Mimi, a 19-year-old, first-generation Hispanic-American college student

Mimi, a 19-year-old, first-generation Hispanic-American college student in her second year at the university, arrives at the university counseling center, accompanied by her roommate, Dana. Mimi is reluctant to complete the initial paperwork and complies only after being informed that it will help the therapist better understand her needs. She identifies as a single female and declines to report her sexual orientation. On her intake form, her top three concerns are listed as academic concerns, depression issues, and family concerns. Mimi is accompanied to the appointment with her roommate Dana. Mimi has requested Dana attend the appointment with her to make her feel more comfortable. As the nurse practitioner, you enter the room to introduce yourself and begin your visit. You begin your assessment of Mimi. While staring at the floor with her legs crossed and both hands covering her face, Mimi shares that she stopped attending class 6 weeks ago because she is “not sure of the point of going to school anymore.” Her appearance is disheveled. She learned last month she has not been admitted to the College of Business and therefore needs to choose another major, which has increased her anxiety. Since she stopped attending class, Mimi feels increasingly sad and has difficulty concentrating, finding herself preoccupied with thoughts of “what went wrong” and trying to imagine what her future might look like. She states that the only reason she came to the university was to “major in business, get a high-paying job in consulting, and take care of my parents.” She reports having a twin brother, who also attends the university and is doing well as a computer science major. Mimi responds to questions without elaboration. Dana interjects that Mimi’s parents have tended to “play favorites,” and Mimi often feels like the “other child.” She states that Mimi has been having difficulty sleeping at night and feels tired most of the time. Dana goes on to indicate that she became concerned after Mimi failed to leave her room for 3 days in a row, and she says Mimi looks like she has lost 10 pounds over the course of 2 months. Dana says “I know that she has enough pain pills to kill herself if she wanted to. She says I’m being ridiculous.” Mimi states she is currently at a 2 on a 1-to-10 scale on suicide likelihood. She has considered suicide because “if I let my family down, there is nothing left to live for, and God will understand as I would no longer be a burden to my family.” She denies current suicidal ideation, plan or intent. When you ask about the pain pills Dana mentioned, Mimi says that she does have some pills left over from a prescription when she had a knee injury over a year ago, but she would not use these to harm herself. She denies engaging in other self-harm behaviors (e.g., cutting) or contemplating harming anyone else. She denies auditory or visual hallucinations. She drinks alcohol rarely and denies illicit drug use. When asked about strengths, she states she is a good volleyball player and is considerate of others. Mimi’s parents own a restaurant where she and her brother worked while in high school. Her parents immigrated to the United States to provide greater educational opportunities for their children. Her parents repeatedly tell her of the sacrifices they made for her and emphasize their expectations for academic success. She is scolded if she fails to answer their calls and if she is not in her room by 10 p.m. Mimi is worried that if she cannot find a way to get into her preferred major, her family will once again disapprove of her and blame her for not trying hard enough. She says, “I’m a disappointment.” Mimi states that she is open to therapy but is not confident it will help her “unless it can get me into my major.” She reports attending three sessions of family therapy several years ago when her mother was having some type of “emotional problems” and she doesn’t recall this being useful for the family. The following questions need to based on the above case. Explain how use of a multicultural perspective (ethnicity and culture) might increase the likelihood of successful treatment outcomes.

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