Aaron is a 24-year-old, unmarried, heterosexual, Caribbean immigrant male who is experiencing symptoms of anxiety and depression. Aaron reports no history of mental health treatment nor any medical or legal problems. He admits to social drinking but denies use of illegal substances. He lives alone in a room he rents above the restaurant where he works. He works 24 hours a week as a waiter, has few friends, and is a part-time student at a local university where he is working on an undergraduate degree in biology. Aaron came to speak with me, a university counselor, because he is having difficulty concentrating and finding the motivation to study. Aaron denied any thoughts or plans of suicide or homicide and stated he felt hopeless and nervous.
In the first session, Aaron struggled with sustaining eye contact, presented as preoccupied, and was indifferent to the attempts to engage him in the intake process. When asked what he thought precipitated counseling, Aaron said that he had a difficult relationship with his parents who, he stated, “are not supportive and could care less” about him. He also reported that his younger brother was killed not long ago. When asked what he wanted to work on in counseling, he said that he wanted to address why his family was so “messed up.” Subsequent sessions explored Aaron’s perspective on his family, the strained relationship between Aaron and his parents, and the loss of his sibling.
During one session, Aaron said his parents had always favored his younger brother and overlooked his criminal involvement, which had been a source of conflict between Aaron and his parents for years. While it had not been confirmed, Aaron suspected his brother’s death was related to gang involvement. Aaron shared that his academic interests and achievement had been ignored by his parents and had never been a source of interest for them.
In a subsequent session, Aaron stated that he had always felt disconnected and different from his parents and brother. Aaron’s family immigrated to the United States from Guyana when Aaron was 8 years old and his brother was 2 years old. His parents brought only his brother and left Aaron with his grandmother, informing him they would bring him over when they were settled. Seven years later, at the age of 15, he joined his family. Aaron reported that reuniting with his family after all that time was difficult. Aaron had always felt rejected by his parents because they did not bring him to the United States with his brother. He experienced a void in his relationship with his parents and his brother, and he felt there was an unspoken alliance between his parents and his younger brother that he did not share. Aaron said that he was often made fun of by them for not losing his accent and for his use of their culture’s traditions and customs. They also ridiculed him for being homesick and missing his grandmother. He said that his parents rarely attended the West Indian activities he participated in, and when they did, they spent more time critiquing his performance than enjoying it.
In the following sessions, Aaron was encouraged to tell the story of his family and how the immigration process disrupted their connections with one another and how this may have affected their ability to grieve together as they faced the death of his brother. Using genograms and having Aaron educate me about his country, I was better able to understand his family’s immigration history and the roles played by extended family members. This approach allowed Aaron to talk more about how and when his anxiety and depression manifested. Later I learned that these symptoms had always been mildly present but became more acute after the death of his brother. Aaron grieved the loss of a brother and examined his feelings of loss around his relationship with parents who were both limited in their ability to include him in their own grieving processes.
After several sessions, Aaron was able to talk more openly about his frustration and disappointment with his family and identify the losses they had all incurred. He allowed himself the opportunity to grieve his brother and the lack of relationship with his parents and began to consider the possibility of a new relationship with them. Aaron reported a reduction in his feelings of anxiety and depression and resumed interest in his academic work. Aaron and I discussed termination at the end of the semester with a recommendation that he continue with individual therapy in the summer months.
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