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Multiculturally Competent Multiculturally Competent Counseling Approaches in Counseling Approaches in International SchoolsInternational Schools
Cirleen DeBlaere, Ph.D.Lehigh UniversityBethlehem, Pennsylvania, USA
OutlineOutlineIntroductionHelping modelCommon mental health concernsApplying the helping modelFinal recommendations
ObjectivesObjectivesParticipants will be able to
articulate a 3-stage model of helping
Identify common mental health concerns with international students
Identify ways in which to implement treatment approaches with consideration of culture
Helping Model
Helping Skills ModelHelping Skills ModelThree Stage Model of Helping
(Hill & O’Brien, 2009)
◦Exploration◦Insight◦Action
Exploration StageExploration StageGoals:
◦ Attend◦ Observe◦ Listen◦ Explore thoughts◦ Explore feelings
Skills: ◦ Non-verbal
behaviors◦ Restatements◦ Open questions of
thoughts and feelings
◦ Reflection
Insight StageInsight StageGoals:
◦ Foster awareness◦ Facilitate insight◦ Facilitate insight
into relationships
Skills:◦ Challenge◦ Open questions
for insight◦ Interpretation◦ Disclosures of
insight◦ Immediacy
ActionActionGoals:
◦ Facilitate action
Skills◦ Open questions
for action◦ Giving
information◦ Process
advisement◦ Direct guidance◦ Disclosures◦ Strategies
Common FeaturesCommon FeaturesEmpathic Collaboration
◦Understanding students at both a cognitive and affective level
◦Genuinely caring about the student◦Nonjudgmental acceptance◦Predicting the student’s reactions◦Communicating one’s experience to
the student in a sensitive and accurate manner
Common FeaturesCommon FeaturesTherapeutic Relationship
◦4 components1. Real relationship2. Working alliance3. Transference4. Countertransference
Working AllianceWorking AllianceThis is the part of the relationship
focused on the therapeutic work◦3 components:
1. Bond The connection between helper and student
2. Goals Consensus about the changes that need to be
made
3. Tasks What is going to take place during the helping
process to meet the goals
Transference & Transference & CountertransferenceCountertransference
Transference ◦Student → Counselor
Countertransference◦Counselor → Student
Common FeaturesCommon FeaturesBackground Variables
◦RESPECTFUL model (D’Andrea & Daniels, 2001) R -- Religious and Spiritual Orientation E -- Ethnic/Cultural/Racial Backgrounds S -- Sexual Identity and Orientation P -- Psychological Maturity E -- Economic Class Standing C -- Current Chronological Challenges T -- Threats to Personal Wellness F -- Family History and Influence U -- Unique Physical Characteristics L -- Location/Language
Common FeaturesCommon Features
Multicultural Counseling Competence◦Awareness
Biases and beliefs
◦Knowledge Knowledge and appreciation of diverse
cultures
◦Skills
Common FeaturesCommon FeaturesClient Readiness:
1. Precontemplation2. Contemplation3. Preparation4. Action
Common Mental Health Concerns
Common Mental Health Common Mental Health ConcernsConcernsThird Culture Kid issues
◦TransitionsAnxietyDepressionSelf-esteemBody image/Eating Disorders Family conflict
Signs & Symptoms: Signs & Symptoms: TransitionTransition Helplessness Greater irritation than
usual when things go wrong
Fear of being cheated, injured, or robbed
Excessive concerns about aches and pains
A strong desire to be home with people who understand them
Delaying or refusing to learn the language of the country
Insomnia and fatigue
Excessive concern for cleanliness
Loss of appetiteLonelinessPoor concentrationHeadachesStomach problemsDepressionHomesickness
Signs & Symptoms: Signs & Symptoms: AnxietyAnxiety Anxiousness Fear Worry Panic Nightmares Avoidance Thoughts of
monsters Thoughts of being
hurt Thoughts of danger Increased heart
rate
Difficulty concentrating
Thoughts of contamination
Depersonalization Stuttering Swallowing Avoid eye contact Trembling voice Nausea Muscle tension
Signs & Symptoms: Body Signs & Symptoms: Body Image/EDImage/ED
Labeling foods as good vs. bad
Skipping meals/Dieting
Feeling guilty for eating
Depressed mood Self-critical thoughts,
words, or behaviors when she/he can not exercise
Exercising in order to eat
Perfectionism Avoiding situations
where she/he may be observed eating
Hiding one’s body by wearing baggy clothing or layers
Feeling anxious or stressed about eating
Social isolation
Applying the Helping Model
Exploration StageExploration StageRecall you are attending,
listening, and exploringDeveloping the therapeutic
relationship
How might culture influence this stage?
