Patterns of Communication

Patterns of Communication vary between cultures, and it is essential when communicating with members of diverse populations to implement cultural and contextual sensitivity.  This struck a chord with me because of the diversity we have here in Hawaii.  Over 45% of the population is Asian (Pearson Education, Inc., 2000), and one segment of that population is the Japanese, who are quite different in the way they communicate.  For example, they use eye contact rarely, and as an American who has been taught that eye contact is important in communication, it can be unnerving.  Working with patterns such as this, especially when they are radically different from one's own, can be an impediment to communication, and anyone in the psychological professions must work toward understanding these differences (Sue & Sue, 1977). 

One idea I like to keep in mind was presented by Stewart and Bennett (2006).  They found, in most cases, people have a natural tendency to judge others according to their personal expectations, which are a direct result of their culture (or context).  What's more is that most people presume the superiority of their own culture.  I have wondered if, perhaps, this presumption is even more common in Americans.  In any event, because these natural tendencies are ingrained, it seems important to remain aware of them. 

Pearson Education, Inc. (2000). Demographic Statistics Hawaii. Infoplease. Retrieved December 11, 2012, from http://www.infoplease.com/us/census/data/hawaii/demographic.html 

Stewart, E. C., & Bennett, M. J. (2006). American cultural patterns: a cross-cultural perspective. Yarmouth, ME: Intercultural Press.

Sue, D. W., & Sue, D. (1977). Barriers to effective cross-cultural counseling. Journal of Counseling Psychology, 24(5), 420-429. doi: 10.1037/0022-0167.24.5.420 

The Haves and the Have Nots

The disparity between resources available to those who have compared to those who have not are remarkable, especially in light of evidence that suggests when individuals perceive their lack of options, it contributes to psychological ill health and sickness (Lever, Piñol, & Uralde, 2005). These same authors concluded that poverty's effects are insidious in that simply perceiving one's circumstances as precarious has a powerful and lasting effect on psychological well-being. However, positive self-perception is increased when individuals learn coping skills and gain a sense of control over their circumstances. In addition to your valuable recommendations, teaching coping skills might be an added benefit.

One fascinating discovery I found in Marks, Murray, Evans, & Estacio (2011) was that although disadvantaged neighborhoods had higher risks of disease than their advantaged counterparts, after controlling income, levels of education, and vocation, there was still a higher risk of disease (Marks, Murray, Evans, & Estacio, 2011). This speaks to the tremendous effects of psychological health and well-being on disease.

References

Lever, J. P., Piñol, N. L., & Uralde, J. H. (2005). Poverty, Psychological Resources And Subjective Well-Being. Social Indicators Research, 73(3), 375-408. doi: 10.1007/s11205-004-1072-7

Marks, D. F., Murray, M., Evans, B., & Estacio, E. V. (2011). Health Psychology: Theory, Research, and Practice (3rd ed.). London: Sage.

The Effects of Culture on the Client Relationship

As a health psychologist, it seems important to understand the complexity that culture contributes to people's overall worldview, which includes how they perceive and react to healthcare. Cultures includes many intersecting factors such as race, ethnicity, religion, vocation, family, social group affiliations, and other circumstances of significance to the client (Sue & Sue, 2008). All of these are aspects of culture and context and they influence the overall affect of the individual (Marks, Murray, Evans, & Estacio, 2011). Furthermore, they may well affect how the client or research participant perceives the world, hence, they may affect the results of a study or necessitate consideration in program design.

Culture is deeply ingrained in all people, to an extent they may not fully realize (Marks et al., 2011). Further, it is critical to the research or the design of effective programs to understand the individual's racial and ethnic heritage and life experiences that may include stigmatization, discrimination, privilege, or disadvantage (Sue & Sue, 2008). All of these experiences will affect the outcomes of research or programs designed for individuals or groups (Marks et al., 2011). For example, if a program were designed to resolve the learned helplessness of chronic welfare recipients, it would be essential to develop a program that could be generalizeable to a variety of diverse populations. A program tailored for African American women may not be effective when applied to a group of Native American women. Consideration of the most salient aspects of a group or culture should be made in research and program design .

