Case Study 7

“The child who sees ghosts every night: Manifestations of psychosocial and familial stress following immigration" (Fang, Lee & Huang, 2013) case study demonstrates how the sociocultural factors and cumulative stressors associated with migration experiences can significantly impact on each family member, as well as the family unit as a whole. This case study can be requested free of charge from your DHB library service or academic provider.

Brief background of the case

Joey and his parents are first-generation immigrants from a suburban area of Southern China. Arriving in the United States at age 6, Joey had only 1 year of preschool education in China and has received most of his formal education in the United States. Joey has acculturated to western culture, while his parents, who moved in their 30s speak little English and strongly adhere to their traditional cultural values and practices.

The presenting issue in this case, namely ghost-seeing, was understood by the attending clinician from a culturally relevant perspective. Rather than focusing on the boy (Joey) seeing ghosts as the treatment target, the therapist uses Joey’s experiences as a vehicle to assess and identify the possible underlying mechanisms for his symptoms.

The case demonstrated successful strategies used by the therapist to engage with Joey and his parents:

• The therapist while empathising with the struggles that Joey and his parents had undergone as migrants, honoured each family member’s strengths and commitment to rebuild family cohesion, and focused on assisting the parents to improve their family relationships as well as their work and housing situation.
• The therapist applies cultural assessment skills in making a differential diagnosis.
• The therapist laid out a tentative case formulation and treatment plan during the initial visits, allowing Joey and his parents to have a clearer sense of treatment goals and plans and consequently result in a shared treatment approach.
• With the treatment plan focusing on the family as a whole, both Joey and his parents were supported while working toward positive family changes.

The case formulation includes exploring the following:

• What should the diagnostic formulation be for Joey?
• What other diagnoses could be considered in making a differential diagnosis?
• What culture-specific information will be needed to make an accurate psycho- social assessment of this case?
• What do you know about the cultural explanations for Joey’s illness?
• What factors in this case assisted Joey’s parent’s effective help-seeking behaviour and therapeutic engagement?