Wk2 Discussion: Self-Care Plan Summary and Refection

CHAPTER TWO: CULTURALLY

EFFECTIVE HELPING

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∗ Culture – “That complex whole which includes knowledge, beliefs, arts, laws, morals, customs, and capabilities acquired by a person as a member of society. It is a way of life of a group of people, the configuration of all the more or less stereotyped patterns of learned behavior which are handed down from one generation to the next through the means of language and imitation” (Adler 1997). Wk2 Discussion: Self-Care Plan Summary and Refection

What is Culture?

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∗ Knowledge of one’s own cultural biases.

∗ Basic knowledge about a variety of cultures.

∗ Willingness and ability to use skills and techniques that better match the culture of the client in crisis.

∗ Experience in counseling and crisis intervention with clients of a different culture.

Four Attributes of Effective Multiculutral Crisis

Intervention (Kiselica, 1998)

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∗ There is a universal measure of “normal” behavior.

∗ Individuals, rather than groups, are the foundation of all societies.

∗ Definitions of presenting problems are limited by professional disciplines.

∗ Western culture relies on abstract thinking.

∗ Independence is valued over dependence.

∗ Professional Counseling is better than natural support systems.

Ten Culturally Biased Assumptions

(Pederson, 1987)

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∗ Linear causality is more accurate than circular causality.

∗ Individuals need to change to fit the system.

∗ The client’s history does not affect the current situation.

∗ Interventionists are aware of ALL of their biases.

ALL TEN ASSUPMPTIONS ARE FLAWED!

Ten Culturally Biased Assumptions Cont.

(Pederson, 1987)

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∗ Universal vs. Focused ∗ Universal View examines racial and

ethnic minorities, as well as special populations.

∗ Focused View examines only “visible and racial ethnic minorities.”

∗ Etic vs. Emic ∗ Etic – one dimensional or linear lens ∗ Emic – gestalt or circular lens

Multicultural View of Crisis Intervention

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∗ What is the client’s world view? ∗ Self-concept, sense of well-being,

emotional control, and relational and attributional styles

∗ Opposing Views ∗ Individualism vs. Collectivism ∗ High-Content vs. Low-Content ∗ High-Uncertainty vs. Low-Uncertainty

Worldviews

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∗ Victims of a crisis base their ability to overcome the trauma by relying on their own set of cultural survival skills.

∗ May be significantly different from the cultural skills of the crisis worker.

∗ Not recognizing the client’s worldview may lead the crisis worker to make grievous errors in assessment and treatment of crisis intervention.

Multicultural perspectives in Crisis Intervention

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Individualism Vs. Collectivism

Individualism ∗ Centralizes the personal

and peripheralizes the social group.

∗ Prefer low-context direct communication.

∗ Prefer a confrontation and arbitration approach to conflict resolution.

Collectivism ∗ Assumes that the

individual is simply a component of the larger social group.

∗ Prefer high-context indirect communication.

∗ Prefer an accommodation approach to conflict resolution.

No difference regarding one’s “sense of family obligation.” ©2013, Brooks/Cole Cengage Learning

High-Content Vs. Low-Content

High-Content

∗ Self-image and worth are defined in reference to a group.

∗ Information is expressed implicitly and non-verbally.

∗ May become embarrassed when talking directly about the crisis event.

Low-Content

∗ Self-image and worth are defined in individual terms.

∗ Information is expressed explicitly.

∗ Does not like the use of stories, proverbs, metaphors, etc. as a method of communication.©2013, Brooks/Cole Cengage Learning

High-Uncertainty Vs. Low-Uncertainty

High-Uncertainty

∗ Abides by a broad range of rigid rules, regulations, and procedures that cover a multitude of situations.

Low-Uncertainty

∗ Abides by a more laid-back attitude of acceptance of the situation and gratitude for survival.

∗ “I’m alive, that’s all that matters, I’ll figure the rest out later.”©2013, Brooks/Cole Cengage Learning

∗ What is your identity? ∗ Mother ∗ Wife ∗ Daughter ∗ Sister ∗ Friend ∗ Athlete ∗ Raised in a small

town

∗ Lives in an urban area

∗ Catholic ∗ Employee ∗ Musician ∗ Recovering

Alcoholic

∗ Alumni of Indiana University

∗ Member of Junior Auxiliary

Social Locations

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∗ RESPECTFUL ∗ Religious/Spiritual ∗ Economic class ∗ Sexual identity ∗ Psychological development ∗ Ethnic/racial ∗ Chronological age ∗ Traumatic threats ∗ Family ∗ Unique physical issues ∗ Language/location of residence

Social Location Models

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∗ ADDRESSING ∗ Age ∗ Development ∗ Disability ∗ Religion ∗ Ethnicity ∗ Social class ∗ Sexual orientation ∗ Indigenous heritage ∗ National orientation ∗ Gender

Social Location Models Cont.