The diversity in America is apparent: 72% of the population is White, 15% Hispanic/Latino, 13% Black, 4.8% Asian, .9% American Indian or Alaska Native, and .2% Native Hawaiian or Pacific Islander (U.S. Census Bureau, 2010). After including other demographics such as family and marital status, gender, religious affiliation, socioeconomic status, and sexual orientation, America's diversity is remarkable. The American Psychological Association (APA) (2002) claimed People of Color remain underrepresented in many research samples. These demographics and this underrepresentation have implications for researchers and program designers. When populations are underrepresented in samples, those studies are not valid for the underrepresented populations (Whiston, 2009). Furthermore, health psychologists would not want to design a program for a population using statistics or norms gained from a different population. If health psychologists hope to effect change in diverse populations as well as in the majority culture (which is rapidly changing), they must consider the effects of culture and context (APA, 2002).

References

American Psychological Association. (APA) (2002). Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists. American Psychological Association. Retrieved December 10, 2012, from http://www.apa.org/pi/oema/resources/policy/multicultural-guidelines.aspx

Marks, D. F., Murray, M., Evans, B., & Estacio, E. V. (2011). Health Psychology: Theory, Research, and Practice (3rd ed.). London: Sage.

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

U.S. Census Bureau. (2010). 2010 census. United States 2010 Census. Retrieved August 10, 2012, from http://2010.census.gov/

Whiston, S. C. (2009). Principles and applications of assessment in counseling (3rd ed.). Belmont, CA: Brooks/Cole, Cengage Learning.

Social Inequities

An Example of Social Inequity

One example of social inequity that has a tremendous effect on health is the systemic stereotyping, discrimination and bias against individuals because of their advanced chronological age (Iversen, Larsen, & Solem, 2009). Similar to systemic racism, a pervasive attitude exists toward older individuals, that they are useless and a liability to society. Institutionalizing the care of elderly adults has become commonplace, and people choose this option vice learning how to attend to their needs within the family environment (Pruchno, 2001). This institutionalization is one of the significant contributors to ageist views (Grefe, 2011) and ageism has become deeply ingrained into American society (McGuire, Klein, & Chen, 2008). Americans have become socialized to the bias and stereotype of ageism to the extent that they perceive the negative effects of ageing on their own lives (McGuire et al., 2008).

Effects on Health
When elders are sequestered from the family environment, they are also ostracized from society. It separates them from the younger generation and makes them less accessible, widening the generational gap (Pruchno, 2001). In addition, segregating the elderly population, or treating them according to bias and stereotype has a significant impact on their health, well-being, and longevity (McGuire et al., 2008). A sense of belonging contributes to aging well and to healthy social and psychological functioning (Nolan, 2011). Other research has established a direct relationship between depression and lacking a sense of purpose, meaning, and belonging. Furthermore, isolation in old age contributes to a higher incidence of suicide (Nolan, 2011).

Ageism

Ageism has been compared to sexism and racism (Byetheway, 2005; McGuire et al., 2008) and as in other cases of systemic bias, inappropriate perceptions need to be changed at the individual and, in this case, the family level. In his article on ageism, Butler (1969) wrote "personal insecurity, once generalized, becomes the basis of prejudice and hostility" (p. 243). If insecurity is a factor in misunderstanding older adults, health psychologists could resolve this issue by creating stronger bonds between elders and their families and the community and demonstrate the benefits of keeping older adults in roles that allow them to continue to function and contribute to society.

Resolving Inequalities

Utilizing Marks, Murray, Evans, & Estacio's (2011) suggestion for "Reducing Inequalities" (p. 56), resolving ageist inequalities could include strengthening the individuals and the community, improving access to and developing programs, and encouraging cultural change. To strengthen the community, a re-integration program could place older adults into the elementary schools where they could work with children. This would create stronger intergenerational understanding and simultaneously give the elders a sense of value as they contribute to their communities. Furthermore, health psychologists could design accessible programs that would help families learn how to manage the care of their elders. Finally, healthy psychologists can inspire change and help others reassess their bias toward older adults. Aging education has been utilized successfully to decrease ageism (McGuire et al., 2008).

