How might you create space for Nikki to explore her gender identity and expressions?

Case Study of Nikki – Chapter 10

Nikki is a 17-year-old male-to-female transgender client. She was sent to counseling by her parents because of their concern that she has become more withdrawn in the past few months. They noticed that she spends much of her time alone in her room and sometimes does not go to school. They are fearful that she will not be able to graduate and go on to college. Nikki disclosed to the counselor that she began to be bullied by her classmates after she asked a friend to the Sadie Hawkins dance. Since then, her classmates have shunned her and she has not felt safe going to school. She mentioned that she would prefer to be homeschooled or to drop out of school. During the course of therapy, the counselor spent time validating Nikki’s experiences, providing psychoeducation to her parents about the effects of bullying, and advocating with school administrators to provide a safe learning environment for her. Nikki eventually was allowed to pursue independent studies while taking select classes with supportive educators who were able to provide her a safe space on campus so that she could work steadily toward graduating with honors.


Counseling Across Cultures (Kindle Locations 7421-7429). SAGE Publications. Kindle Edition.

  1. How might you create space for Nikki to explore her gender identity and expressions?
  2. Given your experiences of power, privilege and oppression, what types of countertransference might you have when working with Nikki?
  3. How might you better incorporate issues of gender and privilege in your counseling work with Nikki?

Case Study of Sean – Chapter 11

Sean, a 15-year-old multiracial (Native American, White, and Black) male, initiated services of his own accord to manage symptoms of depression, including suicidal ideation. Sean was academically advanced for his age and excelled as an artist and skateboarder. He prided himself most on his academic success, and he aimed to graduate from high school early and attend college. Sean had poor self-esteem and lacked a strong cultural identity. In the state where Sean resided, he could consent to treatment. He did so, stating that his father, who was his legal guardian, would not consent. The counselor developed a strong rapport with Sean. Sean was raised in a single-parent household. Sean’s father had a severe and chronic mental illness for which he received sporadic treatment, and he was currently stable. According to Sean, during his childhood he was placed in state custody for a year due to his father’s alcoholism and physical abuse toward him. Sean also spent a year living in a homeless shelter with his father. During this time, he was required to attend therapy, which he found unhelpful to his family. Sean’s father believed it was yet another example of the “White man trying to destroy the Indian.” Sean’s siblings were all incarcerated. His grandparents experienced relocation, boarding school abuse, and slavery. Sean’s immediate family was relatively isolated because of his father’s outrageous behavior. Sean reported that his father would often denigrate him. One day, Sean was limping when he arrived for a therapy session. When asked what had happened, he stated that his father had been angry with him for not doing well in his Native language class and had taken a belt to his legs and then shoved him through the screen door, breaking it. Sean further reported that his father’s fits of rage were a rare occurrence (every few months) and Sean had learned to manage them by accepting the abuse. The counselor reminded Sean of his duty to report child abuse or neglect. Sean then attempted to downplay the story, reporting that he had fallen through the door himself. Sean asked that the counselor not report the incident because he feared being taken away from his father again; Sean felt that his father depended on his care. He was also concerned that any type of investigation would disrupt his schooling and cause his grades to suffer. The counselor was conflicted about whether to report. He considered the following points: (a) client safety, including assessment of the severity, frequency, and impact of the abuse and the vulnerability of the client; (b) obligation to report given the state laws around child abuse and neglect; (c) psychological benefit versus harm to the client as a consequence of reporting, including betraying the client’s trust, potential family fragmentation, and loss of stability, predictability, and family social supports in the client’s environment; (d) client level of independence and maturity; and (e) concern regarding the client, family, and community perceptions of social services as a systemic enactment of violence on families. Sean’s family had experienced generations of marginalization and victimization enacted through systems meant to uphold social policies. The counselor consulted with several colleagues. In addition to emphasizing the legal and ethical obligations of the profession, one colleague asked, “What if something more violent or lethal were to happen to this child and you did not report? Would you be able to live with that?” The counselor decided that he could not. He talked with Sean about the need to report, encouraging Sean to report with him, but ultimately the counselor made the call. The counselor had plans to work closely with the family if the case was investigated, to ensure that the caseworker considered the family’s context and culture. He also hoped to help the adolescent develop a safety plan and build broader networks of social and cultural support while also continuing to support him in his academic strengths. However, after the counselor reported the abuse, Sean did not return to counseling.


Counseling Across Cultures (Kindle Locations 7999-8029). SAGE Publications. Kindle Edition.

