An Exercise in Mapping a Case Study using Brofenbrenner\'s Ecological Model

Running head: CASE ANALYSIS

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Case Analysis Counselling skills: Introduction to Practicum COU5203 Elina Zalkalne Masters in Transcultural Counselling Faculty of Social Wellbeing University of Malta December 2013

CASE ANALYSIS

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Contents Part A: Introduction to the case study ........................................................................................ 3 Introduction ............................................................................................................................ 3 Summary of theoretical orientation ........................................................................................ 3 Context for work and client’s background ............................................................................. 4 Client mapping according to Brofenbrenner’s ecological model........................................... 5 Presenting problem ................................................................................................................. 5 Assessment and formulation of problem ................................................................................ 6 Part B: Therapeutical process .................................................................................................... 7 Negotiating therapeutic aims, plan and goals......................................................................... 7 Possible difficulties in the process ......................................................................................... 9 Conclusion.............................................................................................................................. 9

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Part A: Introduction to the case study Introduction It is December of 2008, in Somalia. A much loved president resigns regretting that he did not succeed in bringing about the change Somalia needed which he promised seventeen years ago. The following months are fraught with conflict and strife as the new government fails at maintaining control over uprising radical Islamist rebels who quickly take over a great part of the Somali territory. A stronger government is established; however, even 3 years later the militia still cannot reclaim the lost lands. Civilian murders, hunger, terror and crime abound and are the order of the day. People walk over corpses and starving children without flinching (OneChangeAgent, 2010). Countless families flee, abandoning belongings and sometimes each other (Healy & Bradbury, 2010). This is the story of so many refugees that arrive on Maltese shores, seeking safety, shelter and peace. It is a story that makes one marvel at human resilience and determination. Despite that, it is a story that leaves scars, and these scars take time and need help to heal. Summary of theoretical orientation As I outlined in my counseling philosophy paper, my personal orientation regarding counseling theoretical approaches is a Person-Centred, Existential and Feminist theory based one. However, after carefully going over this case, I concluded that Existential therapy cannot be viable in this case as it builds upon the notion that clients undergoing this form of therapy have their basic needs met, are verbal and capable of fully comprehending their experiences. Therefore I have chosen to approach this case from a Postmodern and multicultural perspective, integrating the Feminist theory’s focus on social advocacy as well as Cognitive Behavioural therapy, all the while maintaining a Person-Centred approach.

CASE ANALYSIS

Context for work and client’s background To present a brief outline of the client’s case, Magan, a 17 year old Somali boy has been in Malta for the past three years (ever since war broke out in Somalia in 2009), unaccompanied by family or friends, and has had to build a life for himself at the immigrant centre. He has minimal money available, despite having food and lodging provided at the centre, and shows no interest in maintaining an active social presence with his peers or other refugees. Some other details include his devotion to his religion (Somalia is predominantly Muslim), ability to speak English relatively well (unlike his knowledge of Maltese) some evidence of a scholastic education from when he was back in Somalia, and mentions of a grandmother and a younger sister.

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Client mapping according to Bronfenbrenner’s ecological model

Presenting problem The case study presents a number of issues that can be explored in therapy. Magan’s care workers have approached the trainee counselors at the centre because he has been getting into verbal arguments, however, from the case study also I noted some unresolved issues regarding his reluctance to divulge information regarding his religion - and assumingly – his culture, as well as mention of family members. Furthermore, Magan shows distrust of the care workers and has isolated himself from the other members of the refugee community (it is

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unknown whether in his peer group are other Somalis or whether they are all from other African or Middle-Eastern countries). Another issue that I found rather disconcerting is that he speaks of ‘large spans of time about his past that he does not remember’, which would make me immediately think of chronic Posttraumatic Stress Disorder, considering that he’s been away from Somalia for three years. Assessment and formulation of problem The case study leads me to think that Magan’s memory loss, isolation and anger issues stem from his unresolved PTSD, as well as his unmanaged attempts at coping with his loss of home, family, friends and culture. From a Maslowian perspective, only the first level of basic physiological needs is being met in Magan’s case, in the form of shelter and food. Money that is granted to him is too little to provide financial security, not to mention other forms of security such as resources (he does not possess sufficient clothes, which makes one wonder what else he is lacking), belonging and comfort, freedom of fear, employment or property. Beyond that, Magan also does not appear to have a social circle of friends or trusted persons – including the care workers or counselors. Therefore, from an advocacy point of view, as a counselor I would enquire what other needs are lacking that he may require. I can also identify Magan’s difficulty with managing his identity which is what Erikson’s psychosocial stages speak about in his level of development. There is distinct role confusion stemming from the uncertainty about who he is, and what can happen to him – while not wanting to make unfounded assumptions, it is understandable that his situation of having had his original cultural and role identity stripped from him and now having to assume the role of a refugee and navigate completely different forms of identity would cause great psychological distress. Some research about refugees from Somalia painted a dark picture of countless people who go through repeated harrowing traumatic experiences on their journey

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to safety, as they are torn from homes and families often which they cannot re-establish contact with, witnessing murder and rape and dealing with the situations in refugee camps (Unknown, 2013; McGraw Schuchman & McDonald, 2004). Another important issue I found is that Somalis have a negative reaction towards psychological disorders or distress. The people become “socially isolated. The pain of this isolation is felt intensely because Somali culture is traditionally communal and family oriented... This social isolation can be very disorienting and can make the process of healing very difficult.” (McGraw Schuchman & McDonald, 2004) Consequently, Magan’s isolation and unwillingness to communicate takes on new perspectives. Moreover, one must take acculturation into context – the closeness of the Maltese community, and its historical unwillingness to embrace other cultures result in obstacles for refugees. McGraw Schuchman and McDonald further point out that “the impact of war trauma, social isolation and change in social status make acculturation difficult” (2004) as acculturation is not determined only by the greater population but also the individual’s experiences.

