An example of  a socio-cultural approach to therapy will best    illustrate its clinical application.  A twenty-two-year-old woman was  brought in by her husband because of depression and anxiety. She complained that she was depressed because of frequent episodes  of  panic during which she was convinced she would die. She was a thin,   taut, attractive young woman in obvious panic, with a pulse rate of  144 and rapid breathing. She spoke in a meek,thin, and whining voice and looked away from her husband.  She was the only daughter of  religious European-born parents who, when she was eighteen, arranged a  marriage to a highly religious man. They had two children.

The husband complained that his wife, previously a scrupulously clean, orderly, and attentive housewife, had begun to sulk and to neglect the home and the children.She gradually became more depressed and  periodically panic-stricken. The patient was given a short-acting  tranquilizer for a few days to reduce her panic, hyperventilation, and   rapid heart rate.  The therapeutic encounter was a difficult one     because of her reluctance to reveal her feelings about her personal   situation.  After some period of confronting her with evidence of  her rage and the need deal with it, she was able to confide her sense of entrapment  in a marriage to a man she doubted she loved, her sense of  having been placed in servitude,and a bitter resentment about being deprived of an education and a career. The therapist proposed that she continues to clarify the sources of her anger, and that she  makes  moves to correct her situation rather than  “go on strike.”  Her panic seemed due to her feeling that she was losing everything. Her  physical symptoms soon abated but her depression persisted.

As the couple was seen together, she gained the courage to demand         an opportunity for education and for fewer religious strictures. The therapist tried to help them come to some agreement on these  issues and to develop a more loving relationship. Both the husband’s and the wife’s parents (who were also seen)  did not believe that the wife needed a college education or that she should take the time from her      home responsibilities. Psychological testing, done to assess her career potentials, revealed a passive, angry person with an intelligence  so superior that it almost reached the limits of the test.

Her husband finally agreed to her finishing high school and  beginning college. However,he soon felt threatened by her rapid progress and began to disparage her. She gradually realized that she really didn’t love him and couldn’t continue to  live with him. When she  confronted  him with this, he became abusive and she had to flee to her parents’ home.

The patient required several years of  weekly or  intermittent therapy  to help her deal with her real frustrations and privations and to arrive at partial and gradual solutions. She also required help from   community support systems and from her family. Therapy later   focused on assertiveness training so that she could deal with people in a full-voiced and firm manner without being competitive or controlling.

The patient is now divorced, has finished college, and is a part-time instructor in college while attending a graduate Ph.D. program. She is  now functioning constructively in a changed cultural milieu. She has  been caring for her children while she works and studies, and has been able to be compassionate and helpful with her parents.It is  interesting that they, because of their specialized cultural values, mournfully view  their daughter’s present status as a failure. After her divorce her  father became depressed and also required therapy.

The therapeutic attempts for this family required close attention to   and manipulation of  the  socio-cultural institutions that had  helped      shape and limit the lives of the family members. These include, to  mention only a few, the limited mobility of  women in our culture and other conflicts intrinsic to the transcultural situation of this particular family.

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