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, a.

1. 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.

2. 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

3. 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.