Cultural Consideration: Cultural Consideration: Cultural IdentityCultural IdentityHow does the student identify
culturally? ◦Deeds, Stewart, Bond, & Westrick (1998)
226 Asian and Western teenagers from an international school in Hong Kong
4 groups White, Western Chinese, Hong Kong Chinese,
Expatriate Asian Tradition was more highly endorsed by the 2
Asian groups compared to the Western groups White students differed on expectations of
autonomy compared to the 2 Asian groups (Western Chinese were in-between)
Marginalization?
Cultural Consideration: Cultural Consideration: Collectivism/ IndividualismCollectivism/ Individualism
Collectivistic◦ Fate◦ Interdependence◦ Cooperation◦ Natural course of
events◦ Past/present
orientation◦ Relational
Formality
Individualistic◦ Personal control
over environment◦ Privacy◦ Competition◦ Time/Control Time◦ Future orientation◦ Materialism◦ Relational
Informality
Cultural Consideration: Cross-Cultural Consideration: Cross-Cultural CommunicationCultural Communication Verbal
◦ Language◦ Slang◦ Accent
Non-verbal ◦ Touch◦ Physical Space◦ Eye Contact◦ Gestures◦ Body Posture◦ Physical
Appearance (style of dress)
Insight StageInsight StageRecall that you are facilitating
insight with use of challenge, interpretation, immediacy
How might culture influence this stage?
Cultural considerationsCultural considerationsWhat is the value of insight for
this student? How appropriate is the use of
challenge, interpretation, immediacy?
Timing
Action StageAction StageRecall that you are promoting
action that facilitates change
How might culture influence this stage?
Cultural ConsiderationsCultural ConsiderationsPower dynamicsLevel of directivenessDependence/independence
Therapeutic Approaches: Therapeutic Approaches: TransitionsTransitions(Limberg & Lambie, 2011)(Limberg & Lambie, 2011)Transition stage
(arrival)Entering
(adjustment)Leaving
• Orientation with the family (get an interpreter if needed)• Teacher meeting/training•Check-in with students weekly or bi-weekly to gauge their adjustment
• Buddy program (similar interests)• Storytelling/narrative (class, assembly [Diversity Week], one-on-one)• Social events/ gatherings where TCKs can interact with other TCKs• Field trips with reflections• Small group discussions
• Create opportunities for closure if there is time• Social networking can allow for goodbyes when the student leaves abruptly• Provide parents with information about the transition process• Give gifts
Therapeutic Approaches: Therapeutic Approaches: TransitionsTransitions((Dixon & Hayden, 2008)Dixon & Hayden, 2008)
Making contact with someone from the host country before you leave
Homesickness: keep busy and “keep a picture of your friends and relatives by your bed”
Specific transition to the school: Being shown around the school by another student Meeting up with others also new to the school Receiving a booklet with names and photographs of
staff at the school in advance Having an informational website Knowing about clubs at the new school
Therapeutic Approaches: Therapeutic Approaches: TransitionsTransitionsTransition programs (Davis et al.,
2010)
◦Help students develop realistic expectations
◦Use narrative therapy◦Plan trips and activities in the host
country Photo scavenger hunt
Transition teamsTCK support network
Therapeutic Approaches: Therapeutic Approaches: AnxietyAnxietyCognitive Behavioral Therapy (CBT)
has been shown to be very effective ABC model
◦A – Antecedent◦B – Behavior◦C – Consequence
Ex: Social anxiety
Antecedent Behavior Consequence
The other kids don’t like me
Avoid social situation
Minimize anxiety
I see a group of kids socializing
My heart starts to race and my palms
get sweaty
I walk away (minimize anxiety)
Therapeutic Approaches: Therapeutic Approaches: AnxietyAnxietyFight or flight responseRecognize individual anxious feelings
and associated somatic responsesCognitive restructuring
◦ Helpful “green” thoughts and unhelpful “red” thoughts
◦ Challenge and change◦ Focus on the solution rather than the worry
If there is no solution, work on accepting what you can not change
Positive self-talk◦ Recognize personal strengths
Exposure to feared stimuliMaking a coping skills plan
◦ Start easy and increase difficulty
Therapeutic Approaches: Therapeutic Approaches: Anxiety Anxiety Relaxation training
◦ Breathing◦ Progressive muscle relaxation
Stress-management strategies◦ Creating down time
Diet and exercise◦ Reduce stimulants in diet
Desensitization ImageryMeditationAssertiveness trainingMedication
Therapeutic Approaches: Therapeutic Approaches: AnxietyAnxietyBeginning breathing practice:Set 1:
Set II:
Inhale Hold Exhale
4 0 4
4 4 4
2 0 4
Inhale
Exhale
8 8
7 8
6 8
5 8
4 8
3 8
2 8
1 8
Therapeutic Approaches: Therapeutic Approaches: AnxietyAnxietyThought Record
Situation Automatic Thought
Evidence For…
Evidence Against…
Alternative Thoughts
Where was I? Who was I with? What had just happened? What was about to happen?
