Korean American Mr. G

1. Korean AmericanMr. G Kryn M. Palmquist Colleen Chahal

2. Assessment • Name: Mr. G • Age: 40 • Gender: Male • Identifying Information: • Client is a 40 year old Korean American Male. Arrived in the USA 5 years ago, and has limited English capabilities. Currently owns and operates a Laundromat.

3. Reason for Referral • Referral made by CPS. Client has started to drink heavily and was visited by CPS after his children reluctantly described his disciplinary methods to the school counselor. • In general, racial minorities under utilize mental health services (Ford, 1997). Mr. G would not be in counseling if he was not referred by CPS.

4. Chief Complaint/History of Present Illness Client reports feelings of unhappiness, sense of losing the traditional roles of his culture, and downward shift in his occupation.

5. Family History Wife: Mrs. G Married for 15 years Children: John (8) Suzy (10) Parents: deceased Siblings: 2 in Korea, but has not spoken to them since he moved to the United States Describe relationships at home: Conflicting with wife about child rearing

6. Social History Peer Relations: Does not have many friends. Is working 60 hours a week. Relationship with Authority- good Hobbies: In Korea he enjoyed gardening, but is having trouble finding the time to do so in the United States

7. Abuse History Physical: Denied Sexual: Denied Emotional: Denied Neglect: Denied

8. Substance Abuse Alcohol: Has started drinking heavily Cigarettes: Denied Drugs: Denied

9. Medical Early arthritis in the knees Allergies: Bees

10. Symptoms The client’s symptoms include: depressed mood (3-Moderate), anxiety due to downward shift in occupation (3-Moderate)

11. Impairments: Impairments in functioning include: arguments with children and wife (3-Moderate), Feelings of shame (2-Mild), achievement below intellectual ability (4-Severe) and disinterest and lack of motivation (3-Moderate), frustration with majority culture misinterpretation of disciplinary actions

12. Risk Factors: • Suicide: None • Physical Violence: Mild • Has harsh disciplinary punishments for children • Substance Abuse-Moderate- has recently started drinking heavily

13. Strengths/Weaknesses Strengths: gardening, business owner, educated, good ability to establish rapport, strong family support Weaknesses- language barrier, communication problems with children, working below ability, acculturation differences within family

14. Mental Health Status The client appears stated age. Regarding level of consciousness, he appears alert. Affect is appropriate. Mood is okay. He presented himself in an appropriate fashion. Eye contact can be described as poor. His speech is heavily accented. Recent memory appears intact. Remote memory is intact. Psychomotor activity can be characterized by no abnormal involuntary movements. Regarding conceptual disorganization, there is none evident. His thought content is characterized by no significant preoccupations. Attitude can be described as defensive. As far as insight is concerned, poor. Judgment is fair. Attention/Concentration is characterized by ability to attend and maintain focus. Appetite: fair. Sleep: fair.

15. DSM-IV Diagnosis • Axis I: V62.4 Acculturation Problem (primary) • 309 Adjustment disorder with depressed mood • Axis II: V71.09 No Diagnosis or Condition on Axis II • Axis III: Arthritis, Allergic to bees • Axis IV: discord with family, acculturation difficulties • Axis V: 65

16. Clinical Formulation: Client is a 40 year old Korean American male. Client is presenting adjustment problems as evidenced by drinking heavily, feelings of alienation, and depressed mood. Client is also presenting with acculturation difficulties within his family and community as evidenced by achieving below working capabilities, frequent arguments with family members, and struggles with intergenerational roles.

17. Treatment plan All identifying information (name, date, location, strengths/weaknesses etc. ) DSM-IV Diagnosis

18. Problem 1/Goal 1 • Problem 1: Conflict with family members. • As evidenced by: harsh disciplinary actions towards children, arguments with wife over child rearing • Goal 1:Client will be able to communicate effectively with wife and children decreasing use of disciplinary action for 3 months.

19. Objectives for Goal 1 Client will learn about Acculturative Family Distancing (AFD) and differences between children and parents acculturating to the same culture (Ahn, Kim, & Park, 2009). Client will learn about the American education system Client will keep and attend all scheduled appointments Client will explore opportunities for ESL classes

20. Problem 2/Goal 2 • Problem 2: Depression and adjustment to new culture. • As evidenced by: drinking heavily, feelings of shame and betrayal by family, feelings of loss of traditional role • Goal 2: Client will increase Beck’s Depression Rating Scale to an average level in 3 months.

21. Objectives for Goal 2 Client will complete Beck’s Depression Rating Scale Client will reduce drinking to a healthy amount Client will identify feelings of depression Client will learn and apply evidence based coping skills when feeling depressed

22. Interventions Therapist will help client explore religious ties to the community (Lee, 2006). Therapist will help client find prevention programs to teach families on how to recognize and handle their intergenerational differences Therapist will educate client about counseling through psycho-education (Kim, 2005).

23. Interventions Family sessions Therapist will empower client to increase English proficiency to a level commiserate with teaching standards (Sue & Sue, 2008). Therapist will teach client evidence based coping skills Therapist will refer client to Mental Health Association’s Parenting Education Class.

24. Treatment Cognitive Behavior Therapy Family Therapy (Axelson, 1999).

25. Discharge Criteria Client will have raised his score on the Beck’s Depression Rating Scale to an average level Client will have utilized evidence based coping skills to decrease depression symptoms Client will have improved communication with his wife and children to the point where physical discipline is rarely if ever used

26. Review of Signatures I have reviewed this document, have been given the opportunity to provide input, and accept the information contained within. Response: Yes Client: _________________________________    Date: _____ Psychiatrist: ____ ________________________     Date: ______ Provider: Kryn M. Palmquist and Colleen Chahal Cattaraugus County Department of Community Services 1 Leo Moss Drive, Suite 4308 Olean, NY 14760 Title: BS, Mental Health Counselor Intern, SBU ________________________________________ Provider Signature ____________________ Date

27. References Ahn, A. J., Kim, B., & Park, Y.S. (2009). Asian cultural values gap, cognitive flexibility, coping strategies, and parent-child conflicts among Korean Americans. Asian American Journal of Psychology, S(1), 29-44. Axelson, J.A. (1999). Counseling and development in a multicultural society (3rd ed.). Pacific Grove, CA: Brooks/Cole Publishing Co. Ford, D.Y. (1997). Multicultural issues in counseling. In C. Lee, Increasing multicultural Understanding(pp.81-169). Alexandria, VA: American Counseling Association. Kim, Y.S.E. (2005). Guidelines and strategies for cross-cultural counseling with Korean American clients. Journal of Multicultural Counseling and Development, 33, 217-231 Lee, K.S. (2006). Navigating between cultures: A new paradigm for Korean cultural identification. Pastoral Psychology, 54, 289-311 Sue, D. & Sue, D.W. (2008). Counseling the culturally diverse: Theory and practice(5th ed.). Hoboken, NJ: John Wiley & Sons, Inc.