Case Study of Juan
Before interacting with my client as a counselor, I would check any personal opinions and biases I may have at the door. Immediately hearing the term “HIV” may cause some counselors to already have preconceived notations about what the case may be. Which would lead to generalization of the situation and the client, instead of treating each client as its own case. Counselors, if uneducated about the diagnosis may worry about “catching the illness” and allow that to interfere with a successful counseling session with the client. In the case of Juan, it is imperative for me to enter the room on the Pediatric floor with a clear mind, with no judgments and no opinions. I am also entering his space with the mindset to prepare a safe zone for my client while building rapport.
While working with Juan, there are number of things we have to keep in mind in order to make sure we are providing the best counseling service for him. First and foremost, after checking myself at the door, we have to ensure that we assess the wellbeing of our client. Including the current state of mind, he might be in after hearing the news pertaining to his health. To make sure I am being multiculturally competent, I must gain some knowledge and insight into the Latino culture in order for Juan to be able to connect with me and won’t feel as if speaking to me is a waste of time. Generally, counselors should be multiculturally competent in order to understand how an individual’s culture may affect their decisions, actions, personality, and how it may contribute to their identity. Specifically, to Juan, as his counselor I realize that his religion, family beliefs, values and identity plays a huge role in any decisions he made or currently is making.
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To a client, a counselor plays many roles. We are educators, advocates, coaches, liaison and the list goes on. Even though Juan feels he does not need an interpreter due to his personal feelings of acculturation to the English language, I would have to be his advocator against himself. Being his advocator in this particular instance means guiding him into realizing that he might actually need an interpretator to fully understand what is going on with his health and his life overall. There is also a language barrier here and that can not only be difficult for both the medical team and Juan collectively but also may cause physical harm to Juan. Juan might not understand the severity of his diagnosis, since medical terminology can be a little difficult. He might not understand how to maintain his health and the proper steps to take whether it is dealing with finances or medication. We also want to make sure Juan feels that the medical staff is understanding him and contributing to his needs and comfortability. Latinos often expressed feelings of being not understood and unheard, and as a result of them also not understanding doctors, they would end up leaving the office with questions unasked and unheard. Having an interpreter will be beneficial for everyone and will eliminate a few major concerns.
To ensure that Juan receives adequate support, as counselors it is one of our duties to provide resources that can both help and inform the client on any issue, they might need more guidance on. To make sure Juan does not lose motivation, I would provide him with pamphlets focusing on how living a healthy life with HIV is achievable. As a counselor I want to make sure that Juan understands that he is not alone, and support is everywhere if and when he’s ready for it. I would provide phamplets and a list of resources including “The Latino Equality Alliance” , their mission consists of advertising quality, justice and equality for the bisexual, gay, lesbian, transgender or bisexual community for Latinos. Even though Juan’s family is okay with his sexuality, he would also need support from individuals who he can directly relate to and express himself freely with. Part of the Latino culture is the religious belief that bad experiences in life are inevitable and they have no choice but to accept what their fate is can result in Juan lacking emotion or motivation to feel as if life can continue as Juan would want. There are not a lot of support groups for Latino men living with HIV, however there are funds available to increase the help Latinos needs in order to receive medical treatment necessary for obtaining a healthy lifestyle, but there are limited specific Latino support groups for homosexuals living with HIV. As a counselor that is a sign that it is time for me to advocate for my client on a community basis. Whether it means creating a support group in the community or contacting the Centers for Disease Control and Prevention ( CDC), who provides funds for community organizations, health departments, and states to deliver HIV prevention methods and techniques, to also allow more funds in order to create more HIV support groups for Latino since they are among the largest growing minorities in the United States and more resources need to be available (Barthelemy, 2017). Support and treatment works best if they go hand in hand in cases like this and I want to make sure both branches of support are available for my client.
