An example of a socio-cultural approach to therapy will best illustrate its clinical application. A twenty-two-year-old woman was brought in by her husband because of depression and anxiety. She complained that she was depressed because of frequent episodes of panic during which she was convinced she would die. She was a thin, taut, attractive young woman in obvious panic, with a pulse rate of 144 and rapid breathing. She spoke in a meek,thin, and whining voice and looked away from her husband. She was the only daughter of religious European-born parents who, when she was eighteen, arranged a marriage to a highly religious man. They had two children.
The husband complained that his wife, previously a scrupulously clean, orderly, and attentive housewife, had begun to sulk and to neglect the home and the children.She gradually became more depressed and periodically panic-stricken. The patient was given a short-acting tranquilizer for a few days to reduce her panic, hyperventilation, and rapid heart rate. The therapeutic encounter was a difficult one because of her reluctance to reveal her feelings about her personal situation. After some period of confronting her with evidence of her rage and the need deal with it, she was able to confide her sense of entrapment in a marriage to a man she doubted she loved, her sense of having been placed in servitude,and a bitter resentment about being deprived of an education and a career. The therapist proposed that she continues to clarify the sources of her anger, and that she makes moves to correct her situation rather than “go on strike.” Her panic seemed due to her feeling that she was losing everything. Her physical symptoms soon abated but her depression persisted.
As the couple was seen together, she gained the courage to demand an opportunity for education and for fewer religious strictures. The therapist tried to help them come to some agreement on these issues and to develop a more loving relationship. Both the husband’s and the wife’s parents (who were also seen) did not believe that the wife needed a college education or that she should take the time from her home responsibilities. Psychological testing, done to assess her career potentials, revealed a passive, angry person with an intelligence so superior that it almost reached the limits of the test.
Her husband finally agreed to her finishing high school and beginning college. However,he soon felt threatened by her rapid progress and began to disparage her. She gradually realized that she really didn’t love him and couldn’t continue to live with him. When she confronted him with this, he became abusive and she had to flee to her parents’ home.
The patient required several years of weekly or intermittent therapy to help her deal with her real frustrations and privations and to arrive at partial and gradual solutions. She also required help from community support systems and from her family. Therapy later focused on assertiveness training so that she could deal with people in a full-voiced and firm manner without being competitive or controlling.
The patient is now divorced, has finished college, and is a part-time instructor in college while attending a graduate Ph.D. program. She is now functioning constructively in a changed cultural milieu. She has been caring for her children while she works and studies, and has been able to be compassionate and helpful with her parents.It is interesting that they, because of their specialized cultural values, mournfully view their daughter’s present status as a failure. After her divorce her father became depressed and also required therapy.
The therapeutic attempts for this family required close attention to and manipulation of the socio-cultural institutions that had helped shape and limit the lives of the family members. These include, to mention only a few, the limited mobility of women in our culture and other conflicts intrinsic to the transcultural situation of this particular family.
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