© Love Publishing: Cheung & Leung1 Practice Integration (Meeting 10) © Cheung, M., & Leung, P....

© Love Publishing: Cheung & Leung 1

Practice Integration(Meeting 10)

© Cheung, M., & Leung, P. (2008). Multicultural practice and evaluation: A case approach to evidence-based practice. Denver, CO: Love.

Instructors who adopt this book may use the PowerPoints to teach your course without prior permission. Please address questions and comments to [email protected].


Cultural Diversity

Write as many words to describe who you are How do we work with others who perceive

themselves as different from you? Be culturally sensitive Use empowerment techniques Identify strengths Think about solutions


Minority Identity DevelopmentAtkinson, Morten, and Sue (1989) Attitude and Perception (affecting current and

future behavior) Awareness of Developmental Stages (per

individual or community/group) Nonpathological in understanding behaviors Nonlinear in appreciating changes


Cultural Sensitive ApproachesWhat do you do to become self aware?

Step 1: Self Awareness

1. Look into your past and present wants

2. Identify biases from your background

3. Learn new perspectives


Working with Gay & Lesbian ClientsDo Identify client strengths Listen Explore impact of negative

experiences Explore reasons for coming

out, wanting to come out, or being closeted, and related consequences

Be aware of client’s worldview Be knowledgeable about

sexual practices in the gay & lesbian community

Do Educate yourself about safer

sex practices Explore feelings about labels

applied to sexual orientation Assist the client in dealing with

loss and grief related to losing privilege and experiencing oppression

Source: Montrose Counseling Center, Houston


Working with Gay & Lesbian ClientsDon’t Assume a personality disorder Refuse to listen to client’s

theory about “causes” Presume negative experiences

with the opposite sex caused homosexuality

Presume “coming out” or “staying in” is helpful

Focus on sexual orientation if the client does not want to address its connection to current issues

Assume identity confusion Deny your own sexual

preference if asked

Don’t Use offensive language:

“homosexual,” “queer,” “dyke,” “faggot,” “effeminate,” “nellie,” “butch,” “stone dyke,” “queen,” etc., even if you are gay/lesbian

Give an opinion about whether the client is a gay/lesbian even if the client asks you so

Tell your client how s/he should come out

Source: Montrose Counseling Center, Houston


Working with Gay/Lesbian ClientsCase AYou are working with a 13-year-old Anglo

female client (A) who reports to you that she has been having intimacy and sexual contact with her best friend, another 13-year-old female. She thinks that something is wrong with her, that she is “losing her mind” and “going crazy.”


Practice (like a Jeopardy game) Find questions that will help your client to provide the answers in quotes (Case A is provided as an example)

Case A: What questions did you ask to get these answers?

What do you want from me? What is the reason you told me about this? “Put an end to it all.”

How does this encounter relate to your family values? Is it in conflict with your family values? “My parents go to church regularly. I’m sure they don’t want

me to talk about it.” How would your family react to this if they knew?

“My dad is known in the community. He will be mad at me.” What is your view about same-sex relationships?

“I have a boyfriend but we have been fighting a lot recently.”


Case Discussions

In groups of 3–4, provide at least one question to assess the client’s situation

(client’s response is given as a hint)


Case B

Case B: You are working with a 15-year-old African American male adolescent (B) who presents to you with an anxious mood. He states that he does not fit in well with his peers. He is very expressive and shows feminism. He has been recently beaten at school and called a “queer.”


Client’s Response

Case B: What questions did you ask to get these answers?

I don’t have friends. No one helps me when I am being teased in school.

I was once sexually touched by a male friend. I drink alcohol so that I can sleep. I really

don’t want to return to school. My family does not know about my problems.


Case C

Case C: You are working with a 16-year-old Latin American male (C) who presents to you with depressive symptoms. He is reluctant to talk but eventually confides in you that he has been engaging in sexual acts with other boys in the neighborhood. He would like to have a steady boyfriend, but he knows that it will not be tolerated by others.


Client’s Response

What questions did you ask to get these answers?

I don’t know, but I enjoyed doing these (sexual) acts.

I have a boyfriend, but I don’t want to continue this relationship.