Finances may also become a barrier for adequate treatment for Juan, because Latinos are much more likely to be uninsured. Previous research has showed that the Latino group, particularly young adults, are uninsured at a higher rate that other ethnoracial groups, and have difficulties remaining insured once receiving insurance (Terriquez & Joseph, 2016). As a result of fear of deportation or immigration status, Latinos tend to work under the table and affordable insurance is not provided. As Juan’s counselor I may have to become a liaison between him and the hospital’s billing department to make sure he has insurance coverage and as we continue our counseling sessions in the future, following up on the status of his insurance coverage to make sure he is maintaining it.
The first thing we need to do in order to advise Juan into informing his family about his diagnosis is to understand why Juan asked his family to leave and why he doesn’t want his family knowing about his diagnosis. In the Latino culture, there are prevalent gender roles and as a Latino male, there is a certain role Juan has to fulfill (Sue & Sue, 2016). Such roles include providing for his family, protecting and defending his family and lastly being strong. Juan may not feel those things currently and probably cannot communicate what’s going on with him, so he would rather face isolation. Juan might not want to show weakness, how he identifies with his family is how he identifies with himself in the Latino culture. It is also beneficial to keep in mind that the word family is culture orientated so different cultures have different definitions of the word family and what it means to them. In Latino cultures family consists of extended family, who are commonly not blood. Juan may not feel comfortable revealing his issues to individuals who he may not consider family personally. In the Latino culture, family is important to individuals. The dynamic of the family usually include members of the family being close-knit and Juan may need a reminder of that, he would need a reminder of the vital role family plays in Latin cultures. I would communicate with him on his family views. Latinos hold dear regarding family is the collective needs usually override the individual needs, meaning no matter how he thinks his family might react to the news, they most likely going to put their feelings to the side and would want to tend to him. His problem becomes their problem. It is a belief of the Latino culture regarding health, it is better to come together than be apart, when someone from the family is sick, the family wants to come together including extended family. Additionally, I would guide him into understanding that family support is essential with dealing with his diagnosis and he is going to need that close family feeling if things do get tough.
Now that Juan is 18 years old, he will be transferred from Pediatric care to adult care meaning he is now responsible for himself. Reminding him of that and explaining to him that he does have a choice in not being alone, and he can include his family in this part of his life. I would also attempt to explain to him that it would be more beneficial if he would include his family for support, ranging from financial to emotional because he will need both. Since Juan is now 18 years old, he is now an adult and one of the most important things to consider is in the eyes of the hospital, he is now the rightful age to make his own decisions. Juan would also have to consider that a part of the transition is self-advocating for himself, his parents are no longer able to speak for him. The doctors are going to want to hear from Juan himself. He now has to build rapport with his doctors and explain how he’s feeling during every visit, as well as ask whatever questions he may have. Juan would also have to consider the care he might’ve received in the Pediatric center is going to be different than adult care.
A major issue that I would be concerned with Juan about is his change from being a child to becoming an adult overnight. As Juan’s counselor I would assess his mental stability throughout our visit in the hospital and every time we meet to rule out the possibility of any ideas of self-harm. I would also think it is beneficial to explore any feelings of guilt or shame for his current situation as people react differently to life changing news. Juan mentioned being injected with heroin against his will and that’s how he contracted HIV, so I would have to assess his current state to make sure there’s not a possibility of him having any thoughts to harm anyone who he may feel is to blame for his current health status.
I would also want to assess the role of his boyfriend in his life and assess whether that relationship is healthy or not. Gain answers to how he feels about him from when they first met him to now. Find out what is his boyfriend stance on his drug use, is his boyfriend going to be a support system? While we are on the topic of Juan’s boyfriend, I would want to explore the age difference. Juan stated that his boyfriend is several years older than him and he was a minor when they were engaging in sexual activities. I would want to process his thought on that when he is ready to and proceed from there. With the older boyfriend situation, I want to make sure Juan is safe, and aware.
