Saturday, June 30, 2012

Overcoming the Fear of the Unknown?

How do we do it?


Although the answer to this question seems complex at best, the answer is really quite simple. We fear the unknown because of how we perceive it. Our imagination is usually far more frightening than the actual experience. I tend to believe having a fear of the unknown is an evolutionary mechanism for self-preservation and self-protection that keeps us within the boundaries of maintaining control and having access to ample resources.

Wilkins (1998) considers fear of the unknown inaccurate and self-limiting, and because the unknown is devoid of information, we should not place fear there. So, possibly examining the fear itself is more worthy of exploration than exploring the unknown, especially once we understand that it is the fear that scares us. Wilkins (1998) suggests by "letting go of all beliefs that this change...will result in a negative outcome" (p. 60). Then try to create positive anticipation for the unknown. Of course, this may not work well if you are facing a 40-year jail sentence, but for most intents and purposes, I agree with Wilkins.



Wilkins, W. (1998). Overcoming fear of the unknown. Futurist, 32(7), 60.

Roosevelt, F. D. (1933). Speech presented at Inaugural Address in White House, Washington, DC.

Immigration: Then and Now



I thought about several aspects of immigration - then and now. First I thought about the process of coming to America in the late 1800's as compared to coming now. Then there was a process, that was, for the most part, followed. The process was designed by White European Americans. There's still a process, although many immigrants come into the country illegally. The rules and the process are still designed by the American White system.

When I think about it though, the fear of foreigners coming into the country is not a new story. Remembering my high school history, it wasn't long after America won its independence that Congress passed the Alien and Sedition Act of 1798. Ostensibly, Congress created that act to keep away foreigners, more especially, those who might cause problems with the government. One might wonder if there was more to that than met the eye.

In the Boston area near where I'm from (although before my time) the Irish people had a rough time being accepted into White culture. They won their Whiteness by turning their backs on the free Northern Blacks who competed with the Irish for jobs in that part of the country (Ignatiev, 1995).

I would sum my thoughts by describing immigration, yesterday and today as "racial stereotyping, a system that takes advantage of lower middle and working class, the installation of fear, and the implementation of systemic White racist schemes, created to benefit and protect the ruling White class against nonwhites.

Ignatiev, N. (1995). How the Irish became White. New York: Routledge.


The Complexity of Identity




The Complexity of Identity

When people fail to understand the complexity of their identity, they tend to disregard their intersecting similarities, and, in essence, miss sharing the emotional experience that comes from oppression related to gender issues, sexual orientation, and socioeconomic status (Laureate Education, Inc., n.d.).

When counselors (or anyone) perceives individuals as a complex composition of identities, the variety of characteristics opens up new inroads by which to relate to others. For example, when an Asian student cannot relate to a Black student, they may develop a relationship based on the fact they are both women, or that they came from a similar socioeconomic class (Laureate Education, Inc., n.d.). As they establish a relationship based on similar characteristics of their identities, it may be easier to later discuss racial issues.

This may be equally true in the counseling environment. If a counselor embarks on a new relationship with a client who is racially different, it may be important to establish similarities by which the two can relate to each other. For example, if a White client visits a Black counselor, the client may believe nothing common exists between them. This case could also be reversed and the Black counselor feels separate from the White client. If they determine similarities in other aspects of their identity, this may be a way to break through apparent differences.

LaFramboise (Laureate Education, Inc., n.d.) mentions that these similarities can also be helpful between racial groups. When individuals in a racial group become aware of the complexity of identity, they can begin to become aware of intersections whereby they have similarities. These similarities create a sense of camaraderie even though their race is different. LaFramboise (Laureate Education, n.d.) suggests this phenomenon (of finding similarities) has a somewhat disarming affect that puts people on the same team. Parham (Laureate Education, Inc., n.d.) believes racial differences may be the hardest aspect of identity to discuss - feelings and emotions can escalate quickly. If people can establish a position which places them on the same side, or the same team, so to speak, they can easier learn to discuss and understand the racial differences in a less threatening way.

