Her cancer and disfigurement distinguish the subject as being in a specific cultural group due for counseling, with many of the strategies used to engage her centering the culture of sickness and its attendant modes of recovery, rehabilitation and return to normalcy. Current logic supports group-based treatment imperatives for those who may be characterized accordingly. For the subject through, as with most any counseling subject, a number of specific cultural and personal features have made this sickness and its consequences a unique experience. We can also see that her perspective and needs have been formed by dimensions such as the subject's unstable economic upbringing; the sense of difference from wealthy suburban children; and an internal portrayal within the family suggesting a retention of the identity of foreigners in a strange land. The interplay of these multiple dimensions is discussed in the article by Croteau et al. The article quotes several respondents who had observed the impact of overlapping cultural dimensions as having an impact on the way they had experienced the world. Accordingly, one "participant described a 'state of readiness' to see oppression ion the world, a trait that was born out of that individual's 'own personal marginalization.' Still another participant said one's own oppression resulting in 'opening your eyes up to 'the reality that' there are lots of different ways in which people are marginalized." (Croetau et al., p. 249)

And for the subject of our discussion, this connection would be made yet more explicit by a sense of her mother's emotional distress and the havoc that this rained down upon her childhood. Indeed, the connection between her mother's emotional instability, the stressful economic conditions of her house and her medical condition had combined to impose a sense of sustained guilt upon the subject. This is at the center of her treatment needs. Indeed, she notes that "though our whole family shared the burden of my mother's anger, in my heart I suspected that part of it was my fault and my fault alone. Cancer is an obscenely expensive illness; I saw the bills, I heard the fights. There was no doubt that I was personally responsible...

I sat listening as some kind of penance." (Grealy, 9-10)
The combination of these cultural dimensions directs a treatment strategy aimed at deconstructing this internally constructed association between the subject's illness and disfigurement and her family's various dysfunctions. Ultimately, there seems a dissonance centered on the subject's physical condition and the impact which she believes it has had on others. A psychoanalytic strategy would have worked at dispatching with this cognitive dissonance.

Works Cited:

Croteau, J.M.; Talbot, D.M.; Lance, T.S. & Evans, N.J. (2002). A Qualitative Study of the Interplay Between Privilege and Oppression. Journal of Multicultural Counseling and Development, 30.

Grealy, L. (2003). Autobiography of a Face. Harper Collins Publishers.

Hwang, W (2006). Acculturative Family Distancing: Theory, Research, and Clinical Practice. Psychotherapy: Theory, Research, Practice, Training, 43(4), 397-409.

Leary, K. (1995). 'Interpreting in the Dark': Race and Ethnicity in Psychoanalytic Psychotherapy. Psychoanalytic Psychology, 12(1).

Rostosky, S.S.; Riggle, E.D.B.; Horne, S.G. & Miller, A.D. (2009). Marriage Amendments and Psychological Distress in Lesbian, Gay, and Bisexual (LGB) Adults. Journal of Counseling Psychology, 56(1),, 56-66.

Schuengel, C.; Sterkenburg, P.S.; Jeczynski, P.; Janssen, C.G.C.; & Jongbloed, G. (2009). Supporting Affect Regulation in Children with Multiple Disabilities During Psychotherapy: A Multiple Case Design Study of Therapeutic Attachment. Journal of Consulting and Clinical Psychology, 77(2), 291-301.

Szymanski, D.M. & Gupta A. (2009). Examining the Relationship Between Multiple Internalized Oppressions and African-American Lesbian, Gay, Bisexual, and Questioning Persons' Self-Esteem and Psychological Distress. Journal of Counseling Psychology, 56(1).