Transcript Presentation
Topics in International School Counseling
Nick Ladany, Ph.D.
Loyola Marymount University Los Angeles, California [email protected]
Cheryl A. Brown Shanghai American School (Puxi), China [email protected]
Institute Overview
Introductions Elements of Effective and Ineffective School Counseling Critical Mental Health Issues of Children in International Schools Eating disorders, depression, anxiety, substance use and abuse, third culture kids Multicultural Competence Prevention Curricula Effective and Ineffective Supervision Model for International School Counselors Job-A-Like Discussion Sessions Marc Marier (American School of Dubai) Jennifer Melton (Shanghai American School – Pudong)
Importance of International School Counseling
273,000 students enrolled in one of the 520 overseas schools in 153 countries (2006-7).
Multinational student body Unique challenges transient and mobile family lifestyle competing cultural practices limited personnel resources limited professional support Unique demands mental health needs professional development negotiating relationships with parents and school personnel
Needs Assessment Exercise
One-Two-Four-Eight Exercise
Identify mental health needs of students Identify professional needs of counselors Learn a method for intact working groups to identify and clarify issues of importance
Data Sources
Presentations at international school conferences (e.g., NESA, Tri Association, etc.) Research investigation of counselors in the international schools (Inman, Ngoubene, & Ladany, 2008) Today’s discussion
Student Needs
Cultural shock and adjustment Eating Disorders Depression Stress & Anxiety Fears over peer/social acceptance Identity development Substance Abuse/Addictions Transition & Adjustment Security Conflict resolution Family Issues Parent Involvement Psychiatric Disorders (e.g., Bipolar) Anger Management/Relational Aggression Self-esteem Academic Advising Career Development Vocational Counseling
Counselor Professional Needs
Networking Less Isolation from Collegial Support/Networking Consultation & Supervision Academic Resources Referral Resources Technology Financial Resources Time Management Training Space Confidentiality/Privacy Professional Development Multicultural development Support from School Staff Referral Resources Roles & Responsibilities Clear Delineation Administrator & Teacher Understanding
Challenges with Principals, Teachers, & Parents
Lack of Knowledge of Counselor Role Lack of Trust in Counselor Lack of Teamwork and Communication Complexity of Counseling Process Lack of Respect for Student Confidentiality Parental Involvement in Student’s Life Scheduling Conflicts Lack of Empathy for Student Needs Multicultural Misunderstandings Dual/Multiple Relationships
Counselor Activities & Roles
Premise: A child’s emotional needs must be met adequately before educational needs can be addressed
Individual counseling Prevention workshops
Group counseling Parent & Family consultation/counseling Teacher consultation Career development Administration consultation Crisis intervention Assessment & referral Minimum Recommended Counselor:Student Ratio = 1:250
Elements of Effective Counseling
(Ladany, Walker, Pate-Carolan, Gray, 2008) Empathy Manage Countertransference Ability to Tolerate Ambiguity Working Alliance
Three Key Features of an Effective Counselor
Empathy
a genuine feeling of care for the client’s situation, an ability to accurately perceive the client’s experience (both intellectually and emotionally), a capacity to not only imagine the self as the client, but to suspend one’s own experience and personal judgment to comfortably experience the client’s unique inner world “as if” the counselor were the client, a capability to predict the client’s reactions, and an ability to sensitively and accurately communicate this experience to the client (Banks, 2004).
Three Key Features of an Effective Counselor
Countertransference
Present in all helping relationships Pantheoretical An exaggerated, unrealistic, irrational, or distorted reaction related to a counselor’s work with a client. This reaction may include feelings, thoughts, and behaviors that are likely to be in response to the client’s interpersonal style and presenting issues, and/or the counselor’s unresolved personal issues (e.g., family of origin, life experiences, or environmental stressors).
5 Step Approach to Manage Countertransference
1.
2.
3.
4.
5.
familiarize yourself with personal issues that may act as a trigger for countertransference identify cues that alarm you when countertransference may be playing out in session examine how countertransference influences the therapeutic work explore the origins of the countertransference use supervision and consultation to develop a therapeutic plan in the best interest of the client.
Three Key Features of an Effective Counselor Ability to Tolerate Ambiguity
Defining a Counseling Relationship Working Alliance
(Bordin, 1979) Key to positive outcomes Culturally sensitive Applicable across realms of helping e.g., counselor-client; teacher-student; supervisor-supervisee; etc.
3 Components of a Working Alliance
Agreement on Goals of Counseling decrease depression, enhance study skills, decrease anxiety Agreement on Tasks Counseling explore past experiences, focus on cognitions, learn skills, observe classroom teaching Emotional Bond Between Counselor & Client mutual caring, liking, trusting Foundation upon which all helping is based
Elements of Ineffective Counseling
Systemic Factors School culture Parents Contraindicated School Counselor Roles Counselor Factors Empathy challenged Ignore Countertransference Premature attempts to fix/problem solve Inaccessibility to students Weak Working Alliance Children/students not included in goal and tasks, poor bond
Eating Disorders
Some Facts The typical model weighs 13-19% below the normal expected body weight The clinical criteria for anorexia nervosa is 15% below expected weight In the USA, half of adults are dieting. Children see and hear this and internalize the cultural idea that to be thin is to be successful and to be normal weight or fat is to fail.
By age 2, girls are watching TV and are starting to be exposed daily to messages showing that women who are successful are thin.
Before girls even go to elementary school they are exposed to messages (from family and/or the media) that certain foods are “bad” and that sugar and fat make people fat.
Additional Facts
Before girls go to elementary school they have heard women (their mothers, older sisters, caretakers) complain about their bodies and focus on weight loss and dieting.
Weight preoccupation and body dissatisfaction is occurring earlier and earlier. 40% of girls and 25% of boys in grades 1 - 5 reported trying to lose weight. 25% of the girls reported restricting or altering their food intake. (This was about two times as many girls as boys.) By fourth grade, 40% or more of girls “diet” at least occasionally.
