Cultural Diversity Case Study: Biko

Reason For Referral

Biko came to the university counseling center after being told by his girlfriend that if he did not seek help, she would end their 2 year relationship. Behavioral Concerns Biko is a 21-year-old, tall, slightly overweight, African American male. He is currently in his second year of college at a small private university with a double major in Math and Computer Engineering with plans to entering the military after graduation. He was appropriately dressed and had a cooperative attitude. Although he presented himself with a very calm and even-tempered mood, Biko indicated that he felt as if he "was out of control," as it relates to his anger. At times he seemed noticeably uncomfortable, but he kept good eye contact throughout the session. As the session progressed, he seemed increasingly more comfortable and relaxed.

Presenting Concerns

Although encouraged to seek help on the advice of his girlfriend, Biko seemed open to discussing several concerns he wanted to address in counseling. He mentioned that he was hesitant about the suggestion initially but decided to come in anyway because he did not want to jeopardize his future. The most pressing issue was his anger. He indicated that he wants to understand better his problems controlling his anger and how it was related to various feelings and behaviors. Most recently, Biko became angry with his girlfriend Tanisha after she failed to return his phone calls and "stayed out partying" all night. He indicated that Tanisha claimed she told him about her plans and that his anger felt controlling and threatening. Biko also expressed concern about his inability to control his anger when dealing with his family and professional relationships. Biko first noticed his problems with anger when dealing with a teacher in middle school who falsely accused him of copying another student's work and cheating on a test. He remembers this being the first time he felt what he described as "intense anger." During such instances, he described feelings of "hopelessness and helpless" and reported it being the only way he knew how to communicate his frustrations. In high school, he reports that he also frequently felt angry toward girls in particular. Regarding his relationships with "girls," Biko noted he initially thought they wanted to be friends, but later realized they were "all using him" to get help with homework, or so the he can give them rides, or gifts and were "not at all interested" in being friends or having a romantic relationship with him. Biko also noted having some difficulty being understood and making friends, at one point, he states that he began comparing himself to "The Incredible Hulk" because he was feeling as if he was "losing control." He also reported that "people just don't get him." He reported few "real friends" in high school and only a few since starting college. He reports feeling increasingly misunderstood, ignored, and isolated. He stated, "I wish people would really try to get to know me." He discussed that as a tall, slightly overweight, Black man, he has also frequently perceived that others find him intimidating and imposing. Since beginning college, Biko has tried to be more sociable, but he expressed feeling anxious and extremely shy towards other people and believed he cannot trust them. These problems of anxiety, shyness, and trust have surfaced both with other college students and professors. Biko reported that he often has troubling dreams of being at parties where people he does not know ignore and walk away from him when he attempts to be sociable. After discussing these issues and becoming more comfortable in the session, Biko disclosed that his girlfriend is also unhappy with his viewing pornography on the Internet. When his girlfriend learned that he had been engaging in this, she told him that she would break off the relationship if she caught him doing it again. He was reluctant to discuss the details of this behavior; but did indicate that it began after receiving an ex-rated "pop-up ad" while surfing the Internet. Recently, his visiting "pornography sites" has progressed to the point that he sometimes spends several hours a day viewing pornographic material on the Internet. He noted his frustrations with his lack of intimacy with his girlfriend and control issues as possible sources leading to these behaviors.