Establishing similarity creates a safe zone wherein individuals from diverse identity characteristics can come together as comrades to understand the painful and emotional issues related to their differences. Basically, if we can start from a place where we understand each other, it may be easier to use that position as a starting point for a discussion of our differences.

The best way to utilize information about cultural groups when counseling an individual with multiple identities is to use the information to find intersections that overlap with each aspect of identity. Determining positive aspects of each identity gives a client a broader, perhaps softer identity for matters of self-perception as well as for relating to others.

For example, I am not just White. I am a woman, a mother, a daughter, a student, a family member, a good friend, a resident of Hawaii, a spiritual person, an advocate for dying patients, an activist on several issues, and a volunteer. So, even if someone may feel different from me because I am White, they may relate to me as an advocate. The more dimensional description lets others see me as a friend rather than an adversary. It also lets me see myself as a multi-dimensional person, not simply a static statistic. As each person acknowledges their complex identity, they will find more places by which they may intersect with others. This concept is as important for counselors as it is for all people (Sue & Sue, 2007).

References:

Laureate Education, Inc. (Producer). (n. d.). The Intersection of Multiple Identities [Streaming Video]. Baltimore: Author.

Sue, D. W., & Sue, D. (2008). Counseling the culturally diverse: Theory and practice (5th ed.). Hoboken, NJ: John Wiley & Sons.

Cultural Competency Guidelines




Comparison and Contrast between Guidelines

Similarities

The American Psychological Association (APA) offers guidelines pertaining to cultural competence within the psychological professions. The American Counseling Association (ACA) provides a set of ethical codes for the specialization of mental health counseling. Both precepts address cultural awareness in clinical settings, although the ACA (2005) codes are more explicit in defining and describing various dimensions of cultural awareness in the therapeutic alliance. Both guidelines detail the need for cultural sensitivity when diagnosing a mental disorder, in choosing appropriate psychometric evaluations, and understanding the limitations of standardized assessments. Additionally, they encourage the recognition of the affects of diversity on any device or intervention normed on populations other than the client's.

Both guidelines describe the importance of maintaining a non-judgmental worldview and an understanding of non-western and non-traditional, culturally-specific techniques and interventions (APA, 2002). Both intend to advise and develop cultural sensitivity in the psychological professions. They convey the importance of working competently with diverse client populations and maintaining an awareness of the wide range of underlying cultural beliefs and values (Solomon, Greenberg, & Pyszczynski, 1991). Both understand the continuing evolution of cultural awareness in psychology and that guidelines such as these are not exhaustive and must change when appropriate (APA, 2002).

Differences

Perhaps the most obvious difference between the ACA (2005) and the APA (2002) guidelines is the former's contracted focus on the specifics surrounding the therapeutic alliance and the latter's concentration on cultural awareness in a broader range of professional psychological interactions. The APA (2002) guidelines are, however, a descriptive, scholarly guide, supported by an abundance of empirical research, and a critical benefit to those seeking guidance toward cultural competence. One significant difference is the ACA's (2005) direction in counselor education and supervision as it pertains to cultural competence. Although the APA (2002) addresses the need for cultural competence in education, the ACA more directly informs these fundamental issues in mental health counseling. Since the counseling profession focuses on the therapeutic alliance, it is appropriate the ACA (2005) guidelines address the specific needs of counselors. Furthermore, it is befitting that the APA (2002) guidelines represent the wider and more diverse range of psychological specialties embraced by the association.

Guidelines with Personal Resonance

Personally, the APA (2002) guidelines provide a far more definitive range of the culture- specific needs of psychological services. It is scholarly in its scope and the information provided is empirically derived. However, for the focal purpose of mental health counseling, the ACA (2005) guidelines provide a specialized focus on the affects and repercussions of cultural contexts within the therapeutic alliance. Considering my ultimate goal of working as a counseling psychologist, I find the APA (2002) guidelines far more informative of the nature and level of cultural competence required of psychological professionals. That said, the ACA (2005) ethical codes are descriptive and counseling-specific, and will guide the actions of my immediate goal in mental health counseling. For counselors, the ACA (2005) codes are essential for practice, whereas the APA (2002) guidelines can be used as secondary, albeit precise and critical, instruction.



