Question 1: Working with Jacinta requires the therapist to be culturally competent. Jacinta’s intake resulted in a diagnosis of PTSD and Delusions because of her feeling as if her soul has left her body, when Jacinta’s family culture views this belief as common given her symptoms. Three urgent actions occur to me almost simultaneously: Employing mindfulness techniques such as grounding in our work together to increase Jacinta’s felling of safety and presence in the here-and-now; advocating for her to transfer into the program’s women’s Seeking Safety group because it would be more appropriate and helpful to her; and consulting Jacinta’s family and/or community at large about Susto, specifically inquiring about interventions or treatments that have been known to help people afflicted with Susto.
Question 2: Because Jacinta is more knowledgeable about Susto than I am, I would ask Jacinta to tell me more about it, including everything she has heard about it, how it resembles what she herself is feeling, if she knows anyone else who has/had it and what might have helped them, and whether she has any ideas about what might help HER with it. I would also take what I know about trauma and its effects and try to weave it into the framework of Susto in order to connect what her cultural experience with the broader context of TIC. As mentioned in #1 I would also incorporate any information I got from her family and/or community about Susto to show that I hear her, take it seriously, and respect her cultural perspective.
Question 3: I do think the women’s Seeking Safety group that’s part of the agency with which she is already connected sounds like a viable alternative, as it might streamline the referral, acceptance, and paperwork process, provided this arm of the IOP program seems effective and culturally sensitive (hopefully I would be in a position to ascertain this). I would also consider changing her diagnosis to eliminate Delusions from her record if I could.