For a complete list, include geographic location, living area (urban, suburban, rural), occupation, education,

and marital/partner status. ©2013, Brooks/Cole Cengage Learning

∗ Ecology – the living environment in which the intervention occurs.

Social Locations Graph

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∗ Lack of consensus on key terms. ∗ Ethnicity ∗ Race ∗ Ethnic and racial identity ∗ Culture

∗ Inaccurate assumption that current theories of counseling, psychotherapy, and crisis intervention are inherently biased and oppressive.

Shortcomings of a Multiculturalist Approach to

Crisis Intervention

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∗ Much of the literature on multicultural competencies has not been peer reviewed or is not based on empirical research. Wk2 Discussion: Self-Care Plan Summary and Refection

∗ False acceptance of the division between collectivist and individualist cultures.

Shortcomings Cont.

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∗ Empathic

∗ Caring

∗ Demonstrates positive regard

∗ Advocates

∗ Genuine belief that humans are more alike than they are different

Characteristics of Effective Multicultural Counselors

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∗ Do’s ∗ Examine and understand the client’s worldview. ∗ Use alternative roles that are appealing to the client. ∗ Assist the client in utilizing culturally indigenous

support systems. ∗ Take your time to fully triage the situation. ∗ If possible, normalize the reaction to a traumatic

event. ∗ Empower the client.

∗ Don’ts ∗ Impose personal values and expectations onto the

client. ∗ Stereotype the client, client behaviors, or culture. ∗ Force unimodal counseling approaches upon the

client. ∗ Interfere with long-held issues ingrained in the client.

Effective Strategies of Multicultural Crisis

Intervention

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∗ Language Barriers ∗ Confidentiality ∗ Translators

∗ Family member vs. professional translator

∗ Religion/Spirituality ∗ often mistakenly avoided by the crisis

worker ∗ Religion, spirituality, and faith are often a

large part of the crisis response.

∗ Do NOT merely suggest the client consult with their religious/spiritual leader as a means to abdicate your responsibility as a crisis worker.

Obstacles to Effective Multicultural Crisis

Intervention

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∗ Social Support System ∗ May not be used in a linear way. ∗ “Family” may not be limited to those living in the

house of the client. ∗ Using professional services may be taboo in some

cultures.

∗ Occupation ∗ Many crisis workers often mistakenly fail to

address this significant social location.

∗ Rural Geographic Locale ∗ Typically lack resources and do not have the

population to warrant federal aid. ∗ May be suspicious of professional service

workers from other communities.

Obstacles Cont.

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∗ definition of “help” ∗ may differ between the crisis worker and the

client.

∗ Who’s turf is it? ∗ Cultural differences are exacerbated when

an “outsider” crisis worker enters the “turf” of the client.

∗ “Outsider” could mean from a different geographic region, state, county, or even town.

∗ Crisis workers need to be aware of the cultural subtleties. Wk2 Discussion: Self-Care Plan Summary and Refection

More Obstacles

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∗ Local leaders know the infrastructure of the community.

∗ Using local leaders may provide a model of cooperation for community members.

∗ Local leaders may have their own agendas rather than maintaining objectivity.

∗ Non-local crisis workers should not attempt to address social injustices ingrained in the community.

The Dilemma of Local Consultation

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∗ People most likely to receive services are: ∗ YAVIS

∗ Young ∗ Attractive ∗ Verbal ∗ Intelligent ∗ Socially well connected

∗ People most likely NOT to receive services are:

∗ Low-income, elderly, limited-education, and ethnic minorities

Who Receives Services?

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Chapter Thee: The Intervention and Assessment Models

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Triage Assessment System

 Evaluates the severity of a crisis situation. Rapid Systematic Intentional

 Supports the client in gaining: Equilibrium Mobility Autonomy

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Hybrid Model of Crisis Intervention

 No longer a linear or stage model.

 Hybrid Model = linear + systems models. Can be linear or circular Tasks are the foundation  Predispositioning/Engaging  Problem Exploration  Providing Support  Examining Alternatives  Planning in Order to Reestablish Control  Obtaining Commitment  Follow-up

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Task 1: Predispositioning/Engaging

 Clients may not want to talk or may be so out of control that they are not even aware of the crisis worker’s presence.

 Engage in such a way that clients will be receptive to intervention.

Establish a therapeutic bond Inform the client about what to expect

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Task 1 Cont.