What was I thinking at just that time? What’s the worst case scenario? What does this say about me?
What outside evidence supports this thought? •Be careful to avoid mind-reading, making assumptions
What evidence contradicts this thought or leads in a different direction?
What are other possibilities or ways of looking at this situation? Can I give myself or someone else the benefit of the doubt?
I was in the hallways and saw a group of girls looking my way and laughing….
Therapeutic Approaches: Body Therapeutic Approaches: Body Image/EDImage/ED
Again, CBT approaches have been shown to be effective ◦ABC model
Ex: Binge eating
Antecedent Behavior Consequence
Distorted thoughts about
thinness
Strict dieting Binge
Negative emotion
Binge Negative emotion
Therapeutic Approaches: Body Therapeutic Approaches: Body Image/EDImage/ED
Mindfulness approaches are also being increasingly employed (Baer, Fischer, & Huss, 2005)
◦“thought parade” exercise Non-judgmental awareness
◦Promote awareness and acceptance of bodily sensations (hunger and satiety cues)
◦Mindful eating
Therapeutic Approaches: Body Therapeutic Approaches: Body Image/EDImage/ED
Restriction ◦Work within the good foods
Bingeing◦Distraction◦Mindfulness
Purging◦Distraction◦Mindfulness
* Thought record also very helpful
Therapeutic Approaches: Body Therapeutic Approaches: Body Image/ED Image/ED
10 steps to positive body image:1.Appreciate all that your body can do2.Keep a top 10 list of things you like
about yourself (read your list often)3.Remind yourself that “true beauty”
is not simply skin deep4.Look at yourself as a whole person5.Surround yourself with positive
people
Therapeutic Approaches: Body Therapeutic Approaches: Body Image/ED Image/ED
6. Shut down voices in your head that say that your body is not “right” or that you are a “bad” person
7. Wear clothes that are comfortable and make you feel good about your body
8. Become a critical viewer of social and media messages
9. Do something nice for yourself10.Use the time and energy that you
might have spent worrying about food and your weight to help others
Recommendations Recommendations Barletta & Kobayashi (2007)Barletta & Kobayashi (2007)Counselors should:
1. Acknowledge ethnicity and culture as important
2. Respect the roles of family and community values and beliefs in the client’s culture
3. Try to communicate in the language requested by the client
4. Try to eliminate biases and prejudices5. Not overemphasize or underemphasize the
cultural differences between themselves or the student
6. Identify specific skills to help international students adapt to specific situations and roles
7. Help international students consider how their values and perceptions are changing due to their stay in a different country
9 areas of multicultural 9 areas of multicultural competence for school competence for school counselors counselors (Holcomb-McCoy, 2004)(Holcomb-McCoy, 2004)
1. Multicultural Counseling2. Multicultural Consultation3. Understanding ism’s and Student
Resistance 4. Understanding Cultural Identity
Development 5. Multicultural Assessment6. Multicultural Family Counseling 7. Social Advocacy8. Developing School-Family-
Community Partnerships 9. Understanding Interpersonal
Interactions
Selected ReferencesSelected References Barletta, J., & Kobayashi (2007). Cross-cultural counselling with international
students. Australian Journal of Guidance and Counseling, 17, 182-194. Bourne, E. J. (2005). The anxiety and phobia workbook. Oakland: Sage. D'Andrea, M., & Daniels, J. (2001). RESPECTFUL counseling: An integrative model
for counselors. In D. Pope-Davis & H. Coleman (Eds.), The interface of class, culture and gender in counseling (pp. 417- 466). Thousand Oaks: Sage.
Davis, P., Headley, K., Bazemore, T., Cervo, J., Sickinger, P., Winfham, M., & Rehfuss, M. (2010). Evaluating impact of transition seminars on missionary kids’ depression, anxiety, stress, and well-being. Journal of Psychology and Theology, 38, 186-194.
Deeds, O., Stewart, S. M., Bond, M. H., & Westrick, J. (1998). Adolescents between cultures: Values and autonomy expectations in an international school setting. School Psychology International, 19, 61-77.
Dixon, P., & Hayden, M. (2008). “On the move”: Primary age children in transition. Cambridge Journal of Education, 38, 483-496.
Hill, C. (2009). Helping skills: Facilitating exploration, insight, and action. Washington D.C.: American Psychological Association.
Holcomb-McCoy, C. (2004). Assessing the multicultural competence of school counselors: A checklist. Professional School Counseling, 7, 178-184
Limberg, D. & Lambie, G. W. (2011). Third Culture Kids: Implications for professional school counseling. Professional School Counseling, 15, 45-54.
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