In a survey of over 400 fourth grade girls:
One third said they “very often worried about being fat” Nearly half said they “very often wished they were thinner” About 40% of the girls reported dieting “sometimes to very often”
In a study of fifth graders:
40% felt too fat or wanted to lose weight, even though 80% were not overweight. The researchers found children as young as 9 years old with severe eating disorders, including anorexia nervosa and bulimia.
Be Careful What You Wish For
A group of girls ages 11 – 17 were asked “If you had three wishes, what would you wish for?” The #1 wish of nearly every girl was to lose weight.
More than two-thirds of high school girls are dieting and half are undernourished. At the same time, one in five teenagers is overweight
Four Major Weight and Eating Problems
Dysfunctional Eating Not regulated by hunger and satiety Eating Disorders Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorders Overweight & Obesity Size Prejudice Oppression toward obese children Accepting or promoting the cultural ideal of thinness
Signs and Symptoms of Eating Disorders
Labeling foods as good vs. bad Skipping meals Dieting Feeling guilty for eating Counting calories and/or fat Depressed mood Self-critical thoughts, words, or behaviors when she can’t exercise Exercising in order to eat
Signs and Symptoms of Eating Disorders
Avoiding situations where she may be observed eating Perfectionism Hiding one’s body by wearing baggy clothing or layers Preoccupied with models, actresses, their looks, body, weight Feeling anxious or stressed about eating Accepting or verbalizing the cultural ideal of thinness Social isolation
Prevention of Eating Disorders
Creating a school environment that promotes health Parental involvement Preschool awareness Children through the 3rd grade Discussion focusing on health and wellness Beginning in 4th grade Health and wellness Discussion of eating disorders
Role of School Counselor
Identify factors in the school that hinder students’ development of positive ideas about body image and health Offer school-wide programs targeting weight and eating issues Educate and assist teachers and administrators Educate parents Work individually with students Refer students when possible
Depression in Children and Adolescents
10-15% of children and adolescents has some symptoms of depression (Surgeon General, 2000) 20-40% adolescents report feeling sad, unhappy, or depressed over a 6 month period (Achenbach, 1991) 10-20% of parents report their adolescents have felt sad, unhappy, or depressed over a 6 month period (Achenbach, 1991) As many as 20% of children experience a major depression episode before graduating from high school, and between 7% and 9% of children will experience a depressive episode by the time they are 14 years old (e.g., Garrison et al., 1989; Lewinsohn, Hops, Roberts, & Seeley, 1993 )
Symptoms of Depression in Children and Adolescents
Sadness Emptiness Helplessness (nothing ever works for me) Diminished interest or pleasure in most activities (I don’t care anymore) Significant weight loss or gain Poor appetite Insomnia or hypersomnia Marked restlessness or slowness Indecisiveness School failure Poor motivation Concerns about aches and pains Lack of friends Feels inferior Noncompliant Frequently gets into fights Feels unloved
Symptoms of Depression in Children and Adolescents (cont.)
Loss of energy/fatigue Worthlessness Guilt Difficulty concentrating Recurrent thoughts of death Thoughts of suicide Self-loathing (I hate myself) Feeling bad Irritableness or feeling crabby Isolation from peers Loneliness Frequent crying Worries that bad things will happen
Suicide
1.6 per 100,000 for 10-14 year-olds 9.5 per 100,000 for 15-19 year-olds Boys four times more likely to commit Girls twice as likely to attempt Hispanic students most likely of all racial groups 90% of children who commit suicide have a mental disorder prior to death (most common depression, anxiety, substance abuse)
Suicidal Risk Factors
depressed mood thoughts/feelings of hopelessness or helplessness thoughts of hurting yourself plan means time place Contract* what would prevent past attempts social support/interpersonal isolation impulsivity substance use family member
Anxiety in Children and Adolescents
1 year prevalence in children 9-13 years old is 13% Separation Anxiety Disorder Anxiety about being apart from parent(s) Fear parent may become ill or have an accident May develop after a move or trauma Generalized Anxiety Disorder Excessive worry about most things Social Phobia Persistent fear of being embarrassed in social situations Young children tend to exhibit symptoms more behaviorally (e.g., cry, tantrums, timid) Anxiety and depression often coexist
Symptoms of Anxiety in Children and Adolescents
Anxiousness Difficulty concentrating Fear Thoughts of contamination Worry Panic Nightmares Depersonalization Stuttering Avoidance Thoughts of monsters Swallowing Avoid eye contact Thoughts of being hurt Thoughts of danger Trembling voice Nausea Increased heart rate Muscle tension
Role of School Counselor with Depressed and Anxious Students
Availability and approachability Identify depressed or anxious mood Work with parents Work individually with students Receive consultation/supervision Refer students when possible Individual counseling/psychotherapy Family counseling/psychotherapy
Substance Use & Abuse
Often increased accessibility and availability in Overseas Schools
Middle school children 12-15
50% have tried alcohol at least once Average age of first drink10.4 years old 23% have been drunk
Substance Use & Abuse
U.S. High School Senior Lifetime Use Alcohol 81% Tobacco 64% Marijuana 42% Inhalants 17% Hallucinogens 13% Cocaine 6% Often coexist with another mental health disorder
Substance Abuse & Dependence
Factors associated with SA & D Stress Family turmoil Another mental health disorder Physiological predisposition Family member use and abuse Peer use and abuse Academic difficulties Poor self-esteem Poor coping resources Family therapy most effective treatment for children and adolescents True for most childhood mental health issues
Eating Disorders
Some Facts The typical model weighs 13-19% below the normal expected body weight The clinical criteria for anorexia nervosa is 15% below expected weight In the USA, half of adults are dieting. Children see and hear this and internalize the cultural idea that to be thin is to be successful and to be normal weight or fat is to fail.