 How to Engage: Approach slowly, calmly, and with open body

language. Introduce yourself and ask their name. Use their name and maintain eye contact. Use basic listening skills and open-ended

questions. Clarify intentions. Allow client to cathart without escalation.

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Task 2: Problem Exploration

Define the problem from the client’s point of view. May be difficult during the middle of a chaotic

situation Do not need a complete history Do need to identify the precipitating event

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Task 3: Providing Support

 Communicate concern for the client.

 Three types of support: Psychological support  Unconditional positive regard

Logistical Support  Physical support (food, water, shelter, etc.)  Education  Resources

 Social Support  Examine the client’s primary support system

• May not have the resources • May not be easily accessible • May not be willing • Client may be too embarrassed to seek help

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Task 4: Examining Alternatives

 Clients often think they have no options or develop tunnel-vision.

 Three key components: Situational supports Coping mechanisms Positive thinking patterns

 Brainstorm numerous alternatives. Continuous process due to rapidly changing conditions

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Task 5: Planning in Order to Reestablish Control

 Creating a plan includes:  Identifying resources for immediate support Develop coping mechanisms

 A good plan needs to be: Developed by the client Clear Realistic Behaviorally specific  Immediate (minutes, hours, or days)

 A plan allows the client to establish autonomy and become mobile.

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Task 6: Obtaining Commitment

 If Task 5: Planning was done effectively, obtaining commitment may be easy.

 May be simply having the client verbally summarize the plan.

 If lethality is involved, a commitment may need to be written and signed by both parties.

 If there is any hesitation, the crisis worker may need to revisit earlier tasks.

 No commitment should be imposed by the crisis worker!

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Task 7: Follow-up

 Time frame of minutes, hours, or days.

 Inquire about the client’s ability to maintain mobility and equilibrium.

 Reinforces the crisis worker’s support of the client.

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Assessing

 Continuous throughout crisis intervention.

 Allows the crisis worker to evaluate: Severity of the situation Client’s emotional, behavioral, and cognitive status Client’s level of mobility Safety (client’s, self, and others) Success of the crisis worker in deescalating the

situation

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Factors That Impact One’s Emotional Stability

 The duration of the crisis event.

 The degree of emotional stamina.

 The ecosystem in which the client resides.

 The developmental stage of the client.

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Psychobiology Related to Crisis Intervention

 Traumatic events may impact the: Release of neurotransmitters Central and peripheral sympathetic nervous systems Hypothalamic-pituitary-adrenocortical axis

 Abnormal changes in neurotransmitters are involved in mental health disorders.

 Both legal and illegal drugs have a major affect on mental health.

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Triage Assessment Form (TAF)

 Effective method of obtaining a real-time assessment of the client’s affective, behavioral, and cognitive statuses.

 Can be performed quickly by a wide spectrum of trained crisis workers.

Police officers  School counselors Volunteer crisis line workers Resident hall staff

 Informs the crisis worker of the current state of the client and of their own ability to deescalate the situation.

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Do You Know Your ABC’S?

 Three main domains of triage assessment Affective  Feeling or emotional tone

Behavioral  Action or psychomotor activity

Cognitive  Thinking patterns

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Affective State

 Often the first sign of disequilibrium.

 Can manifest as overly emotional or withdrawn.

 Incongruences among what the client says, how it is said, and non-verbal behaviors.

 Key question to ask: Do people typically show this kind of affect in

situations such as this?

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Behavioral Functioning

 Focus on psychomotor activities.  Approaches  Avoids  Paralyzed

 Often difficult for immobilized people to take independent actions.

 Attempt to have the client engage in a small concrete and immediate activity.

 Key questions to ask:  In the past, what actions did you take that helped you get back

in control?  What would you have to do now to get on top of the situation?

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Cognitive State

 Client’s thinking patterns:  Rationalizing?  Exaggerating?  Downward spiral?

 Crisis events are typically perceived as either a:  Transgression (present)  Threat (future)  Loss (past)

 Key questions to ask:  How long has the client been engaged in crisis thinking?  How open is the client to reframing?  How often does the client engage in crisis thinking?

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Rating Clients using the TAF

 Score from high to low to rule out more severe impairments.

 Each domain has a range from 1-10 (1=lowest score and 10=highest score).

 Total rating ranges from 3-30. Total score of 3-10 is a rating of minimal impairment Total score of 11-19 is a rating of moderate

impairment Total score of 20+ is a rating of severe impairment

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TAF Rating

 Using the sample case of Leron from the textbook, how would you score Leron using the TAF . . .

When Leron first exits Union Avenue? When the CIT officer initially meets Leron? When Leron agrees to leave the scene and gets into

the police car? When the CIT officer is following-up with Leron at the

legal aid office?

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