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.

Questions?