References
American Counseling Association (ACA). (2005). 2005 ACA code of ethics [White Paper]. Retrieved from the ACA website: http://www.counseling.org/Files/FD.ashx?guid=ab7c1272-71c4-46cf-848c- f98489937dda

American Psychological Association. (APA) (2002). Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists. American Psychological Association (APA). Retrieved June 17, 2012, from http://www.apa.org/pi/oema/resources/policy/multicultural-guidelines.aspx

Solomon, S., Greenberg, J., & Pyszczynski, T. (1991). Advances in experimental social psychology. San Diego: Academic Press.






Active Listening: The Primary Micro-skill




Active Listening: the Primary Micro-skill

Active listening is the deliberate process of hearing as well as heeding the spoken and unspoken words of clients. It is an active process and requires deliberate attention and focus. Active listening includes the use of head nodding, brief vocal agreements, and consistent eye contact. This micro-skill provides the foundational framework for empathy, which is one of the most healing aspects of the therapeutic alliance. It's overall effects demonstrate to clients validation, responsiveness, acknowledgment, and endorsement, as well as the listener's intent to fully understand the message of the sender. Toller (1999) believes active listening is the basis for all therapeutic communication. If counselors must make one skill their default counseling skill, I believe it should be active listening.

Active Listening: Bridging the Communication Gap

Active listening does more than yield information for intake; it enables a counselor to hear the information that hides between or behind the clients' words. This attentive focus exposes information that is not always spoken, but is, nonetheless, communicated by the client. Active listening contributes some transparency in the communicative aspect of the therapeutic relationship, because this micro-skill lets counselors hear meaning in the often chaotic or imprecise words of the client. It enables the counselor's understanding of the client's world without the client having to express every feeling and emotion (some of which they may not be prepared to articulate or acknowledge.) Clients cannot always clearly say what they mean, but active listening can give a client's unintelligible expression an audible meaning.

Active Listening to Strengthen Counselor Self-Efficacy and the Therapeutic Alliance

Active listening, according to Levitt (2001) supports counselor effectiveness, specifically by establishing a level of confidence in new counselors. Lepkowski, Packman, Smaby, and Maddux (2009) suggest even though new counselors have a fairly accurate self-assessment of counseling skills, they may, in fact, lack the experience to provide them with a strong sense of self-efficacy. Levitt (2001) found, when counselors anxiously manage their use of micro-skills, they listen less effectively and fail to focus on the client.

Rather than trying to focus on a precise delivery of the full range of micro-skills, simply listening actively gives the counselor the experience of efficiency and effectiveness. Self-efficacy directly contributes to the therapeutic alliance because it supports the counselor's comfort level and heightens communication skills as well as the effective implementation of the tools and techniques of counseling (Levitt, 2001). Ultimately, active listening "creates the foundation for good rapport, and for better patient outcomes" (Bryant, 2009, para. 4) and creates a sense of understanding in the relationship.

When active listening is effectively implemented, the counselor and the client are comfortable and communication is optimal. The client perceives the counselor is listening, hearing, and understanding what he or she is saying. Additionally, in dyadic communication, active listening promotes openness and a feeling of safety and trust (Bryant, 2009). This benefits the therapeutic alliance, making the relationship safe and supportive for the client.

References:

Bryant, L. (2009). The art of active listening. Practice Nurse, 37(6), 49-52.

Knapp, H. (2007). Therapeutic communication: Developing professional skills. Los Angeles: Sage Publications

Lepkowski, W. J., Packman, J., Smaby, M. H., & Maddux, C. (2009). Comparing self and expert assessment of counseling skills before and after skills training, and upon graduation. Education, 129(3), 363–371.

Levitt, D. H. (2001). Active listening and counselor self-efficacy: Emphasis on one microskill in beginning counselor training. Clinical Supervisor, 20(2), 101–115.

Toller, P. (1999). Chapter 3: Learning to listen, learning to hear: A training approach. In P. Millner & B. Carolin (Eds.). Time to listen to children: Personal and professional communication (pp. 48-61). New York: Routledge.



