What are TWO multicultural considerations relevant to the following case including 'how' the cultural identities of the client(s), counselor(s), and other stakeholders impact ethical decision-making process and outcomes?

CASE VIGNETTE

You live and practice psychotherapy in a rural area. You began to provide psychotherapy to Mr. DiMencha, a 52-year-old Italian immigrant, who suffers with depression. After six sessions, Mr. DiMencha suffered a significant concussion while at work. His impairment is noticeable to you without any type of testing. He struggles with understanding concepts and his conversation becomes tangential during the next two sessions.

Mr. DiMencha's co-worker, Janet, helped him find an attorney so that his rights are protected. You had Dr. DiMencha sign a release giving consent for you to talk with the attorney as well as Janet. From a phone call with the attorney, you learn that Workers Compensation wants to work out a settlement. However, the attorney has little awareness about how impaired Mr. Dimencha is. The client has never met the attorney face-to-face, only by email and phone contacts.

Mr. DiMencha demonstrates a variety of cognitive deficits. He needs assistance and monitoring with daily tasks, such as home care, shopping, transportation, understanding the settlement process, reading his mail, and paying his bills. He will likely need to go into an assisted living facility. His family lives ata. Distance and provides minimal help. Workers Compensation refuses to pay for the case management services of an independent social worker. Attempts to find social service agencies able to help him have not been successful. Mr. DiMencha doesn't appear to understand his legal rights or the settlement process.

Prior to providing extra-therapy support, you had Mr. DiMencha sign a document explaining your fees for the additional services. You are not sure that he completely understands what is happening or understands the version of the informed consent for additional services. You have been doing much of the case management work, e.g. locating a long-time friend who is willing to help him at home, referring him to a neuropsychologist for testing, engaging in lengthy discussions with his primary care physician and neurologist, participating in multiple conversations with the attorney, and trying to find a guardian or power of attorney.