Multiculturally Competent Counseling Approaches in International Schools Cirleen

Multiculturally Competent Counseling Approaches in International Schools Cirleen De. Blaere, Ph. D. Lehigh University Bethlehem, Pennsylvania, USA

Outline Introduction Helping model Common mental health concerns Applying the helping model Final recommendations

Objectives Participants 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 Model Three Stage Model of Helping (Hill & O’Brien, 2009) ◦ Exploration ◦ Insight ◦ Action

Exploration Stage Goals: ◦ ◦ ◦ Attend Observe Listen Explore thoughts Explore feelings Skills: ◦ Non-verbal behaviors ◦ Restatements ◦ Open questions of thoughts and feelings ◦ Reflection

Insight Stage Goals: ◦ Foster awareness ◦ Facilitate insight into relationships Skills: ◦ Challenge ◦ Open questions for insight ◦ Interpretation ◦ Disclosures of insight ◦ Immediacy

Action Goals: ◦ Facilitate action Skills ◦ Open questions for action ◦ Giving information ◦ Process advisement ◦ Direct guidance ◦ Disclosures ◦ Strategies

Common Features Empathic 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 Features Therapeutic Relationship ◦ 4 components 1. 2. 3. 4. Real relationship Working alliance Transference Countertransference

Working Alliance This is the part of the relationship focused on 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 & Countertransference Transference ◦ Student → Counselor Countertransference ◦ Counselor → Student

Common Features Background 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 Features Multicultural Counseling Competence ◦ Awareness Biases and beliefs ◦ Knowledge and appreciation of diverse cultures ◦ Skills

Common Features Client 1. 2. 3. 4. Readiness: Precontemplation Contemplation Preparation Action

Common Mental Health Concerns

Common Mental Health Concerns Third Culture Kid issues ◦ Transitions Anxiety Depression Self-esteem Body image/Eating Disorders Family conflict

Signs & Symptoms: Transition 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 appetite Loneliness Poor concentration Headaches Stomach problems Depression Homesickness

Signs & Symptoms: Anxiety 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 Image/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 Stage Recall you are attending, listening, and exploring Developing therapeutic relationship How might culture influence this stage?

Cultural Consideration: Cultural Identity How 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: Collectivism/ 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 Communication Verbal ◦ Language ◦ Slang ◦ Accent Non-verbal ◦ ◦ ◦ Touch Physical Space Eye Contact Gestures Body Posture Physical Appearance (style of dress)

Insight Stage Recall that you are facilitating insight with use of challenge, interpretation, immediacy How might culture influence this stage?

Cultural considerations What is the value of insight for this student? How appropriate is the use of challenge, interpretation, immediacy? Timing

Action Stage Recall that you are promoting action that facilitates change How might culture influence this stage?

Cultural Considerations Power dynamics Level of directiveness Dependence/independence

Therapeutic Approaches: Transitions (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 biweekly to gauge their adjustment • Buddy program (similar interests) • Storytelling/narrative (class, assembly [Diversity Week], oneon-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: Transitions (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: Transitions Transition 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 teams TCK support network

Therapeutic Approaches: Anxiety Cognitive 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: Anxiety Fight or flight response Recognize individual anxious feelings and associated somatic responses Cognitive 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 stimuli Making a coping skills plan ◦ Start easy and increase difficulty

Therapeutic Approaches: Anxiety Relaxation training ◦ Breathing ◦ Progressive muscle relaxation Stress-management ◦ Creating down time Diet strategies and exercise ◦ Reduce stimulants in diet Desensitization Imagery Meditation Assertiveness training Medication

Therapeutic Approaches: Anxiety Beginning breathing practice: Set Inhale Hold Exhale 4 0 4 4 2 0 4 Set 1: II: Inhale Exhale 8 8 7 8 6 8 5 8 4 8 3 8 2 8 1 8

Therapeutic Approaches: Anxiety Thought 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 mindreading, 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 Image/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

Therapeutic Approaches: Body Image/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 Image/ED Restriction ◦ Work within the good foods Bingeing ◦ Distraction ◦ Mindfulness Purging ◦ Distraction ◦ Mindfulness * Thought record also very helpful

Therapeutic Approaches: Body Image/ED 10 1. 2. 3. 4. 5. steps to positive body image: Appreciate all that your body can do Keep a top 10 list of things you like about yourself (read your list often) Remind yourself that “true beauty” is not simply skin deep Look at yourself as a whole person Surround yourself with positive people

Therapeutic Approaches: Body Image/ED 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 yourself 10. Use the time and energy that you might have spent worrying about food and your weight to help others 6.

Recommendations 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 prejudices 5. 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 competence for school counselors (Holcomb-Mc. Coy, 2004) 1. Multicultural Counseling 2. Multicultural Consultation 3. Understanding ism’s and Student Resistance 4. Understanding Cultural Identity Development 5. Multicultural Assessment 6. Multicultural Family Counseling 7. Social Advocacy 8. Developing School-Family-Community Partnerships 9. Understanding Interpersonal Interactions

Selected 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-Mc. Coy, 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

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