My family is Catholic. I don’t live with my parents.


Case D

Case D: You are working with a 17-year-old Asian American female (D) who moved to the U.S. from Vietnam about 5 years ago. She is reluctant to seek help, but she told you that she is attracted to girls. She begs you not to tell her parents because she is afraid that she is lesbian.


Client’s Response

Case D: What questions did you ask to get these answers?

I can’t talk about it with my parents. My English is not good. I have not been doing well in school for the last 3

months, and my parents hired a female tutor for me. I don’t know how to tell you about my feelings, but I

have been crying a lot.


Case E

Case E: You are working with a parent (E) who reports that she suspects that her son is gay. She found that him chatting on the internet with many unknown guys and may be browsing pornographic materials. She does not know whether her husband is aware of the situation and is afraid of telling him.


Client’s Response

Case E: What questions did you ask to get these answers?

I don’t want to talk about me. In my culture, women do not have power.

I don’t know how to talk with my son or my husband. I can’t stop the internet access because my

husband uses it. I feel embarrassed if I have to talk about sex with

my son.


The Nonlinear Stages of Coming Out Stage One: Identity Confusion Stage Two: Identity Comparison Stage Three: Identity Tolerance Stage Four: Identity Acceptance Stage Five: Identity Pride Stage Six: Integration of Identity


The Nonlinear Stages of Coming Out Stage One: Identity Confusion

“Could I be lesbian/gay?” Stage Two: Identity Comparison

“I may be lesbian/gay.” Stage Three: Identity Tolerance

“I probably am lesbian/gay.” Stage Four: Identity Acceptance

“I am lesbian/gay.” Stage Five: Identity Pride

“I am with my lesbian/gay peers.” (us and them) Stage Six: Integration of Identity

“I am me.” Brady, S., & Busse, W. (1994). The gay identity questionnaire: A brief measure of homosexual identity formation. Journal of Homosexuality,

26(4), 22.


Integration of Theories: Categorization

Psychodynamic Experiential and Relationship-

Oriented

Cognitive and Behavioral

Purpose/

Goal

Insight Awareness Change

Technique Memory recall

Subjective experiencing

Action-oriented assignments

Role Analysis Listening Empowerment


Dream AnalysisMary’s Dream in a session: When you talked about repeating patterns in my family, I thought of

a reoccurring dream almost once a week that has been bothering me. In this dream, I was in a strange place. I thought I was with someone but it was not very clear. Joe might be there, and so were Ami and Kevin. I was walking up some steep stairs that seemed to be dangerous or difficult to climb up. I thought I was going to fall but I managed to support myself with the handrail. When I stood still to catch my breath, I saw Joe next to me. Ami was behind me saying something I couldn’t hear or understand. When I reached the top of the stairs, I saw a house and many trees. I tried to enter the house through a big hole but the hole suddenly got smaller. I got in the house but Joe wasn’t coming along. I felt that walls were surrounding me. I stepped on a snake or a piece of gum or something like that. I was scared and wondered why I continued to go into this house. I looked through a window and wanted to see if Joe was still outside but saw a man I never had met before. This man’s face suddenly enlarged before I stepped into some kind of empty air.


Integration: Dream Work

Psychodynamic Thinking

Experiential

Relationship

Feeling

Cognitive

Behavioral

Doing

System Thinking-Feeling-Doing


Integration Examples: Dream Analysis Talk about the dream Use imaginary Pay attention to the now

feelings Identify self-interpretation

results Become part of the dream

and identify feelings Examine behaviors that

need to be changed

Identify each client’s interpretations

Ask, “How does this dream help you or your family?”

Ask, “What did you learn from this dream?”

Ask, “How does this dream relate to other people’s expectations?”

Ask, “What is purpose of bringing this dream to this session?”


Integration Examples: Any problem Talk about the problem Use imaginary Pay attention to the now

feelings Identify self-interpretation

results Become part of the problem

and identify feelings Examine behaviors that

need to be changed

Identify each client’s interpretations

Ask, “How does this problem help you or your family?”

Ask, “What did you learn from this problem?”

Ask, “How does this problem relate to other people’s expectations?”

Ask, “What is purpose of bringing this problem to this session?”