By age 2, girls are watching TV and are starting to be exposed daily to messages showing that women who are successful are thin.
Before girls even go to elementary school they are exposed to messages (from family and/or the media) that certain foods are “bad” and that sugar and fat make people fat.
Additional Facts
Before girls go to elementary school they have heard women (their mothers, older sisters, caretakers) complain about their bodies and focus on weight loss and dieting.
Weight preoccupation and body dissatisfaction is occurring earlier and earlier. 40% of girls and 25% of boys in grades 1 - 5 reported trying to lose weight. 25% of the girls reported restricting or altering their food intake. (This was about two times as many girls as boys.) By fourth grade, 40% or more of girls “diet” at least occasionally.
In a survey of over 400 fourth grade girls:
One third said they “very often worried about being fat” Nearly half said they “very often wished they were thinner” About 40% of the girls reported dieting “sometimes to very often”
In a study of fifth graders:
40% felt too fat or wanted to lose weight, even though 80% were not overweight. The researchers found children as young as 9 years old with severe eating disorders, including anorexia nervosa and bulimia.
Be Careful What You Wish For
A group of girls ages 11 – 17 were asked “If you had three wishes, what would you wish for?” The #1 wish of nearly every girl was to lose weight.
More than two-thirds of high school girls are dieting and half are undernourished. At the same time, one in five teenagers is overweight
Four Major Weight and Eating Problems
Dysfunctional Eating Not regulated by hunger and satiety Eating Disorders Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorders Overweight & Obesity Size Prejudice Oppression toward obese children Accepting or promoting the cultural ideal of thinness
Signs and Symptoms of Eating Disorders
Labeling foods as good vs. bad Skipping meals Dieting Feeling guilty for eating Counting calories and/or fat Depressed mood Self-critical thoughts, words, or behaviors when she can’t exercise Exercising in order to eat
Signs and Symptoms of Eating Disorders
Avoiding situations where she may be observed eating Perfectionism Hiding one’s body by wearing baggy clothing or layers Preoccupied with models, actresses, their looks, body, weight Feeling anxious or stressed about eating Accepting or verbalizing the cultural ideal of thinness Social isolation
Prevention of Eating Disorders
Creating a school environment that promotes health Parental involvement Preschool awareness Children through the 3rd grade Discussion focusing on health and wellness Beginning in 4th grade Health and wellness Discussion of eating disorders
Eating Disorder Prevention Program
Psychoeducation Media literacy “fat talk” Size acceptance Emotional eating Stress management Self-esteem Promoting healthy body image Social Norms What are social norms?
What influences social norms?
What misperceptions exits within your school?
What are the consequences of these misperceptions?
Actual social norm data E.g., in reality, diets don’t work
Role of School Counselor
Identify factors in the school that hinder students’ development of positive ideas about body image and health Offer school-wide programs targeting weight and eating issues Educate and assist teachers and administrators Educate parents Work individually with students Refer students when possible
Depression in Children and Adolescents
10-15% of children and adolescents has some symptoms of depression (Surgeon General, 2000) 20-40% adolescents report feeling sad, unhappy, or depressed over a 6 month period (Achenbach, 1991) 10-20% of parents report their adolescents have felt sad, unhappy, or depressed over a 6 month period (Achenbach, 1991) As many as 20% of children experience a major depression episode before graduating from high school, and between 7% and 9% of children will experience a depressive episode by the time they are 14 years old (e.g., Garrison et al., 1989; Lewinsohn, Hops, Roberts, & Seeley, 1993 )
Symptoms of Depression in Children and Adolescents
Sadness Emptiness Helplessness (nothing ever works for me) Diminished interest or pleasure in most activities (I don’t care anymore) Significant weight loss or gain Poor appetite Insomnia or hypersomnia Marked restlessness or slowness Indecisiveness School failure Poor motivation Concerns about aches and pains Lack of friends Feels inferior Noncompliant Frequently gets into fights Feels unloved
Symptoms of Depression in Children and Adolescents (cont.)
Loss of energy/fatigue Worthlessness Guilt Difficulty concentrating Recurrent thoughts of death Thoughts of suicide Self-loathing (I hate myself) Feeling bad Irritableness or feeling crabby Isolation from peers Loneliness Frequent crying Worries that bad things will happen
Suicide
1.6 per 100,000 for 10-14 year-olds 9.5 per 100,000 for 15-19 year-olds Boys four times more likely to commit Girls twice as likely to attempt Hispanic students most likely of all racial groups 90% of children who commit suicide have a mental disorder prior to death (most common depression, anxiety, substance abuse)
Suicidal Risk Factors
depressed mood thoughts/feelings of hopelessness or helplessness thoughts of hurting yourself plan means time place Contract* what would prevent past attempts social support/interpersonal isolation impulsivity substance use family member
Anxiety in Children and Adolescents
1 year prevalence in children 9-13 years old is 13% Separation Anxiety Disorder Anxiety about being apart from parent(s) Fear parent may become ill or have an accident May develop after a move or trauma Generalized Anxiety Disorder Excessive worry about most things Social Phobia Persistent fear of being embarrassed in social situations Young children tend to exhibit symptoms more behaviorally (e.g., cry, tantrums, timid) Anxiety and depression often coexist
Symptoms of Anxiety in Children and Adolescents
Anxiousness Difficulty concentrating Fear Thoughts of contamination Worry Panic Nightmares Depersonalization Stuttering Avoidance Thoughts of monsters Swallowing Avoid eye contact Thoughts of being hurt Thoughts of danger Trembling voice Nausea Increased heart rate Muscle tension
Role of School Counselor with Depressed and Anxious Students
Availability and approachability Identify depressed or anxious mood Work with parents Work individually with students Receive consultation/supervision Refer students when possible Individual counseling/psychotherapy Family counseling/psychotherapy
Substance Use & Abuse
Often increased accessibility and availability in Overseas Schools
Middle school children 12-15
50% have tried alcohol at least once Average age of first drink10.4 years old 23% have been drunk
Substance Use & Abuse
U.S. High School Senior Lifetime Use Alcohol 81% Tobacco 64% Marijuana 42% Inhalants 17% Hallucinogens 13% Cocaine 6% Often coexist with another mental health disorder