Part B: Therapeutic process Planning therapeutic aims and goals. From what the case study outlines regarding the initial session, Magan shows reluctance to open up to the counselor which he demonstrates by turning up late and not communicating, despite which he still agrees for further sessions. He has also been participative in group activities that the trainee counselors have organised indicating an interest in the counseling process. A point that struck me from the description is that despite what he has been through, he remains optimistic and hopeful for the future, which is a great

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indicator of his resilience. Some research into the situations that refugees experience to better understand Magan’s case revealed that there is plenty of reason behind his PTSD: “Immigrants, and most certainly refugees, have likely endured one or more of the following traumatic events prior to resettlement: malnutrition or famine, violence, political persecution and torture. Often trauma goes untreated until long after resettlement” (McGraw Schuchman & McDonald, 2004), which gives evidence to my suspicions. This would make me wish to implement cognitive techniques borrowed from the CBT approach, as this is particularly suited for cases of PTSD. I had considered REBT; however, its highly confrontational style may cause further distress to Magan. Through the use of guided discovery, Magan could come to terms with his past and explore his memories and the dissonances in his identity, as well as work on his anger management. I find this approach would work well as it is relatively fast and because it allows the client to use his worldview and belief system in his personal explorations – very culturally sensitive. This, I believe, is a fundamental perspective particularly regarding Magan’s relationship with religion and his reluctance to share it with others. I suspect that he may feel like this is a remnant of his past life which he still resolutely clings to and fears that it may be taken away from him too. Furthermore, CBT “addresses the role of the external environment,... [and] the focus on present behaviour” (Corey, 2012). Implementing the Feminist therapeutic approach may also benefit Magan particularly considering their strong advocacy stance regarding changing social structures and allowing clients to voice their experiences and feelings regarding discrimination, helplessness and oppression. The techniques used in the feminist approach are built around the individual and work on empowerment, cognitive restructuring, relabeling, racial power inequalities and exploring one’s place in society, among others. What I particularly admire in the feminist approach is its emphasis on direct action on the therapist’s part in order to achieve social policy change and greater advocacy for their clients, so as Magan’s therapist I’d be willing to

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help him have his voice heard and contact authorities or agencies for whatever means he may require. Furthermore, working with Magan I would draw techniques and approaches from Narrative therapy as it places problems within the sociocultural context and not upon the client and allows the client to construct his own story (externalising the issue and rebuilding his story in an alternative and healthier way), besides it, congruently with the invaluable Person-Centred approach emphasises the relationship between client and counselor, as well as maintains the necessary warmth, unconditional positive regard and genuineness on part of the counselor which I believe Magan would greatly benefit from, as it could be that the care workers that interact with him do not operate from this perspective. Possible difficulties in the process My identity of a foreigner may make him open up to me (self-disclosure would be vital here), and possibly result in me feeling sympathetic rather than empathic towards Magan, which could further arise issues of countertransference (or transference from his part, if he sees me either as a threat or a trustable person). It may be a long process until (possibly if) Magan can trust me, and I can foresee that he would test me, because despite my role as a counselor I still retain the identity of a white woman belonging to the population majority and this would have to fit somewhere within Magan’s belief system. The language issue may also present a challenge as he may find it difficult to describe his story. I certainly feel that supervision would be crucial in the therapeutic process because I may find it very hard to withstand exploring his traumatic experiences. Conclusion Not having much previous experience with multicultural studies before this paper, I undertook it as a challenge, reading up on the history of Somalia, refugee experiences and multicultural research articles. Placing myself in the shoes of a young African boy who has

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been through traumatising experiences was not easy, but it shed light (both positive and negative) on how the socio-political and historical context affect people, the fragility and strength of humanity, and the importance of immersing oneself in the client’s experiences. However, the foremost thing I gained from this exercise was deepened understanding that as counselors we are not there solely to listen to clients and aid them – we can, and should, actively advocate change and aim to lessen all forms of discrimination.

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Bibliography Corey, G. (2012). Student manual for theory and practice of counseling and psychotherapy. California: Brooks/Cole. Davy, J. (2011). How to write a client case study. In R. Bor, & M. Watts, The trainee handbook: A guide for counseling and psychoterapy trainees (pp. 153-177). California: Sage. Healy, S., & Bradbury, M. (2010). Endless war: A brief history of the Somali conflict. Retrieved from Conciliation resources: Working together for peace: http://www.cr.org/accord-article/endless-war-brief-history-somali-conflict McGraw Schuchman, D., & McDonald, C. (2004). Somali mental health. Bildhaan – An international journal of Somali studies. OneChangeAgent. (2010, September 16). On Somalia. Retrieved from Blogspot: http://developsomalia.blogspot.com/2010/09/psychological-damage-and-politics.html Unknown. (2013, 12 22). Dominant psychological paradigms in refugee literature and humanitarian interventions. Retrieved from The refugee experience: http://www.forcedmigration.org/rfgexp/rsp_tre/student/brief/paradigm/par_p3.htm