Ageism ravages an already vulnerable population. It lessens an older adult's ability to enjoy full participation in society (Nolan, 2011). Perpetuating the bias and stereotyping that separates and ostracizes these individuals from mainstream society is devastating for them and a significant loss for the culture (Nolan, 2011). Education can help reduce the prevalence of ageism, and instill the idea that people at all ages have the same fundamental need to belong.

References

Butler, R. N. (1969). Age-Ism: Another Form of Bigotry. The Gerontologist, 9(4), 243-246.

Bytheway, B. (2005). Ageism and age categorization. Journal of Social Issues, 61(2), 361-374. doi: 10.1111/j.1540-4560.2005.00410.x

Grefe, D. (2011). Combating ageism with narrative and intergroup contact: Possibilities of intergenerational connections. Pastoral Psychology, 60(1), 99-105. doi: 10.1007/s11089-010-0280-0

Iversen, T. N., Larsen, L., & Solem, P. E. (2009). A conceptual analysis of Ageism. Nordic Psychology, 61(3), 4-22. doi: 10.1027/1901-2276.61.3.4

McGuire, S. L., Klein, D. A., & Chen, S. (2008). Ageism revisited: A study measuring ageism in East Tennessee, USA. Nursing & Health Sciences, 10(1), 11-16. doi: 10.1111/j.1442-2018.2007.00336.x

Marks, D. F., Murray, M., Evans, B., & Estacio, E. V. (2011). Health psychology: Theory, research, and practice (3rd ed.). Los Angeles, CA: SAGE.

Just in Case You Were Interested in Health Psychologists...

Health psychologists have become important players in medical settings as well as in colleges and universities, rehabilitation clinics, "pain management centers, public health agencies, hospitals, and private consultation/practice offices" (APA Division 38, 2009, para.4). Other career paths include options as university faculty, and as researchers (Swartz, 2005). Health psychologists can work with clinicians, creating models for effective care, implementing the biopsychosocial model of health (Marks, Murray, Evans, & Estacio, 2011). As a university instructor, one might focus on classroom teaching as well as research within the university (Swarz, 2005). As a health psychologist in a research track, one might pursue grant funding, or provide research skills for private or government organizations (Swarz, 2005).

Some of the challenges undertaken by health psychologists include understanding chronic illness, creating awareness regarding preventive lifestyles, examining the future needs of various populations and creating health care systems that meet those needs Gatchel, n.d.). Health psychologists can work with pharmacists, nurses, physical and occupational therapists, and social workers to promote physical and mental health, preventive care, and help create safer and more effective healthcare systems and government policy related to the health and care of large populations (University of the Sciences, 2011).

APA Division 38. (2009). About health psychology: Becoming a health psychologist [Brochure]. Author. Retrieved December 4, 2012, from http://ehis.ebscohost.com.ezp.waldenulibrary.org/

Gatchel, R. J. (n.d.). Current and future trends in health psychology [PowerPoint slides]. Retrieved from www.uta.edu/studentorgs/psichi/gatchel-utapsychconf.502.ppt

Marks, D. F., Murray, M., Evans, B., & Estacio, E. V. (2011). Health psychology: Theory, research, and practice (3rd ed.). Los Angeles, CA: SAGE.

Swartz, S. D. (2005). Possible careers in health psychology--A student's perspective. The Health Psychologist, 27(3), 4.

University of the Sciences. (2011). Careers in health psychology. University of the Sciences. Retrieved December 4, 2012, from http://www.usciences.edu/academics/collegesDepts/SocialSciences/HealthPsychology/Careers.aspx

What is Health?

From a personal perspective, good health is feeling somewhere between good and ideal in body, mind, and spirit. All three of these aspects have an integrated effect on my overall experience. I find it somewhat remarkable that although physical health can determine our very existence, it is psychological health that is the most compelling aspect of experience. For example, I have met individuals with exceptionally good physical health, yet because of psychological challenges, they are miserable. On the contrary, I have met individuals in the final stages of terminal illness who have found happiness, peace, and healing, despite physical demise. So, although emphasis has often been placed on physical health, it is apparent to me that, perhaps, psychological health is the governor of the quality of human experience.