Thursday, June 21, 2012

Micro-Skills in Counseling



Using Micro-Skills Comfortably and Effectively

Personally, it would feel fairly natural to begin a counseling session. I am social and enjoy talking with people. I might engage in some small talk to help them feel comfortable unless they seemed to disengage with small talk or if they intimated that they wanted to get to the issues for which they sought counseling. If engaging in small talk did not seem appropriate, I would move toward letting them express their needs. For example, I might ask them if they would like to talk a little about what brought them in today. That said, the micro-skills I am most comfortable using are active listening, reflecting, and reframing. One of my concerns with using micro-skills is implementing them as techniques but with a delivery that does not betray their technical nature. In other words, using techniques, but with empathy and genuine care.

Active Listening

I find active listening an essential component to any social alliance, certainly in the therapeutic relationship. As a new counselor, Levitt (2001) posits active listening will increase my ability to feel comfortable in my new position and function more effectively with clients. Levitt (2001) further contends that active listening supports empathetic responses. Toller (1999) believes counseling is "based on the understanding that it is through the experience of being listened to, accepted and truly heard by another person that we can begin to heal some of the pain and hurt of our human existence" (p. 48-49). In some situations, research suggests active listening is far more effective than giving advice (Paukert, Stagner, & Hope, 2004).

Not only does active listening validate and promote growth in the client, it does the same for the counselor. Toller (1999) additionally believes the value of active listening surpasses counselor fluency, experience, and any one particular theoretical orientation (Toller, 1999). Gloria Steinem (1992) expressed the belief that every person wants to feel validated and yearns for someone to acknowledge and accept their higher self, or at least the hidden self who craves to be seen and endorsed. Active listening seems the primary hue on the color wheel of micro-skills. Levitt (2001) cites Neufeldt et al. (1995) as writing "Ironically, anxious attention to skills and performance creates less attention to the client, thus trainees become less effective listeners and counselors" (p. 102).

Reflecting

Knapp (2007) regards reflecting and paraphrasing as the same skill, so for the purposes of this post, I will refer to them as such. Reflecting clients' words and feelings lets them know the counselor is listening attentively and is interested in their issues, especially the reasons for which they are in counseling. One important aspect of Knapp's (2007) perspective on reflecting is the idea that as well as aiding the therapist's understanding of a client's story completely, "reflection helps the client hear what he or she is saying, which may facilitate introspection and self-understanding" (p. 71). I feel comfortable with reflecting. It will keep me engaged with the client and allow me to subtly offer the client a perspective from a slightly different angle (me relating the story rather than hearing it from their own voice.) Furthermore, reflecting will prove to the client I am interested and considering their situation. This care and consideration will build trust and appreciation, contributing to the therapeutic alliance.

Reframing

Reframing allows the counselor to put a positive spin (loose application of the term) on the client's perspective. Without imposing personal beliefs and values, the counselor can help clients perceive their circumstances from a slightly different perspective. As Knapp (2007) explains, reframing can help clients who present information in an excessively negative manner or is highly critical of him or herself. I am comfortable using this micro-skill carefully. Helping clients perceive a lighter or more positive side of a situation can help them reflect and consider other perspectives. Whether the client can accept the positive side of the situation or he or she fails to do so, the counselor's interest, consideration, and care will contribute to creating a therapeutic relationship.

References:

Knapp, H. (2007). Therapeutic communication: Developing professional skills. Los Angeles: Sage Publications.

Levitt, D. H. (2001). Active listening and counselor self-efficacy: Emphasis on one microskill in beginning counselor training. Clinical Supervisor, 20(2), 101–115.

Paukert, A., Stagner, B., & Hope, K. (2004). The Assessment of Active Listening Skills in Helpline Volunteers. Stress, Trauma, and Crisis, 7(1), 61-76. doi: 10.1080/15434610490281075

Steinem, G. (1992). Revolution from within: A book of self-esteem. Boston: Little, Brown.

Toller, P. (1999). Chapter 3: Learning to listen, learning to hear: A training approach. In P. Millner & B. Carolin (Eds.). Time to listen to children: Personal and professional communication (pp. 48-61). New York: Routledge.