  1. What are the different contexts of marginalization that may have been at play in this situation? How might your experiences of marginalization influence your perspective and choice to report?
  2. How well did the therapist behave in accordance with: (a) the legal standards, (b) the ethical standards of conduct in psychology, (c) the ethical standards of conduct with racial/ethnic minorities and marginalized groups, and (d) personal ethics? Where do the standards conflict or align in regard to this case?
  3. How do you think the therapist’s choice to report affected the client’s marginalization and other issues for which he sought help in counseling? How do you think the client might have been affected if the counselor had not reported?

Case Study of Ling and Mohammed – Chapter 12

  1. Given the information on Ling provided in this chapter, as Ling’s therapist, how would you attempt to strengthen the working alliance by helping her to surface some of her “culture teachers” (Pedersen et al., 2008) and their influences on her decisions and experiences?
  2. Given the information on Mohammed provided in this chapter, what hypotheses do you make regarding his reluctance to focus on his home country? What do these hypotheses imply about the similarities or differences between your worldview and Mohammed’s?
  3. What ethical responsibilities do counselors have for addressing racism and other forms of oppression directed toward international students?

Case Study of Eduardo – Chapter 13

Laura is a counselor at a small, private, progressive, and predominantly White university in the northeastern United States. Laura is a White, straight, U.S.-born cisgender woman of Dutch descent who graduated from an Ivy League university. She has been a mental health practitioner for the past 8 years and considers herself to be an effective and competent clinician. For the past 2 months, Laura has been working with Eduardo, a 19-year-old cisgender man, a freshman at the university, who initially presented with a depressed mood, inability to concentrate, and general anhedonia. Eduardo is an immigrant from the Dominican Republic; he was 5 years old when he arrived in the United States with his family. He grew up in the Southeast, which he considers home and where his family still lives. He is the eldest of four siblings (María, Carmen, and Lissette are 14, 12, and 6, respectively) and the first one in his family to go to college. Eduardo’s parents, who are extremely proud of their “college boy,” worked multiple jobs while he was growing up and now own a small neighborhood restaurant. Eduardo works there during school breaks and is studying business so that he can take over the management of the restaurant and allow his parents to retire. In the course of treatment, Eduardo discloses that for the past 6 months he has been having erotic encounters with men. He discounts these encounters as “just playing” and, after a recollection of every encounter, he tells Laura about his plans to get married to a woman and to have a large family. He tells Laura that he is not gay, because he is “very masculine” (un tigre) and always the “top” during sex, which he considers comparable to having sex with a woman. Lately, Eduardo has been talking a lot about one particular young man, Clive, with a lot of tenderness and affection. Eduardo talks about Clive wanting to go on “real dates” and finds these requests “ridiculous,” as he does not date men. At the same time, Laura notes Eduardo’s worsening mood and apathy turning into passive suicidal ideation. She is familiar with research linking closeted homosexuality with negative psychological consequences. Since coming out is empirically correlated with improved mental and general health functioning, Laura is convinced that Eduardo’s worsening mental health is related to his inability to come out and decides that she will assist Eduardo with this process. Laura’s therapeutic goals are not easy to implement, however. No matter how gently she brings it up, Eduardo becomes angry and, at times, leaves sessions prematurely. At one point, Laura shares her experience of being the only nonlegacy student among her friends at her Ivy League university in order to show Eduardo that she knows what it means to feel different and not always accepted. She also shares the story of her gay cousin, who came out about 10 years ago. She states that she knows how hard it is to come out, but she imagines that things must be so much easier for gay people now than they were for her cousin. Laura’s disclosure is met with a blank stare from Eduardo. One day, Laura looks around her office and notices that none of the books or pamphlets she has available relate to “gay issues.” She makes an effort and brings in pamphlets advertising the university’s Gay, Lesbian, Bisexual, and Queer Student Union. At Eduardo’s next session, she asks him if he would be willing to go with her to the organization’s open house the next week. Eduardo’s eyes well up with tears. He says, “I cannot believe you. You have no idea who I really am.” He storms out of the room and does not come back for his next three scheduled appointments.


  1. What assumptions does Laura appear to be making about the etiology of Eduardo’s symptoms?
  2. What are some of the important intersectional issues (in terms of gender, sexuality, and ethnocultural background) at play for Eduardo? What are some of the important intersectional issues at play for Laura?
  3. What sexual orientation microaggressions can you identify in Laura’s interactions with Eduardo?