Perhaps the most salient aspect of health is the interconnectedness between physical and psychological health and well-being and the implications both have on quality of life. Although physical health wields tremendous influence on psychological health and well-being, in its somewhat reciprocal relationship, psychological health and well-being affect physical health. Although one might question which has the more significant influence, it is certainly fair (in my opinion) to presume they are inextricably connected.

Another remarkable aspect of health, is that in many circumstances, it becomes relative to an individual's culture or context. One might say, we identify and judge health within the context of the domain in which it occurs. For example, it is well-documented that in diagnoses of cancer or terminal illness, individuals make psychological adjustments to accommodate new normals in regard to their health. In other examples, such as in later adulthood, research suggests when individuals perceive themselves as being healthy, they remain in better health than those who see themselves as unhealthy, even when their physical health is identical. Using health in relative terms, individuals may be healthy for their age or healthy in light of their medical circumstances. Nevertheless, although the meaning of health may be somewhat nebulous and changing over the course of the lifespan and various circumstances, the physical body, mind, and spirit seem to have a remarkably powerful relationship.

A New Program...

Last week, and just in time to accommodate my inclusion into this quarter's classes, I have embarked on a new academic odyssey in the ph.d. program for health psychology.  Still at Walden.  I've been thinking about this change for several months, and intended on entering the same program after finishing my master's degree.  Through an odd, but ominous chain of events, I realized the health psychology program was where my passion lyed...laid...lay...lie...lay...WTF, whatever.  I never felt comfortable with the proper usage of that particular word.  Anyway, I'm excited, although feel as if I am grieving a loss, of sorts.  Grieving, I suppose, the future in counseling I had planned for several years.  But, I do feel renewed, and thankful to have finally made this decision.  I know it doesn't seem like that big a deal, but, it feels big to me.  Maybe I will explain the chain of events that lead me to finalizing my decision another time.  It was a lesson in openness, or receptiveness, in general, at least in the spiritual sense, that it can provide direction in the oddest of forms and sequences of events.  Alrighty then...here I go...

Assessing Baby Boomers

I believe the ability to accurately assess older clients has, and will continue to become an important issue in counseling. As the Baby Boomer generation reaches retirement and older age, this population will need assessments that may be somewhat different than the typical measures used for evaluating older individuals from previous generations. People live longer and the needs of the current aging population has demands not common in the aging population of 50, or even 20 years ago. As Whiston (2009) mentioned, 60 is the new 40, and this group has expectations for their future (Mellor & Rehr, eds., 2005). The knowledge used for the current elderly population will not suffice for those who are aging now (Mellor & Rehr, eds., 2005).

The sheer numbers of individuals entering later adulthood and their new breed of needs has powerful implications for the profession. The needs themselves create a necessity along with the fact that this country has never before experienced such a large number of individuals entering into old age simultaneously (Mellor & Rehr, eds., 2005). This generation has a history of activism, and even as they age, will most likely continue to make demands on the profession, which will instigate new means of measuring "grief, loss and loneliness, and depression" (Whiston, 2009, p. 404). An abundance of research determined that this group will continue to break the mold as they age (Frey, 2010).

This group will most likely not be the bingo players of today's elderly population, and along with their unusual need for activity, they may also approach psychological issues differently (Richman, 2012). Barbera (2012) claimed the greatest psychosocial needs of this population will be social connectedness, their vastly different preferences as compared to previous aging populations, their penchant toward continuing education and their love of activism, especially as it pertains to their physical and mental health care. They will want to be centrally involved in any decisions made about their care and they will demand to be educated on the meaning and results of any assessment used to make decisions about their care.

The Baby Boomer generation will expect support systems, especially those that advocate and facilitate self-support, and in concert with their awareness of the mind body connection, they may instigate significant change in the counseling profession, specifically, how psychological issues are assessed (Barbera, 2012).

Barbera, E. F. (2012). 10 anticipated psychosocial needs of baby boomers. Long-Term Living: For the Continuing Care Professional, 61(2), 32-33.