Substance Abuse & Dependence
Factors associated with SA & D Stress Family turmoil Another mental health disorder Physiological predisposition Family member use and abuse Peer use and abuse Academic difficulties Poor self-esteem Poor coping resources Family therapy most effective treatment for children and adolescents True for most childhood mental health issues
Preventive Interventions with School-Age Youth
Vera & Reese (2004)
Tripartite Concept of Prevention
Primary Prevention
Target children and adolescents who are currently unaffected by a particular problem for the purposes of helping them continue to function in healthy ways
E.g., anti-drug programs that are school-wide Secondary Prevention
Targets children and adolescents exhibiting early stage problems to forestall the development of more serious difficulties
E.g., working with aggressive kindergartners to curb later violent episodes Tertiary Prevention
Targets children and adolescents with established problems or disorders in order to reduce the dureation or consequences of the problematic behavior
Similar to direct counseling
Risk and Protective Factors
Characteristics of children and adolescents and their environment that influence their chance of developing mental health problems
Biological predispositions, personality traits, problematic behaviors, faulty beliefs, family processes peer influences, school experiences, and community variables
Risk factors
Negative aspects of the self or environment
Protective factors
Foster resilience to risk and promote competence and adaptive outcomes
Types of Interventions
Person-centered
Offer services directly to the target population
E.g., communication skills training, self-esteem enhancement Environment-centered interventions
Seek to modify the child’s social context
E.g., parental child rearing techniques, teacher’s classroom management techniques Need to understand developmental differences among youth Need to understand multicultural differences among youth Outcome Evaluation
Obtain multiple perspectives
Need to consider both proximal and distal goals and outcomes
Best Practices
Programs that attempt to affect multiple risk and protective factors at both person-centered and environment centered levels
Substance Abuse Prevention
Contextual risk factors
Norms regarding drug use Accessibility Physiological predisoposition
Low bonding to family Early persistent problem behaviors
Academic failure Low degree of commitment to school
Peer rejection in elementary grades
Alientation and rebelliousness
Early onset of drug use Family use of drug and alcohol
Protective factors
Membership in structured, goal directed peer groups
Strong attachment with parents
Parental involvement
Substance Abuse Prevention
Early person-centered prevention efforts failed
“Just say no” Increased knowledge and awareness but rarely changed drug use
Oversimplified the complexity of drug use and abuse
Contemporary programs more effective
Combine person-centered and environmental-centered levels of intervention
Assertiveness skills Enhanced coping Interpersonal self-efficacy Alter norms in families and peer-groups regarding drugs
Multicultural Issues
"Travel is fatal to prejudice, bigotry, and narrow-mindedness, and many of our people need it solely on these accounts. Broad, wholesome, charitable views of men and things cannot be acquired by vegetating in one corner of the earth all one's lifetime."
-- Mark Twain
Third Culture Kid (TCK)
Defined as "a young person who has spent a sufficient period of time in a culture other than his/her own, resulting in the integration and blending of elements from both the host culture and his/her own culture into a third culture."
Culture - Blend
intensity of exposure to a second or third culture, age at which child comes into contact with a culture other than that of the parents, amount of time a young person spends within a second or third culture.
TCK
A TCK's roots are not embedded in a place, but in people, No two children/individuals are alike.
TCK Strengths
Independent exercise leadership increased maturity cross cultural skills broader world view
Isolation
TCK Challenges
Unresolved grief or sadness Trust issues Can never go back home again Feel cheated and angry. . . Delayed adolescence Repatriation
Issues specific to different age groups
Preschoolers threatened by moving personnel packing their bed, toys and personal belongings Grade School Children worry about details -- finding their way home, finding a room in their new school
Issues specific to different age groups
Teenagers biggest fear is acceptance by their peers College Students and Young Adults distance can create sense of loss instructors and schedule in overseas schools will contrast
Adjustment issues manifest:
Drug use Depression – acute sense of isolation Eating disorders Anxiety Involvement in solitary pursuits Identity Issues
What can you do?
Maintaining continuity Watch for signs of adjustment problems Listen carefully to child’s concerns Approach teacher/counselor about concerns Assign a few manageable chores Work to develop a caring, nurturing environment overseas
Recognize positive aspects of their life Recognize and talk about losses Value keeping in touch with life in the home country
Repatriation
When returning to the home country, parents may need to help teachers and administrators in the new school understand the transition the children will be going through in the first few months.
If possible, money should be budgeted for school clothing so that the student will ''fit in."
Returning children should be encouraged to keep in touch with friends they made while overseas.
Parenting/Teaching In A Stressful World
Shifts in Socio-Political Climate How do TCKs experience world changes?
How are these experiences reassessed? How do TCk’s reassess the nation when it is now the enemy? How do TCKs evaluate shifts in home land differently from Americans reared all their lives within the U.S.? How is the threat of terrorism handled?
Multicultural Counseling
Counselor Multicultural Competence
(Ancis & Ladany, 2010) Multicultural Issues related to multiple cultures that include gender, race, sexual orientation, ethnicity, disability, socioeconomic status, nationality, age, religion, etc.
Counselor Multicultural Competence Knowledge Self-Awareness Skills
Counselor/Psychologist Multicultural Competence
Consists of three interrelated subconstructs: 1. Multicultural Knowledge- general knowledge about multicultural issues such as an academic or intellectual understanding of how factors such as gender, race, sexual orientation, disability, nationality, religion, and so forth, may influence a clients life; and multicultural knowledge unique to the specific clients. 2. Multicultural Self-Awareness- ability to reflect upon and understand one’s own multiple multicultural identities, and how these identities are expressed in a counseling relationship.
