Clinical Rotations in Costa Rica, Week 2

This is Brian and Dot reporting from the Neuropsychological Clinic at UNIBE, Costa Rica. The second week included observations of the final testing sessions of our two young children and one adolescent. Tests evaluating attention, written expression, and perceptions of self and family were utilized. The mother of one of the examinees was interviewed in order to elicit a more thorough understanding of the boy’s development. As he was raised by his maternal grandmother in Guanacaste, a rural region lying northwest of San Jose, he did not have the same educational opportunities as those of his peers who grew up in the city. As a group, we are confident that the results of the psychological batteries will allow these youngsters to receive the necessary educational accommodations they so need and deserve. In addition to observing the administration of the final psychological batteries, we observed two therapy sessions conducted by a clinical psychologist in which she employed REBT (Rational Emotive Behavioral Therapy) with a young male and young female, both in their early twenties. Similar to CBT, in which the therapist examines the interaction between thoughts, feelings and behaviors, it was refreshing to see a more pro-active approach used in the first session, where the focus of the interview was on the clients’ presenting problem and their perception of it, not so much on biographical information. The male client presented with anxiety regarding the distancing of his girlfriend and his disillusionment in the lack of affection he was receiving. The female client, also presenting with relationship difficulties, more specifically dealing with depression, reported recent suicidal ideation. The therapist used REBT to challenge some of her irrational beliefs and provided the client with psychoeducation regarding the benefit of psychopharmaceuticals.

This is Elena reporting about clinical experiences in both Hospital Calderón and the Miguel Obregón public school. At the hospital, students observed a session with the head child psychiatrist on a case involving a nineteen-year-old female youth who experienced depressed mood and affect. The female’s mother was present in session, and was asked to be seated in a chair while the client and psychiatrist sat on the floor. The psychiatrist explained that this dynamic allowed for her to be closer to the client, while creating an authoritarian role for the mother. The psychotherapeutic approach in session contrasted with my training in the US in that initially it appeared that less emphasis was concentrated in validation and building therapeutic rapport, and rather more interrogation and advice-giving were utilized instead. The technique included using leading and close-ended questions, as well as commenting on what the client should/should not do. While at first this approach elicited a strong reaction in me, I feel like maintaining an open and flexible position in the matter was key, especially after learning more about the client’s history and diagnoses post-session. Nonetheless, after sitting in on other sessions and intakes, this style seemed to be normative. In the journey towards cultural competence, the importance of maintaining an open mind and being flexible about therapeutic approaches is becoming starkly apparent, as well as noting one’s reactions to said approaches. My experience at the Miguel Obregón public school was exciting and added the education piece to my snapshot of Costa Rican culture and society. I observed a fourth grade class of about 20 students move through subjects such as Math, Spanish, and Social Studies. I was impressed by the advanced material and eagerness of students to learn; I even had the pleasure of helping students with pre-algebra work! The children were allowed recess time (“recreo”) frequently, which seems to have aided in their excellent ability to focus in class. Students had many questions about the US, and were excited to share information about their country. What a treat to have been able to experience and reflect on such different settings and populations this week.

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