Competencies Needed by Social Workers Informational Intellectual Interpersonal Intrapersonal Intervention OtherYou did this exercise at the beginning of the

semester. Have any of these areas improved?


ASK Multicultural CompetenciesASK Self Assessment (tested in CPS by Leung & Cheung, 2001–2005) Attitude

Be open Ask for clients’ clarifications Be positive Learn about clients’ culture Use previous experience as a guide

Skills Ask questions re: cultural differences Ask for client’s understanding through reflections Find other meanings re: client resistance Assess strengths Acknowledge cultural uniqueness Address inappropriateness without judging from cultural values

Knowledge Know various greeting methods Understand diversity Use culturally relevant information in outcome evaluation


Variations from Mary & Joe’s Case This family is composed of Joe (42) and Mary (38), and

their two children, Ami (16) and Kevin (8). The couple has been married for 17 years. In the past two years, they have been experiencing communication difficulties with their children and are therefore seeking help to “glue” the family back together. Joe is a mechanical engineer and Mary is a substitute school teacher who has recently been attending a graduate social work program. They describe themselves as a middle class family.

Your TASK: Write down three individual or family characteristics of families we might work with that are different from this family


Human and Family DiversityHuman Diversity Race/Ethnicity Gender / gender role

perception Class, income Age Education Occupation Religion / spirituality Cultural values / beliefs

Problems Variations Poverty, lack of support Substance abuse Mental health/illness Health Discrimination School/ Work Behavioral/perceptual Relationship/

communication Resistant client/

involuntary


Human and Family DiversityFamily Diversity # of children, childless,

having children earlier or later in age

Intergenerational Issues Interracial Composition International connection Marriage/Cohabitation GLBTQ Extended Families Family relationships Adoption/Foster Care Divorce/Reconstituted

Family Immigration status

Practice Variations Theory-based techniques Start from where the client is Assessment (self and client)


Applying to DiversityPsychodynamic PAST Thinking History of

family

Experiential

Relationship

NOW Feeling Mutuality & differences

Cognitive

Behavioral

FUTURE Doing Effect of change

System ALL -Thinking

-Feeling

-Doing

Empowerment


Termination in Family Practice How do you know it’s time to end?

How do you prepare the family for termination?

How would you respond if one of your clients in the family asks, in the final session, if she or he could see you again in the near future?


Integration: TerminationPsychodynamic Thinking

PreparationTalking out thinking (accepting)“What comes to your mind about this last session?”

Experiential

Relationship

FeelingPositive feedback & supportTalking and listening to each other

Cognitive

Behavioral

DoingFuture wishesClarifying the meaning of feeling-relationship connections

System -Thinking

-Feeling

-Doing

ConnectivenessAcknowledging each’s strengths




Experiential

Relationship

FeelingPositive feedback & supportTalking and listening to each other“What would you like to say that will help each other maintain a healthy relationship?”

Cognitive

Behavioral

DoingFuture wishesClarifying the meaning of feeling-relationship connections

System -Thinking

-Feeling

-Doing





Experiential

Relationship


Cognitive

Behavioral

DoingFuture wishesClarifying the meaning of feeling-relationship connections“What would you do in the future if a problem occurred among all of you?”

System -Thinking

-Feeling

-Doing





Experiential

Relationship


Cognitive

Behavioral

DoingFuture wishesClarifying the meaning of feeling-relationship connections“What would you do in the future if a problem occurred among all of you?”

System -Thinking

-Feeling

-Doing

ConnectivenessAcknowledging each’s strengths“What is the greatest strength that you would bring to this family in the immediate future?”


