1. What are familismo, personalismo, respeto and machismo? Why was it important for the therapist to take these factors into account when treating Mr. Alvarez?
2. According to the Cognitive-Behavioral Therapy (CBT) model, thoughts, feelings, and behaviors are inter-related and dependent upon one another. (a) How might Mr. Alvarez's thoughts that he is useless affect his feelings and behaviors and contribute to the perpetuation of his depression? (b) How did behavioral activation (increasing physical and social activities) counteract his depression?
3. Cognitive distortionsare irrational thoughts and thought patterns that may lead to the development and maintenance of anxiety and depression. How does Mr. Alvarez engage in the cognitive distortions defined below?

• • Mindreading:The person may think he or she knows what another person thinks despite no external confirmation that his or her assumption is true
  • Black and White Thinking: Something is either good or bad, right or wrong, all or nothing. Difficulty acknowledging shades of gray.
  • Discounting the Positive:Failure to acknowledge positive attributes about self or situation, and instead focus on negative attributes.

4. This therapist was uniquely qualified to treat Mr. Alvarez because he spoke Spanish fluently and was familiar with Latinx culture. Unfortunately, these idyllic therapist-client matches are a rarity. How might a therapist compensate for differences with a client in ethnicity, sexual orientation, and culture?