Middle Phase

The focus of treatment was his role transition since the accident and the ensuing role dispute with his girlfriend as the sole provider for the family. He subsequently set goals for treatment: to overcome anxiety and depression related to feeling unproductive, to relearn how to make a living and provide for his family, and to feel less anger and hostility in interacting with his girlfriend and others around him.

During subsequent IPT sessions the therapist began each session asking Sr. A about his thoughts and feelings about himself since the accident and how things were going in his relationship with his girlfriend. The therapist found it challenging to elicit Sr. As feelings about this transition for two cultural reasons. He avoided discussing his feelings because they entailed the unappealing, culturally dystonic role of a weak male unable to provide for his family. Providing and sacrificing for the family is part of the ethos offamilismo and an important part of Sr. As identity, one that had made him feel competent and proud but now elicited feelings of inadequacy, low self-esteem, and sadness. Sr. A also revealed that discussing his feelings would contradict his strong belief in God, in whose hands matters lay.

The therapist reframed the importance of emotional expression by using cultural idioms such as desahogarse to describe unburdening oneself of painful emotions. The therapist also facilitated his expressing emotions within the context of Biblical passages and interpretations. It was important during this phase and throughout treatment that the therapist took a stance characterized by simpatia and formalismo. “Senor A, you [formal: usted] mentioned that during the past week reading from the Bible and reflecting on your experience and emotions has helped your mood. As I had mentioned to you, I am not familiar with the Bible as you are. You mentioned that sharing the word of God is the evangelical way and I wonder if you would be willing to share with me passages that you feel relate to your experience since the accident, or even how you have been interacting with your girlfriend"

Sr. A was enthusiastic about this idea and each week recited Biblical passages that he believed pertained to his experience and emotions. Discussing his immigration experience and perceived social injustice freed Sr. A from feeling trapped and allowed him to explore options such as vocational rehabilitation and practical solutions to his immediate life problems.

As he felt more comfortable expressing his emotions, Sr. A experienced relief in his mood symptoms. Through the use of Bible passages and role-plays in session, he began to express his emotions more freely to his girlfriend and his pastor. Sr. A reported less irritability and conflict with his partner, which gradually led to decreased social isolation overall, as he and his family began to socialize at church outings and extended family gatherings.

Having achieved two of his three goals for treatment, the therapist and Sr. A began to explore steps that he could take to become more productive and to find employment. The therapist introduced this idea of problem solving by using another Hispanic concept,poner de suparte (the need to do one’s part), to encourage patient agency in confronting or resolving conflicts. Interactions at church presented Sr. A with the opportunity to give conferences at church meetings. Sr. A also partnered with a friend who owned a natural medicine store in his neighborhood to write a natural medicine newsletter for sale in the store. At week twelve, Sr. A also began doing volunteer work caring for the elderly, and delivering sermons over a local Hispanic religious radio station.

Termination Phase

Sr. A believed that prayer and waiting patiently brought him to therapy. By termination of treatment, he reported an improvement in his mood symptoms (Ham-D-17 score = 8) and attributed this to the love of God, the therapy, the opportunity to start vocational rehabilitation, and his conducting religious services over the radio.

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