IIZ - Chapter 2: Ethics & Multicultural Competence (Stress and Trauma, Building Resilience) pg. 51 - 81

Ethics & the Counseling & Psychotherapy Process

  • Ethics is a system of moral principles that we apply through our commitment to excellence, reverence for others, and willingness to take action to improve life for ourselves and others

    • typically prescribed by social systems

  • Ethical codes are thoughtful professional lists of do’s and don’ts for our profession.

  • morals are individual principles we live by that define our beliefs about right and wrong

Ethics & Responsibility Summary

  • confidentiality

    • need trust in the relationship

  • recognize limitations

    • equal atmosphere with clients, share constraints, inform them they are free to stop the process at any time, talk to supervisor if you don’t feel prepared

  • seek consultation

    • constantly obtain supervision and consultation in your work

    • be aware of individual & cultural differences

    • remember both the golden rule and platinum rule

      • treat client how you would like to be treated

      • treat clients the way they want to be treated

    • give special attention to ethical treatment of children & their rights

      • importance of early childhood experiences

      • right of survival, developing to the fullest, being protected and being heard

Multicultural Humility & Social Justice Competencies

  • early history of interviewing populated primarily by white men - minor attention to cultural difference to women or BIPOC

  • the rise of the multicultural movement in the United States can be traced to the Civil Rights Act, followed by the growth of awareness in activists from groups such as African Americans, those who are of mixed race, women, the disabled, war veterans, and individuals who may identify as lesbian, gay, bisexual, transgender, queer, intersex, or asexual

  • impact of politics enacted in personal decisions and relationships with friends and family

  • your competence in multiculturalism is based on your level of awareness, knowledge, skills, and action

    • self and other awareness and knowledge are critical, but one must also have the skills and the ability to act.

  • awareness of our clients’ backgrounds and social contexts enables us to understand their uniqueness more fully.

  • approaching clients with humility help us deepen our understanding by directly hearing their stories in a caring and an ever-learning relationship

RESPECTFUL Interviewing & Counseling

  • RESPECTFUL Model - listed multiple groups and communities which impact our lives & represent some of the multiple voices that clients bring to us

  • identify past and present voices & communities that affect your own thoughts, feelings, and behaviors

Individualism and/or Community

  • we all are members of multiple communities, many of which influenced our life path and may even become our main identity today

  • the giants of psychology looked at the person primarily as an individual - with little attention to our communities and their meaning to us

  • Without context you only know part of the person

  • Community (Merriam-Weber) - A group of people living in the same place or having a particular characteristic in common. A feeling of fellowship with others, as a result of sharing common attitudes, interests, and goals

  • Community-based research seeks to empower communities and effect policy changes. It seeks to democratize knowledge by recognizing and valuing the unique strengths and perspectives of all members involved in the research process.

  • there is also the possibility of cultural and historical trauma in each of the RESPECTFUL dimensions.

    • e.g., slavery → daily microaggressions → personal & group trauma, frustration, anger, hopelessness, depression

  • intersections among multicultural factors are important

    • e.g., biracial family

  • You can add the RESPECTFUL model to your skills and action by helping clients extend their understanding of themselves as cultural beings and building resilience and cultural health

  • remember that each client that visits you has a long historical culture that is still carried within

Privilege as a Multicultural Counseling Issue

  • privilege - power given to people through cultural assumptions and stereotypes, as well as unawareness and disinterest in past oppression

  • “invisibility of Whiteness” - European Americans tend to be unaware of the advantages they have because of the color of their skin

  • Counseling and therapy have too often focused on privileged people and failed to advocate for those in need

  • all your skills in empathy, understanding, and advocacy will be needed as mental health issues and disagreements increase, as they did during 2020–2021 during the depth of the pandemic

  • moving from one social class to another is quite challenging

Stress & Trauma

  • A national mental health crisis has been identified by the American Psychological Association (2020, 2021) and stress has become a major and defining issue in virtually all counseling and therapy.

  • mental and physical health declining due to inability to cope in healthy ways with stressors recently experienced

  • the most affected groups are parents, essential workers, young people, and people of color

Individual Stress

  • Krupnik (2020) conceptualizes the stress response on a continuum

    • normative stress responses (recuperate quickly) → pathological stress responses (recuperation partial) → traumatic stress responses (disrupt mental & physical functioning)

  • Holmes-Rahe Life Stress Inventory (Holmes & Rahe, 1967) is still one of the most used tools in our field

    • it is an instrument with 43 items, each of which is assigned a number of units, called Life Change Units (LCUs)

    • the more events a person has experienced in the prior year, the higher the score

    • scores between 150 and 300 points imply a person has about a 50% chance of a major stress-induced health disorder in the next 2 years

    • scores of 300 points or above indicates an 80% chance of a major illness within the next 2 years

  • events that elicit a traumatic stress response may be relational, environmental, or cultural

  • the effects of these stressors are many, such as neurobiological changes in the brain; weakening of immune defenses; and interpersonal and intrapersonal difficulties, parenting issues, and mental disorders

  • ACEs

The Soul Wound & Historical Trauma

  • soul wound - occurs with and from historical trauma

    • Indigenous Americans over the generations

      • result: poverty, racism, poor medical attention shorter life span, loss of awareness of cultural heritage and spirituality over the centuries

  • Psychological liberation from historical trauma occurs when clients discover that what they saw as a personal issue is not just “their problem.”