3. Multicultural Skills- reflected in multicultural counseling self-efficacy (i.e., confidence to perform particular multicultural skills) along with the adeptness to carry out these multicultural skills.
Models of Multicultural Identity Development
Knowledge of simple demographic or nominal variables (e.g., race) insufficient to predict behavior.
More Explanatory Models: Racial Identity (e.g., Cross, 1971, 1995; Helms, 1990, 1995; Helms & Cook, 1999) Gender Identity (e.g., Downing & Roush, 1985; McNamara & Rickard, 1989; Ossana, Helms, & Leonard, 1992) Sexual Orientation Identity (e.g., Cass, 1979; Chan, 1989; Rust, 1993; Troiden, 1988) Ethnic Identity (e.g., Phinney, 1989, 1992; Sodowsky, et al., 1995) Needed: Scheme to help organize and manage multiple models Apply across multiple demographic variables gender, race, sexual orientation, ethnicity, disability, socioeconomic status
Heuristic Model of Non-Oppressive Interpersonal Development
(Ancis & Ladany, 2001, 2010)
Socially Oppressed Groups (SOG)
Female Person of color Gay/Lesbian/Bisexual/Transgendered Non-European American Person with a Disability Working Class
Socially Privileged Groups (SPG)
Male White Heterosexual European American Physically Abled Middle to Upper Class
Means of Interpersonal Functioning (MIF)
For each demographic variable, people progress through similar phases thoughts and feelings about oneself, as well as behaviors based on ones identification with a particular demographic variable Common Features Between SOG & SPG e.g., ., both women and men will exhibit complacency regarding societal change in the less advanced stages of MIF Unique Features Within Socially Oppressed and Socially Privileged Groups e.g., generally, women feel less empowered and men will perceive greater entitlement People can be more advanced in terms of their MIF for one demographic variable (e.g., sex) than their MIF for another variable (e.g., race). e.g., a White woman may have an understanding of the limiting effects of sex role socialization but lack an awareness of White privilege Social Context: Initial model restrictively applied to people who live in the United States, however, expanded and emic applications currenltly under development
4 General Stages of Means of Interpersonal Functioning
(1) Adaptation
Features: apathy regarding the socially oppressive environment, superficial understanding of differences among people, endorsement of oppressive contingencies, active participation in oppressive acts
(2) Incongruence
Features: previous beliefs about oppression and privilege seem incongruent; conflict; confusion; dissonance; some awareness; no real commitment to advocacy
(3) Exploration
Features: anger may be a prominent emotion, some of which is founded on current recognition of oppressive situations but also fueled by guilt or shame for not having recognized the oppressive state of affairs previously; hypervigilance, hyperawareness, seek “encounter-like” events.
(4) Integration
Features: proficiency in associating with multiple SOGs & SPGs, insight into oppressive interactions, committed pursuit of non oppression in the environment
Stages of Means of Interpersonal Functioning (Gender: Female)
(1) Adaptation
Believes equality exists and oppression doesn’t (2) Incongruence Event occurs such as reading about salary discrepancies between men and women (3) Exploration Engages in reflection and seeks out information about feminism and women’s roles (4) Integration Able to make realistic appraisals of types of gender oppression and sorts through possible advocacy stances
Stages of Means of Interpersonal Functioning
(1) Adaptation
(Gender: Male)
Over attributes gender differences to genetics, “I’m not privileged” (2) Incongruence Okay with having women around at work but less inclined to have partner work outside the home (3) Exploration Engages in exploring how being a man has advantages in our culture (4) Integration Is able to function interpersonally with men and women who are at various stages of interpersonal functioning
Stages of Means of Interpersonal Functioning (Race: Person of Color)
(1) Adaptation
Identification with White people, denigration of People of Color (2) Incongruence A White friend tells an African American person that she never thought of her as African American (3) Exploration Associate with groups or organizations that strongly identify with people who are Hispanic (4) Integration Engages in multiple forms of advocacy for people who are Asian
Stages of Means of Interpersonal Functioning (Race: White)
(1) Adaptation Colorblind perspective, we all belong to the human race (2) Incongruence Intellectual understanding of racism but no real advocacy to change matters or White privilege (3) Exploration Actively considers what it means to be White (4) Integration Adept at interacting with People of Color at various stages of interpersonal functioning
Stages of Means of Interpersonal Functioning ( Sexual Orientation: Gay, Lesbian, Bisexual, Transgendered )
(1) Adaptation Identifies with heterosexual norms in the US culture (2) Incongruence Recognition that sexual feelings cannot easily be ignored; Tension between being out versus closeted becomes difficult to maintain (3) Exploration Joins GLBT organizations or reads about others who proudly proclaim their sexual orientation as GLBT (4) Integration Adept at living in multiple worlds of people with a variety of sexual orientations
Stages of Means of Interpersonal Functioning (Sexual Orientation: Heterosexual)
(1) Adaptation Gay-bashing; Homosexuality is a sin (2) Incongruence Questions unhealthy heterosexist stance based on contact experiences (3) Exploration Actively examines the privileges associated with being heterosexual (4) Integration Able to advocate for and associate with people who have diverse sexual orientations
4 Stages of Means of Interpersonal Functioning
(1) Adaptation Features: apathy regarding the socially oppressive environment, superficial understanding of differences among people, endorsement of oppressive contingencies, active participation in oppressive acts Client: :unlikely to be aware of multicultural dynamics between the counselor and client Counselor: unlikely to attend to multicultural issues in conceptualizing clients
4 Stages of Means of Interpersonal
Functioning
(2) Incongruence Features: previous beliefs about oppression and privilege seem incongruent; conflict; confusion; dissonance; some awareness; no real commitment to advocacy Client: present with some conflict related to a recent multicultural event Counselor: may include demographic information in case conceptualizations, however, the information is not well differentiated or integrated
4 Stages of Means of Interpersonal Functioning
(3) Exploration Features: anger may be a prominent emotion, some of which is founded on current recognition of oppressive situations but also fueled by guilt or shame for not having recognized the oppressive state of affairs previously; hypervigilance, hyperawareness, seek “encounter-like” events.
