Sunil in Treatment: Sunil Intake,

SUNIL

In Treatment: Sunil

Intake, Axis 1-5 diagnostic, outline of treatment initiatives specific to Sunil

Sunil is a retired widower from Calcutta who is currently living with his son and his son's family in New York and is experiencing cultural and familial conflicts with the family, as well as physical distress about the arthritis he has in his knee. According to the Axis I: Clinical Disorders of the DSM, Sunil could be said to be experiencing major depression precipitated by his sudden shift in lifestyle and the death of his wife. Although some might classify Sunil as experiencing a personality disorder according to Axis II: Personality Disorders and Mental Retardation, such as obsessive-compulsive disorder based upon his need for control, it is important to remember the cultural conflicts between himself and his family and the particular, non-Western cultural situation from which Sunil originates.

According to Axis III: General Medical Condition, Sunil has physical problems with his knee, which impairs his mobility. According to Axis IV: Psychosocial problems, Sunil is experiencing problems with his adult child and his extended family on an immediate level, thanks to his shift in living circumstances. He has nowhere else to live and misses his homeland and his former relationship with his wife, over which he had more control. An Axis V overall global assessment suggests that Sunil is functional, but needs further therapeutic assistance in culturally adjusting to his lifestyle change;, dealing with the death of his wife; and assistance in adjusting to his current level of physical mobility as well as a more overall, deeper sense of a loss of control over exterior circumstances.

ESSAY 2: RESPECTFUL counseling

Sunil enters into the therapeutic relationship somewhat hostile, given that the give and take of the 'talk therapy' assumed to be normal as a part of Western culture is not part of his overall worldview. Rather than seeking to pathologize this, his perspective must be accepted as 'real to the patient.' Dr. Weston, rather than challenging Sunil's discomfort, allows Sunil to discuss his resistance to therapy and Sunil's belief structure regarding therapy as part of the process. The most effective part of Dr. Weston's process was that the therapist did not state that Sunil was 'wrong' in the man's beliefs that the Western modality of therapy was overly tolerant of weakness.

Dr. Weston realized that Sunil was feeling ineffectual and powerless as a result of his current life circumstances. Sunil's willingness to return indicates that this approach was effective. As a therapist, I would not judge Sunil and would allow him to direct the initial phases of the process. Rather than immediately delving into the loss he had experienced after his wife's demise, for example, I would allow Sunil to talk about what might seem like rather petty grievances attached to his immediate living situation. Sometimes talking about external, mundane circumstances are a conduit to exploring to deeper issues; moreover, it is not my place as a therapist to judge what is 'most significant' or insignificant.

ESSAY 4: Bronfenbrenner's (1976, 1988) description

On the microsystem of Sunil's immediate psychological conflict, through talk therapy and perhaps the use in the future of some antidepressants (depending on Sunil's feelings about the use of medication), Sunil's mood disorder may be treated. The mesosystem of dealing with family conflicts may require equipping Sunil with more effective techniques to cope with the conflicts between his children or a family-wide therapy session to create a more effectively integrated and responsive family structure. The exosystem of larger cultural awareness requires an understanding of the therapist's part of how not all cultures are equally supportive of therapy and that many cultures support a more patriarchal dynamic than is acceptable in the west or would be acceptable to Sunil's larger family. A non-judgmental, culturally sensitive approach during all individual family situations is required.