Marginalized Identities, Family Conflict, and Psychological Distress: The Process of Psychotherapy with a Chinese American Adolescent

This case study describes the process of psychotherapy with a second-generation Chinese American early adolescent who presented with internalized mental health symptoms and passive suicidal ideation. The therapist worked with the client over a two-year period and gradually uncovered deeper issues, specifically, her marginalized and multiple oppressed identities as a Chinese American, gay, and transgender male and the impact of these identities on her sense of self, her relationship with her parents, and her place in the world. Relational-cultural theory (RCT) provided a means to foster connections, provide a safe environment, and validate the sociopolitical realities that lead to psychological distress. Although there was initial difficulty implementing the cognitive-behavioral therapy (CBT) to treat the client's obsessive-compulsive disorder, this approach was effective later after the therapist had addressed the client's underlying concerns. The monthly family sessions also helped to improve the parent-child relationship. This case highlights the importance of incorporating relational, contextual, and cultural factors when working with ethnic and gender minority youth. Implications for counseling Asian American youth and parents are discussed. What is the public significance of this article? This clinical case study describes a treatment process combining relational-cultural therapy, cognitive-behavioral therapy, and family sessions for a Chinese American adolescent struggling with intersecting marginalized identities, mental health symptoms, and family conflict. It also highlights the importance of addressing relational, contextual, and cultural factors that impact the effectiveness of psychotherapy for Asian American adolescent clients.