A Sea of Trouble: A Relational Approach to the Culturally Sensitive Treatment of a Severely Disturbed Client

In this article we will show how a relational approach provides a conceptual framework that shapes and informs culturally sensitive practice with a severely disturbed client. We argue that a relational approach facilitates therapeutic action through the intense focus on countertransference, the close attention to enactments, and the therapist's authenticity and self-disclosure. Additionally, we emphasize that a therapeutic matrix that includes the cultural, racial, socioeconomic, and institutional factors, increases the likelihood clinicians will attend to what Perez-Foster calls their dissociated and disavowed personal values. We present a case that had a less than satisfactory outcome where the therapist found herself in a sea of trouble. The case illustrates how a relational approach enhanced the therapist's understanding of the case and allowed her to continue to work with a difficult and challenging client. We conclude by suggesting that our conceptual understanding of this case exemplifies a necessary and appropriate focus for future social work research and practice.