Family Background

Biko was raised in a rural Georgia town and is the middle child of three boys. At age 11, his parents divorced, and his mother relocated Biko and his siblings to a larger metropolitan area. After residing in this area for two years, his parents reconciled and remarried. Biko reported that he did not want his parents to remarry and still believes they should not be together because of the regular arguments about financial issues. He also cited the degree to which his father travels as a sales representative as a source of stress in their relationship. In commenting on his parents' relationship, he noted, "his parents did lots of arguing and throwing objects at one another." He noted that his older brother was frequently the one to take care of him and his younger brother and to try to maintain peace in the house. Biko described growing up in a lower-class background as a child and progressing towards middle-class standing when his parents remarried and moved into their first house. Both of his parents completed college at historically Black Universities. Although supportive of Biko going to college, they preferred that he go to a historically Black college, especially because most of Biko's primary and secondary school education took place in primarily white schools. Biko said that even though he chose to go to a different college, he still identifies with his African American background. He chose to attend a predominantly White college because he did not want to follow in his parents' footsteps, getting away from them and what they represented, namely, "a lot of fighting and arguing." Biko maintains that he has a good relationship with his brothers and keeps in contact with them. His brothers decided not to attend college. Instead, both joined the military as soon as they graduated from high school. One brother currently resides in Korea, while the other lives in Germany. He describes his relationship with his brothers as being similar to the "three musketeers" and said that no matter what, "nothing could tear us apart." Although Biko indicated that he loves his parents, he also stated that he does not have a lot of respect for their returning to a marriage that "wasn't good in the first place." Biko did not comment on his personal relationship with his father; however, he did indicate that most of his memories about his father have not been positive. Relational and Interpersonal Relationships Biko has been seeing Tanisha for almost 3 years. They met at a campus cultural event, and he first noticed her at a local church that they both attended. He said he was initially drawn to her because she seemed to be interested in the same types of campus and national issues as him. He expressed frustration, however that they had not been sexually intimate for the majority of their relationship. After dating for about two years, he indicated that they were intimate on only one occasion, the first sexual experience for both of them. Afterward Tanisha talked with Biko about her feelings of extreme guilt, sadness, disappointment, and regret due to fears of becoming pregnant and how premarital sex was prohibited due to her religious (African Methodist Episcopal) values. He feels conflicted about premarital sex because he feels ready to become sexually active on a regular basis, although he also believes that premarital sex is a sin. Biko also seems to resent that she was the one to make the final decision on the issue and felt he was not heard, and his feelings were not considered. Coping Strategies Biko reported that he has tried to find ways to reduce his anger and attempted to be more sociable by working out on a more regular basis. He often plays sports, but he reports that this has provided him little relief. He admits to being at a loss for how to cope with his feelings of anger, particularly when he feels "extreme rage." Biko denied drinking frequently as it makes him "feel more out of control" and he tends to get into fights. Career Progress Biko's goal is to complete his education and join the military after graduation, and hopefully join his brothers at one of the locations at which they are stationed. He said he has thought about asking Tanisha to marry him, but is concerned that he is not ready, given the problems they are currently having. Biko expressed concern about the ways in which his inability to control his anger effectively could influence both his relationship with Tanisha and his career goals in the military.

In analyzing this Case:

1. From a multicultural competency perspective, what is the impact of bio-psycho-social characteristics and concerns of diverse populations, both nationally and internationally, on the counseling relationship and process? What led you to formulate this conceptualization? (2.F2a, 2.F2c, 2.F2e, 2.F2f.)

2. Applying Sue's Tripartite Framework for understanding the Multiple Dimensions of Identity to describe this client's situation, what additional information would be helpful in formulating your conceptualization? How and when would this information be collected? Include in your response, the impact of heritage, attitudes, beliefs, understandings, and acculturative experiences on the counseling relationship and process. (2.F1k, 2.F2d, 2.F2g, 2.F2f.)

3. Describe relevant theories, models, and professional counseling ethics related to multicultural counseling, cultural identity development, and social justice advocacy utilized in your work with this client. This may include multicultural considerations for the client as well as relevant differences of power and privilege between and for you and the client. Note how these considerations would or would not be addressed by using A Racial/ Cultural Identity Development model. (2.F1i, 2. F.2.b,c, e, f & g.)

4. Imagine that you are a middle-aged, 55-year-old clinician. Imagine Biko's issues with anger, which sometimes manifests as physical aggression and has been noted in various side conversations around campus. From a MCC perspective, describe how you would approach the therapeutic relationship with this particular client: discuss any ethical considerations that might be considered in working with this client; discuss how you might intervene on his behalf from a standpoint of advocacy and/ or from a standpoint of social justice advocacy. Note any dynamics that may emerge and how this might be approached in therapy. (2.F1e, 2.F2h, 2.F5k, MHC3e.)

5. Considering 1-4 above, discuss what approaches might "not fit" when working with this particular client? (CACREP 2016- 2.a-h)