Client: heightened awareness of multicultural issues for self or between the counselor and client Counselor: eager to “cause insight”
4 Stages of Means of Interpersonal Functioning
(4) Integration Features: proficiency in associating with multiple SOGs & SPGs, insight into oppressive interactions, committed pursuit of non-oppression in the environment Client: seek counselors who are advanced in their MIF Counselor: accurate empathy with clients that are from multiple SOG & SPG groups, conceptualizations cognitively and integratively complex with respect to multicultural issues
4 Types of Client-Counselor Interpersonal Interaction Dynamics
Similar to Racial Identity Interactions (Cook, 1994; Helms, 1990; Helms & Cook, 1999)
Progressive
the counselor is at a more advanced stage than the client (e.g., counselor-integration, client-adaptation)
Parallel-Advanced
the counselor and client are at comparable advanced MIF stages (e.g., integration, exploration)
Parallel-Delayed
the counselor and client are at comparable delayed MIF stages (e.g., adaptation, incongruence)
Regressive
client is at a more advanced stage than the counselor (e.g., client integration, counselor-adaptation)
Implications for Client Outcome
Counseling Process Counseling Outcome Best to Worst Outcomes: Parallel-Advanced or Progressive Parallel-Delayed Regressive
Implications for Societies and Cultures Social structures can be classified as operating within a dominant stage of functioning
Sexual Abuse Prevention
General Session
Nick Ladany, Ph.D. & Roger Douglas, Ed.D.
Clare Burgess, Shana Flicker, & Lauren Kulp
Most Common Social-Emotional-Behavioral Issues in the International Schools Cultural Adjustment Eating Problems Depression & Suicidality Stress & Anxiety Substance Abuse Transition & Adjustment Diversity Crisis Management and Response Family Issues & Parent Involvement Learning Disabilities Anger Management Mental Health Disorders (e.g., Bipolar) Self-esteem Career Development
Sexual Safety, Sexual Assault, and Sexual Awareness
Program Philosophy
The Sexual Safety and Sexual Awareness Program is designed for teaching professionals, counselors, staff, administrators, and parents to (1) create a sexually safe environment for children and adolescents (2) prevent incidents of sexual abuse and violence (3) offer resources in the event that abuse or violence occurs
Sexual Abuse and Assault
Child Sexual Abuse
is the exploitation or coercion of a child by an older person (adult or adolescent) for the sexual gratification of the older person. Child sexual abuse involves a continuum of behavior ranging from verbal, nonphysical abuse to forcible touching offenses. It can take the form of a single encounter with an exhibitionist, occasional fondling by a casual acquaintance, years of ongoing abuse by a family member, rape, or exploitation through pornography and/or prostitution.
Sexual Assault
occurs when one of the following conditions exist Force, even if there is no bruise or injury Fear, even if the victim didn’t fight back A person is disabled and cannot give consent A person is severely intoxicated or unconscious as a result of drugs or alcohol The victim is under the age of 18
Sexual Abuse and Assault Occurs
20% of women and 5-10% of men have experienced some form of sexual abuse as children and adolescents Peak ages: 7-13 years old Up to one half of victims under the age of 7 70-90% of the time the perpetrator is known Kept secret through bribes and threats
The Scope of Sexual Victimization in Germany (Kury, Chouaf, Obergfell-Fuchs, & Woessner, 2004) Sample of 309 women university students 27% reported at least one experience with unwanted sexual intercourse because it was hopeless to stop the man 40% reported unwanted touching of breasts or genitals 58% reported at least one experience of stalking Alcohol and drug use increases risk (Krahe, Scheinberger, & Waizenhoter, 1999)
United States vs. Germany
Teen Pregnancy Rates U.S. 5 times higher than in Germany Sexually Transmitted Infection Rates (HIV, Syphilis, Gonorrhea, Chlamydia) U.S. 5-66 times higher than in Germany Reasons Unwritten Social Contract: “We’ll respect your right to act responsibly, giving you the tools you need to avoid unintended pregnancy and sexually transmitted infections, including HIV.” Societal openness and comfort with sexuality and pragmatic governmental policies.
Prevention Programs
Best Practices
involves programs that attempt to affect multiple risk (self-esteem) and protective factors (resilience) at both person-centered (skills training) and environment-centered (school, family) levels Most effective when learning takes place over time with practice.
Child abuse prevention programs lead to greater knowledge and skills regarding sexual safety.
Curriculum Overview
Kindergarten: Giving and getting safe touches Dealing with unsafe touches Learning the touching rule Learning the safety steps Grade 1: Identifying touches: safe touches/unsafe touches Safety: Physical abuse-Telling an Adult Learning the touching rule The always ask first rule (this is stranger danger basically) Grade 2: The touching rule The always ask first rule Secrets about touching-telling a grown-up Identifying touches safe touch/unsafe touch
Curriculum Overview
Grade 3: The touching rule and safety steps The always ask first rule Identifying touches safe / unsafe / unwanted touch Cyber safety: Go Places Safely Grade 4: Harassment-knowing what to do Cyber safety - What's Private?
Defining and Understanding Sexual Safety Grade 5: Safety with cyber pals Keeping Out of Danger Defining and Understanding Sexual Safety
Curriculum Overview
Grade 6: Safe talking in cyberspace Knowing Who You Can Ask and Tell Defining and Understanding Sexual Safety Grade 7 Cyber safety: Personal information and meeting up Refusal Skills Defining and Understanding Sexual Assault Grade 8: Cyber safety: Online chat/messaging Signals of Intent to Have Sex Defining and Understanding Sexual Assault Grade 9: Cyber safety: Grooming and luring Dating violence Reducing Risk of Sexual Assault Defining and Understanding Sexual Assault
Curriculum Overview
Grade 10 Cyber safety: Cyber stalking Date rape What is sexuality?
