT) is a practical approach for children with ADHD. It teaches parents how to manage their child’s behavior through positive reinforcement, clear rules and consequences, and consistent discipline. BPT can also help Steven’s mother to address his anger and aggression toward his younger sisters and to improve their family dynamics and communication (Mah et al., 2021). Play therapy is also a practical approach for young children with ADHD, which can help them to develop social skills, emotional regulation, and problem-solving strategies (Drisko et al., 2020). These therapies can also address any comorbid anxiety or depression contributing to Steven’s symptoms.
Moreover, it is essential to involve Steven’s mother in the treatment process, to provide education and support, and to address any cultural or language barriers that may affect their communication or adherence to treatment. Steven’s mother is reluctant to put him on medication for ADHD, and it is important to respect her decision and provide alternative interventions that are evidence-based and culturally sensitive. Addressing any legal and ethical issues related to domestic violence and child custody is also essential. Since Steven is a victim of domestic violence, it is essential to assess any p...