Ethnic awareness in the cognitive behavioral treatment of a depressed African American female

Abstract

This case depicts an African American female who is currently depressed and experiences what appear to be anger attacks where she responds to perceived threat with verbal aggressiveness. As a result of these problems, the patient has experienced occupational and interpersonal difficulties. The following case formulation represents a blend of traditional cognitive behavioral therapy (CBT) with cultural sensitivity and cultural competence. Consistent with traditional CBT, the primary problems are first partitioned into their cognitive, behavioral, and affective components. Then, specific CBT techniques (e.g., behavioral activation, role-playing, and cognitive restructuring) are employed to manage the patient's depression and anger attacks. Along with these traditional techniques, several factors related to the patient being African American are discussed, specifically, the relationship between the patient's ethnicity, early termination, and the necessity of therapist flexibility. In addition, consideration is given to the role that culture may play in the expression of anger as well as to the relationship between culture and the utilization of techniques to decrease attrition and increase the patient's perceived empowerment. The combination of CBT and cultural sensitivity/competence are conceptualized as necessary for the successful treatment of African Americans in general, and this patient in particular.