Decision Making Defining and Understanding Sexual Assault Grade 11: Sexual harassment Gender roles/stereotypes Assertive Communication Defining and Understanding Sexual Assault Grade 12: Sexual orientation Setting Sexual Limits Defining and Understanding Sexual Assault Date rape drugs
Instructional Considerations
Create a Support Team Staff support important Teachers are in best position to implement program and make a difference Student access Consistency of information Knowledge of individual students Best position to assess learning
Classroom Guidelines
Setting up the classroom Circles and horseshoes Can use a “station” Establishing ground rules Behavioral conduct rules Encourage students to participate in making the rules Frame rules in the positive Instead of “Don’t talk out of turn” say “Raise your hand and wait until you’re called on.”
Classroom Guidelines
Setting the pace Encouraging participation from all Wait time (5-10 second rule) Attend to nonparticipators Handling disruptive behavior Follow-up later as may be a sign of abuse
Lesson Highlights
Grade Level Content Areas Materials Procedures (teaching steps) Reflection Resources
Sample Lesson Plan
Grade Level:
Elementary School – Grade K
Content Area:
Getting and Giving Safe Touches
Objectives:
Students will be able to identify safe, caring touches
Materials:
Precut magazine photos of safe touches Construction paper for each student Paste Doll
Procedure (Teaching Steps):
1. Warm-up / Review Review some of the rules that the children have learned that keep them safe. For example: Always ask you parents / guardian if someone wants you to go with him or her. Always ask your parents / guardian if someone wants to give you a gift.
2. Story and Discussion (Safety rules for touching) Explain that there are many different types of touch. There are safe touches and there are unsafe touches. Safe touches are good for your body. They make you feel cared for, loved, and important.
3. Show and Explain photograph A (or use a picture of a parent and child hugging) *Photograph A is on the back of card 8, Preschool/Kindergarten, unit II Touching Safety.
Explain who / what is in the picture. For example, “This is a picture of Chris and his dad.” Discuss the following questions with the class: a) Does this look like a safe or an unsafe touch? (Safe touch) How can you tell? (By the faces of the two people. They look happy.) b) Why do you think the parent is hugging the child? (He loves Chris. He is happy. They haven’t seen each other in a while.)
Procedure (Teaching Steps):
4. Introduce a doll or puppet and ask the students to give the doll or puppet safe touches (pats on the head, holding hands, shaking hands.) a) Ask the class who gives safe touches likes the safe touches they gave the doll or puppet.
b) Demonstrate a safe touch with the students by shaking their hands.
5. Activity: Safe Touch Collage Have each student choose several pictures of safe touch that he or she likes and glue them onto a piece of construction paper. In a sharing circle, ask the children to say why they like the touches they’ve chosen and from whom they like to receive such touches.
6. Summarize the lesson Remind the students that they have learned about different kinds of touch and that safe touches are good for your body and make you feel cared for, loved, and important.
Reflection
Students will be able to recognize safe touches
Resources:
Video:
Joey Learns the Touching Rule
Book:
Sam’s Story. A Committee for Children Publication
Questions and Reactions
Teacher Training
Guidelines for Appropriate Touching of Students
Evaluate What is your preferred style of touching?
Appropriate Touch Children need appropriate touching Should originate from student needs Give options Talk Establish appropriate boundaries that are sensitive to culture, beliefs, and person history
Recognizing Disclosures of Child Abuse Teachers are in a unique position to recognize and help abused children Signs of Abuse Sudden changes in behavior Inappropriate sexualized behavior Excessive play with private body parts Disclosure
Types of Disclosure
Direct Disclosure Indirect Hints “My brother wouldn’t let me sleep last night.” “Mr. Jones wears funny underwear.” “My babysitter keeps bothering me.” Disguised Disclosure “What would happen if a girl told her mother she was being molested, but her mother didn’t believe her?” Disclosure with Strings Attached “I have a problem, but if I tell you about it, you have to promise not to tell anyone else.”
Responding to a Disclosure
Find a private place to talk with the child Remain calm Do your best not to express panic or shock Express your belief that the child is telling the truth Use the child’s vocabulary Reassure the child that it is good to tell Reassure the child that it is not her or his fault and that he or she is not bad Determine the child’s immediate need for safety Let the child know that you will do your best to protect and support her or him Tell the child what you will do Seek assistance If a child discloses during a lesson, acknowledge the child’s disclosure and continue the lesson. Later find a place where you can talk to the child alone.
Questions and Reactions
Parent Workshop
Protection Guidelines
Establish a Safe Environment Babysitters Day care After school friends Dating relationships Relatives Observe Patterns of Others Adults focused on child relationships more than adult relationships Adults singling certain children out for attention
Guidelines for Choosing Babysitters
Ask each prospective babysitter for names and phone numbers of other families for whom he or she has worked. Call the parents and find out what they think of the babysitter. Ask whether there were ever any problems.
Let the babysitter know your family safety rules, including touching safety rules. Tell her or him that you have taught your child to tell you when any of the rules are broken, even if the child has been told to keep it a secret.
Occasionally return home early or unexpectedly so you can see firsthand how things are going. You could also call your child sometimes while you are out.
Ask your child whether he or she likes the babysitter. If your child does not like the babysitter, ask for more information. Do not leave your child with someone that he or she doesn’t like.
Never leave a child in the care of someone who is using drugs or alcohol. Drugs and alcohol undermine a person’s judgment.
Touching Rules
Touching Rule #1 No one should touch your private body parts except to keep you clean and healthy If someone does: Say words that mean “no” Get away Tell a grown-up Touching Rule #2 Don’t keep secrets about touching
Teach Safety Rules
Introduce touching rules along with other safety rules.
Talk about the rules often and practice them with your child.