    • see external and historical racism, sexism, heterosexism, other forms of oppression

  • The helping professions have all too often failed to see that the issues that clients bring to us are deeply involved with societal dysfunction, harassment, and oppression

  • The trauma of severe abusive treatment can persist over generations. Furthermore, there is now clear neurobiological evidence that changes in the genome can be transferred from one generation to the next (epigenetics)—and onward from that point to future generations

Awareness, Knowledge, Skills, and Action for Multicultural & Social Justice Competence

Be Aware of Your Own Assumptions, Values, and Biases

  • Unless you see yourself as a cultural being, you will have difficulty developing awareness of others

  • contextual issues beyond a person’s control affect the way the person discusses issues and difficulties

  • Oppression, discrimination, sexism, racism, and failure to recognize and take disability into account may deeply affect clients without their conscious awareness.

Microaggressions

  • Microintervention Strategies: What You Can Do to Disarm and Dismantle Individual and Systemic Oppression**

    • basic text and resource for issues involving racism, discrimination, and effective treatment

  • It is best that you be prepared to watch for instances of microaggressions, help clients name them for what they are, and provide counseling for emotional support, cognitive understanding, and deciding when and how to respond to these painful events

  • Social justice in counseling recognizes that oppression negatively affects the well-being and health and mental health of clients, families, organizations, and communities

    • indicates ways to dismantle systems of oppression, policies, structures, and practices

  • Advocacy, taking action on the part of a client and/or collaborating with a client toward systems change, is an essential part of multicultural competence.

Racial Battle Fatigue

  • developed by william smith

  • negative & racially charged experiences of all POC in America

  • physical, mental, emotional stress of coping with the constant stream of microaggressions & overt racism for POC

    • consequences of constantly facing racially dismissive, demeaning, insensitive, hostile racial environments and individuals produces a public health crisis → increased mental health disorders

  • causes mental, emotional, and physical strain that can produce psycho-physiological symptoms

    • suppressed immunity

    • increased sickness

    • tension headaches

    • trembling and jumpiness, chronic pain in healed injuries

    • elevated blood pressure

    • pounding heart beat

    • constant stress & anxiety

    • insomnia

    • ulcers

    • difficulty thinking or speaking coherently

    • emotional & social withdrawal

  • symptoms above can lead to long-term health issues & mental, physical, emotional exhaustion → left untreated, can become chronic & lethal

  • helpful things to buffer these effects:

    • reflective coping style

    • active problem-solving

    • cognitive restructuring

    • expression of emotion

    • social support seeking approaches

Skills and Action to Cope with Discrimination & Build Resilience

  • cultural health - faith, trust, and pride in family’s cultural background

  • attentional network - how we attend to the world and then integrate internal &n external perceptions

  • brain map in memory - solid memories of strength enable coping with microaggressions, though they still hurt

  • good input generally + good output → experience good things, brain map has positive turn

  • garbage in, garbage out → if people fed garbage of life, then people will have negative mindsets

    • damaging output from being raised in a family, community, region in which only provided prejudiced info

    • negative beliefs about self or others can be embodied and hard to change

    • difficult life experiences → interpret daily life in negative terms

  • What do we do with instances of microaggressions and harassment in counseling?

    • move the perceptual frame and interpretations of life issues and concerns

    • build resilience and build strength through skilled use of communication skills

    • watch for signs and stories that represent microaggressions    

      • be willing to self-disclose and share your support appropriately

      • Often just sitting with a client is not enough

      • Watch for teachers and other influential persons who may be problematic

      • Seek help from community leaders.

      • Look for stories of heroes in the culture, in family members who have survived, and in personal models for growth

      • Help clients name the issue and identify contextual/environmental factor

      • Educate clients to understand their goals, expectations, and legal rights—and provide tools

    • must not impose our beliefs on clients → client needs to be ready to act

Neuroscience & Neurobiology: The Results of Trauma & Possible Treatment

  • when trauma occurs, typically:

    • the thinking center is under activated (PFC)

    • emotion regulation is under activated (anterior cingulate cortex, ACC)

    • the fear center is over activated (amygdala)

  • difficulty in concentration, making decisions, lack fo control of emotional outbursts

  • Post Traumatic Stress Disorder

  • Trauma-focused cognitive behavioral therapy (TFCBT) is recognized as a form of CBT for individuals and families

    • often integrates other theories and strategies

    • listening skills are essential in CBT and virtually all methods

  • children of trauma survivors are

    • more likely to develop traumatic, mood, and anxiety disorders

    • suffer endocrine and molecular alterations.