Frey, W. H. (2010). Baby Boomers and the new demographics of America's seniors. Generations, 34(3), 28-37.

Mellor, M. J., & Rehr, H. (Eds.). (2005). Baby boomers: Can my eighties be like my fifties? New York, NY: Springer.

Richman, A. (2012). Are Wii ready for the baby boomers? Long-Term Living: For the Continuing Care Professional (LONG TERM LIVING), 2012 Apr; 61(4): 24-6, 61(4), 24-29.

Whiston, S. C. (2009). Principles and applications of assessment in counseling (3rd ed.). Belmont, CA: Brooks/Cole, Cengage Learning.

Death and Dying

Death, in medical terms, takes place when vital functions cease. This includes brain activity, respiration, and heartbeat (Santrock, 2008). Personally I support the idea that death, for all significant intents and purposes occurs at the cessation of higher cortical functioning. Lawyers and the legal system may argue over what constitutes death, so advanced directives will help individuals and their families from the intrusive nature of the law and lawyers at a time when sensitivity and privacy are preferred by most families. Ethically, it is the duty of medical practitioners to do whatever is necessary to support life unless directed otherwise expressed by the individual in a living will or other type of legally acceptable directive.

In some Australian Aboriginal communities, the morning ceremonies can be elaborate and complex (Jacklin, 2005). Community members may burn the camp and move to another location. Once an individual is deceased, it becomes taboo to mention his or her name for a specified amount of time, perhaps forever. Although the dead remain in the minds of the family and community, they may not be openly mentioned or discussed. Most often, the dead individual's belongings are burned (Jacklin, 2005).

Australian Aborigines believe they are a part of the earth. Typically, these people do not fear death and believe it is a time when the spirit is released to its sacred home. Still, though, as in many cultures, the death of family and loved ones causes tremendous grief and sadness (Northern Territory Government - Australia (NTGA), n.d.). Failing to conduct ceremonies properly may cause the deceased spirit to become trapped and fail to progress into the spirit world. Because of this, spiritual ceremonies are taken seriously (NTGA, n.d.). Deceased individuals are given a morning name which is used in place of the name they used throughout their lifetime (Jacklin, 2005). Sometimes, other individuals with the same name will take a new name (NTGA, n.d.).

Although various populations have radically different ceremonies and ritualistic ways of coping with death, for most people, the death of family or a loved one is a deep loss, even when it is a renewal or spiritual progression or reward for the deceased (Stroebe, 2010). Even in American culture, honoring the dead comes in many different presentations, and various ethnicities practice rites that others might find offensive.

As a counselor, it is important to acknowledge and understand the significance and far reaching implications of losing a loved one. Such loss predisposes an individual to psychological and physical ill health (Rudlow, 2012). Although research identifies processes of coping after the loss of a loved one (Stroebe, 2010), of critical importance is understanding there is no one way to grieve loss or the process of dying. Encouraging a client to do either according to personal expectations could cause potential harm (Kübler-Ross, 1970; 1985; 1981)

References

Jacklin, M. (2005). Collaboration and closure: Negotiating Indigenous mourning protocols in Australian life writing. Antipodes: a North American Journal of Australian Literature, 19(2), 184-191.

Kübler-Ross, E. (1970). On death and dying. [New York]: Macmillan.

Kübler-Ross, E. (1981). Living with death and dying. New York: Macmillan.

Kübler-Ross, E. (1985). On children and death. New York: Collier Books.

Northern Territory Government - Australia. (n.d.). Indigenous Traditional Religions. Global Dialogue Foundation. Retrieved November 18, 2012, from http://www.globaldialoguefoundation.org/

Rudow, H. (2012). The bereaved at greater risk of heart attack after loss. Counseling Today: CT Daily. Retrieved from: http://ct.counseling.org/2008/01/working-through-grief/

Santrock, J. W. (2011). A topical approach to life-span development (3rd ed.). New York, NY: McGraw-Hill.

Stroebe, M. S. (2010). Bereavement in family context: Coping with the loss of a loved one. Family Science, 2(3/4), 144–151. doi: 10.1080/19424620.2010.576081