Agree on family touching rules to use with other children and adults. Decide how you will teach these rules based on your child’s age, developmental level, and your own family values.
Examples of Talking about Safety Rules
If someone is touching you and you want her or him to stop, say words that mean “No” (like “I don’t like that” or “Stop that”). Then he or she needs to stop. If you are touching someone and he or she says “No,” you need to stop.
A bigger person should not touch your private body parts except to keep you clean and healthy. No one should touch your penis, vulva, vagina, or bottom except to keep you clean and healthy. If someone does, say words that mean “No.” Then get away and tell a grown-up.
Do not keep secrets about touching.
Discuss Touching Safety
Answer your child’s questions Take advantage of natural teaching moments Give age-appropriate answers Be approachable. Tell your child: If you ever have any questions, just ask me It’s never too late to tell Read a children’s book about touching safety together Start a conversation with your child: Let’s review the Touching Rules today Before you go, let’s practice what you would do if someone tried to break the Touching Rules
Signs of Abuse
Sudden changes in behavior Inappropriate sexualized behavior Excessive play with private body parts
Responding to a Disclosure
Remain calm Reassure your child by saying: I’m glad you told me It’s not your fault I am always here for you Seek help for your child and yourself Professional counselors Healing takes time
Questions and Reactions
Elements of Effective Supervision
(Ladany, 2005; Ladany & Inman, 2010) Attend to the Supervisory Relationship Apply Models of Supervision (e.g., Critical-Events Model) Attend to Unique Features of Supervision Evaluative Educative Involuntary Engage in Role Induction Differentiate Supervision from Psychotherapy Attend to Supervisee-focused and Client-focused Outcomes Recognize the importance of Covert Processes Keep abreast of Ethical and Legal Issues Offer Evaluations that include Goal-Setting and Feedback Enhance Multicultural Competence Tend to Administrative Responsibilities (e.g., note taking, s’ee oversight) Consider Group Supervision and Peer Supervision as important adjuncts Secure Supervision Training
A Critical Events-Based Model of Supervision
Ladany, Friedlander, & Nelson (2005) The Supervisory Working Alliance Marker Task Environment Consists of Interaction Sequences Resolution Successful or Unsuccessful
Purpose and Scope
Theoretically- and empirically-informed guide to practice Pantheoretical, contextual, interpersonal Useful for supervisors and supervisors-in-training across mental health disciplines
What is an “Event”?
An event or episode is a period of time in the process of therapy/supervision during which a specific task is addressed Events have an identifiable beginning, middle, and end Events occur within and across sessions Events can occur within events
Critical Events
Common, possibly universal, challenging despite theoretical differences despite differences in setting, professional specialty, etc.
Pose a dilemma that cannot/should not be ignored by the supervisor
Events-Based Model
Supervisory events are qualitatively different from therapy events because supervision is… explicitly evaluative explicitly educational typically involuntary
A Critical Events-Based Model of Supervision
Ladany, Friedlander, & Nelson (2005) The Supervisory Working Alliance Marker Task Environment Consists of Interaction Sequences Resolution Successful or Unsuccessful
The Supervisory Working Alliance
(Bordin, 1983) Mutual Agreement about the Goals of Supervision e.g., mastery of specific therapy skills e.g., understanding how the trainee’s personal issues influence work with clients Mutual Agreement about the Tasks of Supervision e.g., review therapy session tapes e,g., trainee is responsible for initiating supervisory discussion Emotional Bond Mutual caring, liking, trusting
Critical Events
Remediating Skill Difficulties and Deficits Heightening Multicultural Awareness Negotiating Role Conflicts Working Through Countertransference Managing Sexual Attraction Repairing Gender-Related Misunderstandings & Missed Understandings Addressing Problematic Supervisee Emotions and Behaviors
Marker
Supervisee’s behavior, statement, or series of statements signaling the need for a specific kind of help “Informs” the supervisor of the task to be addressed Can be explicit or implicit Different dilemmas can be signaled with similar Markers (e.g., prolonged silence)
Task Environment
Interaction Sequences
Focus on the Supervisory Working Alliance Normalize Experience Attend to Parallel Process Focus on Skill Focus on Self-Efficacy Exploration of Feelings Focus on Supervisee’s Dynamics Assess Knowledge Focus on Evaluation Case Discussion Focus on Multicultural Awareness Focus on Countertransference Careful of too much
Case Review
Resolution
Self-Awareness
Knowledge
Skills
Supervisory Alliance
Continuum of Successful to Unsuccessful
Prototypical C rit ical Event in Sup ervision
Marker Resolution
Ineffective Supervision
Reviews of the supervision literature Not all supervision is rosy Supervisees get harmed Supervision failures are a result of: Supervisor factors Supervisee factors Dyadic factors (Inman & Ladany, in press; Ladany & Inman, 2008)
Degree of Trainee Openness to Learning and Supervisor Competence
Active Learner Passive Learner Indifferent Learner Competence of Supervisor Incompetent Neutral Competent
11.1% 11.1% 11.1% 11.1% 11.1% 11.1% 11.1% 11.1% 11.1%
Elements of Ineffective Supervision
Supervisor Factors
Inclination to infantalize supervisees Incompetent evaluation Too positive --- Gatekeeping No valid or reliable instruments Multiculturally misguided (i.e.,racist, sexist, homophobic) Ethically challenged in relation to supervision Inadequate Training Supervisor specific training Misapplication of theory (unique features of supervision)
Supervisee Factors
Openness to learning Receptivity to feedback Training in helping skills Capacity to learn helping skills Capacity for deep self-awareness Capacity for knowledge acquisition (perhaps over-rated)
Dyadic Factors
Supervisory alliance Too much case discussion Over indulgence in client-focused outcomes
Recommendations
Recognize the value of post-degree supervision In the international schools, be innovative Increase supervisor accountability Supervisor training Reconsider the role of evaluation in supervision