  • children who suffer trauma

    • “Exposure to adversity in childhood is a powerful predictor of health outcomes later in life—not only mental health outcomes such as depression and anxiety, but also physical health outcomes such as cardiovascular disease, diabetes, and cancer.”

    • show biological signs of aging faster than children who have never experienced adversity

      • early puberty, cellular aging, and changes in brain structure

Resilience & Positive Psychology

  • Resilience is the ability to bounce back from normal daily setbacks, temporary failure, and early or late trauma of many types.

    • Search for positive stories of strength

    • help the client remember the resources they have in family and friends

    • identify what the client has done right

    • therapeutic lifestyle changes (TLCs) provide a number of strength-focused actions that clients can take to improve wellness and mental health

      • exercise

      • spiritual and religious resources

      • building cultural identity

      • relaxation & meditation training

Positive Psychology and Therapeutic Lifestyle Changes: Building Client Resilience

  • Positive psychology’s central aim is to encourage and develop optimism and resilience

  • Optimism is defined in various dictionaries with many affirmative words—among them, hope, confidence, and cheerfulness.

    • trust that things will work out and get better, a sense of personal power, and a belief in the future

    • Revised Life Orientation Test (LOT-R) an effective scale to measure optimism

  • field of counseling has developed an extensive body of knowledge and research supporting the importance of positive psychology, a strength-based approach

  • positive psychology movement is well aware that happiness is not possible in the midst of excessive stress

  • Encouraging and teaching clients to becoming fully engaged in life is basic to positive psychology

Advocacy

  • Advocacy-oriented professionals, educators, and students recognize the influence of social, political, economic, and cultural factors on human development → living in context

  • ACA Advocacy Competencies

    • 2 dimensions

      • extent of client involvement

      • level of advocacy intervention

    • 6 domains

      • client/student empowerment

      • client/student advocacy

      • community collaboration

      • systems advocacy

      • collective action (formerly public information)

      • social/political advocacy

TLCs for Stress Management, Building Mental & Physical Health, Brain Reserve, and Resilience

  • therapeutic lifestyle changes

    • exercise

      • largest study, conducted on 104,046 individuals, found that more leisure time physical activity was associated with reduced major adverse cardiovascular events and all-cause mortality risk, whereas more occupational physical activity was associated with increased risks

      • Key to stress management and behavioral health is getting blood flowing to the brain and body

    • nutrition, weight, supplements

      • avoid the whites (pasta, sugar, salt) and snack only on healthy food

      • vegan, vegetarian, and Mediterranean diets have proven to be effective

      • obesity facilitates diabetes and other illnesses, including cancer, and it encourages the development of Alzheimer’s disease

      • supplements can be helpful but make sure they talk to their doctor before taking them

      • can be an area of sensitivity for some clients, issues of eating need to be approached with care

    • social relations

      • We want our clients to engage socially as fully as possible, as this not only builds mental health but also builds the brain and body

      • People with negative or ambivalent relationships have been found to have shorter protective telomeres, thus predicting age-related disease

      • careful listening skills become essential → need to search for the positive stories and strengths that can lead to better relationships

    • cognitive challenge

      • Take a course, learn a language, learn to play an instrument—basically do something different for growth and the creation of new neural networks

      • adult learners should “jiggle their synapses a bit” by confronting thoughts that are contrary to their own

    • sleep

      • A full rest is critical for brain functioning and development of new neural networks.

      • Lack of sleep is one of the indications for depression or anxiety

      • questions during intake, follow through to learn more, make contact with them and follow their sleep patterns

      • counseling around sleep issues belongs primarily to experts and medical professionals. If you sense serious problems, such as sleep apnea or continued inability to sleep, referral to medical professionals

    • meditation & relaxation

      • meditation makes a positive difference in your well-being and brain, even increasing gray matter.

      • help immune system, increase optimism & positive mood, negate some effects of stress

      • assess what areas of stress management, meditation, and relaxation may be relevant to your client

    • multicultural pride & cultural identity

      • a positive psychology/wellness approach recognizes that multiple forms of oppression do exist, but finding personal and cultural strengths can increase one’s self-respect and strengthen identity

      • RESPECTFUL Model with clients if they seem interested

    • helping others

    • stop use of drugs & alcohol

    • art, music, dance, literature

    • nature break

    • control screen time

    • no smoking