In addition to Juan’s mental status and his current thoughts/ feelings on his boyfriend, I would also want to assess his drug use and what hi idea of safe sex is. Since his family already knows about his sexual orientation, is it possible that he is hiding his drug usage from is family? Does he not want his family to know about his health status because he might’ve contracted HIV from the usage of drugs since his boyfriend is HIV negative and couldn’t of transmitted it to Juan In order for Juan to fully feel comfortable with me and for me to get answers from him, I would have to make sure I have gained his trust meaning what Juan and I discuss stays only between us unless he speaks of harm to himself or someone else. With Juan I must touch on all aspects to provide the proper counseling service he needs.
Juan, however, may have a few hesitations on attending counseling or speaking to me because in the Latino culture, religion is extremely important, and Latinos believe in praying about their troubles and accepting their fate. So, they not see counseling as a necessary tool for cleansing, venting or support. Latinos also believe in their own medicine and spiritual treatment for various reasons. One being insurance coverage as mentioned earlier, and two because they are not aware of the purpose of counseling. Some Latinos believe that evil spirits cause mental health problems so that can cause Juan and his family to not come or participate in counseling (Sue & Sue, 2016).
Latinos fear going to the doctor because they fear they might get undesired treatment and as a result of that they may group all health professionals into that generalization which may prohibit Juan from attending counseling sessions with me. Family structure is important in a Latino family. Family members attending counseling may be waiting on the head of that particular family to lead the session and then other members follow in that person’s path (Barthelemy, 2017). While counseling Juan, the family may be a little unresponsive, but as Juan counselor I will remain patient, and work on building a relationship to achieve a breakthrough with the head of his particular family. Working towards that breakthrough might be hard if the head of Juan’s family is a male, mothers are usually more open to the idea of counseling versus the male counterpart. Even though my focus is on Juan currently, it is important to work on the family as a whole, because that is how they proceed in their daily lives, I wouldn’t want Juan to feel as if I don’t respect their culture since family support is everything to Latinos. That is if Juan reconsidered his decision on involving his family in this counseling journey.
Latinos are considered outsiders (Catalano & Waugh, 2013). They may feel as if nobody values or understands their culture, so they tend to stay out of the way and not seek any help even if it is needed. No matter what your job status is as a Latin American it is hard to shake the stigma that surrounds the assumption of the Latino culture and face discrimination because of it. There is a common misconception that all Latinos are poor and when they are first seen they automatically get grouped into a category of land workers and gardeners. Latinos often face discrimination because there is an automatic assumption that they don’t have insurance. Juan might fear rejection and that can affect him getting continuous help after leaving the hospital. Since I know he is likely to may face discrimination, as his counselor I have make sure to process any thoughts he might have on the view of Latin Americans from other races, advocate and assist in making sure he is receiving proper care towards his diagnosis.
Many Latinos may also miss out on their rightful resources because of two main things, lack of knowledge and they might not be proficient enough in the English language, so it is difficult to comprehend and communicate in order to receive assistance with what’s rightfully theirs. Juan may feel as if he is not receiving the best care because of his race, since many Latino children are overlooked and receive suboptimal care in comparison to their white counterparts. Since Juan is of the Latino descent Juan may be subjected to receiving fewer interventions and in this specific case, that could include his blood laboratory studies because of the lack of available communication between the doctor and parents who speak limited English. (Connors, 2019).
Using my multicultural skills, I would use religion and family in my treatment plans to help guide Juan into the right direction along with his family. I would need to gain knowledge on what his goals are in counseling and work with him on achieving that. In this case, I would want to work collaborative with Juan on his goals because I have a few goals for him, but I do want him to feel included in this since it is a huge change for Juan. Goals I have for Juan would include including his family, taking better care of himself, and still valuing himself . Since religion is an important factor in the Latino culture, I would find out if that is important to Juan because he is an individual and if so, combine his love for god and strong believe in faith as his motivation. Before considering the termination phase of the counseling process I would have to be sure with myself and my supervisor he is ready or not for termination. I would consult with my supervisor a few times to provide great services for Juan. I want to also make sure I am not overwhelming Juan and allowing him to understand that everything happens on his time.