Skills or Strategies

Relationship-building skills Commitment

Verbal following, exploring, and focusing skills Concreteness (e.g., list, genogram, activities, artwork as a tool) Feeling/emotion focused (e.g., guilt, losses) Congruence (e.g., body language, definitions, problem identification)

Communication focus Engaging Decision-making process Child and family focused Content and developmental process

Multidimensional assessment Assumption and meaning checks Cultural sensitivity and differences (e.g., cultural shock, religion) Solutions-focused Change-oriented


Other learned skills…

Assessing intrapersonal and environmental systems Forming and assessing group work Negotiating goals and formulating a contract

Planning and implementing change-oriented strategies

Enhancing clients’ problem solving, social, assertiveness, and stress management skills


Other learned skills…

Developing resources, planning, and advocacy as intervention strategies

Enhancing family relationships Intervening in social work groups Additive empathy, intervention, and

confrontation Managing individual and family barriers to

change


Body–Mind–Spirit Theory in Practice

Current Trend


Concept of Holistic Health

Lowenberg Holistic Health Model

Body Language http://www.bbc.co.uk/science/humanbody/bo

dy/index_interactivebody.shtml Do the “Spot the fake smile” exercise: http://www.bbc.co.uk/science/humanbody/mi

nd/surveys/smiles/index.shtml


Dimensions of Body–Mind–Spirit Intervention (Chan, Ho, & Chow, 2001)

Cognitive Behavioral Emotional Physical Spiritual

Cognitive restructuring

Positive thinking

Secondary gains

MeditationGuided imageryRelaxation trainingAffirmationsLove & forgivenessLaughter & playLife enrichment plan

Emotional healingSkills for dealing with emotionsTraditional Chinese perspectivesMutual support and understanding

Breathing exercises

Physical exercises

Faith

Goal and meaning of life

Sense of self-worth and dignity


Interventions in Best Practicehttp://mybeautifulamerica.com/mybeautifulamerica.htmwww.webmd.com

Try a mind-reading game:http://www.learnenglish.org.uk/games/magic-gopher-central.swfMoral of this game: We must believe in body–

mind connection to make the game work.


All possible answers

All possible answers are: 0 (0-0=0) 9 (10-1, 11-2, …=9) 18 (20-2, 21-3, …=18) 27 (30-3, 31-4, …=27) 36 (40-4, 41-5, …=36)

45 (50-5,…=45) 54 (60-6, …) 63 (70-7, …) 72 (80-8, …) 81 (90-9, …)

The principle is… Keeping the answers (body) Changing the symbols (mind)

In treatment, we must change the patient’s mind to something positive before an effect can take place.


Body–Mind–Spirit Intervention You can fight your physical illness Enjoy peace of mind Love, forgiveness, & letting go Taking control of your life Inspiring hope and search for the purpose of

life

(Chan, Ho, & Chow, 2001)


Anandarajab, G. (2008). The 3 H and BMSEST models for spirituality in multicultural whole-person medicine. Annals of Family Medicine, 6(5), 448-458.


Evidence

Medically connected Theoretically supported Data from patients with specific illnesses Using acupressure points to treat depression


Use of Minimal Encouragers

Don’t “Hm…Hm…” too much Don’t repeat the same words Don’t repeat every word the client has said


Minimal EncouragersMinimally… Yes. I agree. Go on. I see. And … Tell me more … I’m listening. After that … Then …? I hear you.

A bit more…(showing empathy) I can see it. I can feel it. What’s next? What did you see? Who’s there? What else happened? How do/did you feel? It sounds like… It feels like …

Try to avoid, “That’s good!” or “Good!” when the answer is not a positive feeling.

Instead, say, “I feel it.” “I hear you.” “That seems to be ___ (sad, scary, frightened).” “It brings emotions even by hearing it now.”


Time For Joy

Today I picture myself flooded with the flow of a powerful light that is guiding me on my positive path of success and happiness.

—Ruth Fishel, Time for Joy


References

Atkinson, D. R., Morten, G., & Sue, D. W. (1989). Counseling American minorities. Dubuque, IA: Wm. C. Brown.

Brady, S., & Busse, W. (1994). The gay identity questionnaire: A brief measure of homosexual identity formation. Journal of Homosexuality, 26(4), 22.

Chan, C., Ho, P., & Chow, E. (2001). A body–mind–spirit model in health: An eastern approach. Social Work in Health Care, 34(3/4), 261–282.

Cheung, M., & Leung, P. (2008). Multicultural practice and evaluation: A case approach to evidence-based practice. Denver, CO: Love.

© Love Publishing: Cheung & Leung1 Practice Integration (Meeting 10) © Cheung, M., & Leung, P....

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