Multicultural Considerations with a Substance Abuse Client

Van is a 26-year-old multi heritage male. Over the past 6 months, Van’s use of alcohol and marijuana has increased significantly. His usage has coincided with his disclosure to his parents that he is gay, which conflicts with their beliefs and values. He thinks he has let his parents down and feels depressed and isolated. Van has been attending counseling for the past month. In this session, the discussion focused on understanding substance use and cultural expectations.

Counselor: Van, we’ve been talking the last several sessions about your coming out process and how this has devastated your parents. You knew telling your parents that you’re gay was going to be hard, but you didn’t think it was going to be this painful. They are very angry and disappointed.

Van: I didn’t want to disappoint them, but I couldn’t keep living this lie. They were pressuring me to settle down, get married, and have a family. They believe I’m making a choice to be gay as an act of defying them. The weight of their anger and disappointment sits heavy in my heart.

Counselor: I’m sensing your pain as we talk and the heavy toll it’s taking on you. Tell me more about your parents’ cultural beliefs about being gay.

Van: In my culture, being gay has always been viewed as some sort of defect and has been looked down on. My parents don’t support this lifestyle and believe it’s sinful. They made it clear that they would never accept this lifestyle in any of their children. I was always fearful because I knew I was gay for a long time.

Counselor: You knew deep down that identifying as gay meant you’d never be accepted by your parents so you turned to alcohol and drugs as a way to numb the pain.

Van: Well, it’s a lot easier to drink and get high to take away the pain than to feel it. Yet I still feel it and sometimes it only magnifies the feelings. Maybe I should just give them what they want because I see how much it is hurting them and me. It’s so confusing and I don’t know what to do.

Counselor: You’re questioning yourself and thinking giving them what they want will make everything better. (Van looks dejected, like he is feeling lost and confused. It is clear he is struggling with his truth versus family and cultural expectations.)

Van: Yeah.

Counselor: (Using an advanced empathic statement to make the implicit message explicit.) Van, as we’ve been talking today and over the last several sessions, might it be that you can’t accept yourself as a gay man unless your parents can also accept you in that way? That you have struggled for a long time with the realization that being true to who you are means alienating your family? Knowing that you’re disappointing them has led to alcohol and drugs as a way to numb the pain. Yet the pain never goes away.

Van: (Van sits for several minutes in silence reflecting on the counselor’s response.) I just wanted the pain to stop, but how can it as long as I keep denying who I am. I can’t control how they see me, but I can control how I see myself and how I want to live my life. I’m really tired of feeling like I have to be something I’m not. I need to find other ways of dealing with this problem, and I realize using alcohol and drugs is not solving this problem.

Counselor: You want to be true to yourself and find healthier ways of dealing with the pain. We can use our time together to explore what cultural expectations and messages you want to embrace while finding healthier ways to deal with painful emotions.

A multi culturally competent counselor examines any value conflicts and biases that arise as the client is telling his story and addresses them. The counselor also attempts to see the presenting problem from the client’s worldview. Strategies for change will likely require exploration and resolution of conflicting cultural messages and healthier ways of coping as the client moves toward embracing his identity.

Discussion Questions

1. What other strategies for change should be integrated into the work with Van?

2. How should the counselor go about dealing with the substance abuse concerns?

3. What other cultural issues do you believe should be considered and why?