For A-plus Writer Only

Book Reference

James, R. K. & Gilliland, B.E. (2017). Crisis intervention strategies (8th ed.). Boston, MA: Cengage Leaming.

Multicultural Perspectives in Crisis Intervention Laura Brown is the past president ofDivision 56, lm:ll Trauma Psychology; she is a diplomate (recognized as knowing a lot and contributing a lot) in clinical psychology, has received numerous awards, and has authored what we believe is the best book on cultural competence when it comes to doing trauma ther- apy, Cultural Competence in Trauma Therapy: Beyond the Flashback (2008). So we can pretty much assume she knows what she's talking about when she says, "After three decades of working intentionally with trauma I can say with utter certainty that I know that I have no idea of how any particular person will have experi- enced and made sense, or not, of her or his traumatic experiences" (p. 16). Therefore, as you read this chapter, understand that one of the best minds in this field is confessing to her ignorance when it comes to ferreting out all the ways that culture affects her clients. The message is that we're a long way from knowing all we need to know to effectively weave multiculturalism into crisis intervention. However, we do know more than we did in the last edition of this book, and the way research is moving (Bernal & Rodriguez, 2012; Brown, 2008, 2009; D'Andrea & H eckman, 2008; Ponterotto & Mallinckrodt, 2007; Ratts & Pedersen, 2014; Ridley & Shaw-Ridley, 2011; Worthington & Dillon, 2011; Worthington, Sott-McNett, & Moreno, 2007), we're going to know more and more. So please understand that this chapter isn't a GPS for multicultural com- petency in crisis intervention that will precisely target your destination, but more like a compass that will point you in the right general direction.

In the United States in the 21 st century we live in a pluralistic culture (Sue & Sue, 2013), and the same

27

28 • PART ONE Basic Training: Crisis Intervention Theory and Application

could be said for practically every country in the world. So just what is this abstract and amorphous thing called "culture"? And how does it become "multi"? Furthermore, what makes it important in the crisis business? Bernal and Rodriguez (2012, p. 4) propose that culture is an intergenerationally transmitted system of meaning shared by a group of people and may have both concrete objects such as buildings and art and subjective components such as social norms, and beliefs that define it as separate and distinct from other cultures.

Adler (1997) defines culture as "that complex whole which includes knowledge, beliefs, arts , laws, morals, customs and capabilities acquired by a person as a member of society. It is a way oflife of a group of people, the configuration of all the more or less stereo- typ ed patterns of learned behavior which are handed down from one generation to the next through the means of language and imitation" (p. 14). Members of a given culture hold all of the foregoing to b e pretty much self-evident truths to live by, as a way of mak- ing order and sense out of their lives. Thus, they are generally able to live with one another in an overall peaceful, profitable way with some sense of control over their lives and the community within which they reside. The "multi" part comes into play when we start to mix up people from different cultural communities with different assumptions about all those variables Adler is talking about. As it was originally formulated in the counseling field, multiculturalism refers to race, ethnicity, and culture and has focused on four racial-ethnic minority groups (Asian, Black/ African, Latino/Hispanic, and Native American). The term diversity refers to dimensions of personal identity and individual differences (Arredondo & Glauner, 1992). These two terms are the foundation on which counselor cultural competency based training has been built (Arredondo & Archiniega, 2001). However, as we move into the 21st century global community, that training model may be limited in preparing hu- man service workers to effectively meet the needs of more diverse societies (Tomlinson-Clarke, 2013). Cross national boundary interaction through stream- lined technological connectedness has resulted in the globalization of the counseling profession (Tomlin- son-Clark, 2013), and that is particularly true of the crisis intervention business. One need look no further than the Crisis Intervention Team International con- vention to see law enforcement and human service workers from ar~und the world grappling with the role of the police in dealing with the mentally ill.

Therefore, understanding and being able to be culturally competent in the heat of a crisis event is crit- ical because few clients will be mirror cultural images of the interventionist. Thus, culturally competent hu- man service workers should be aware of their personal beliefs, values, biases, and attitudes; have an awareness of and knowledge of the world view of culturally di- verse individuals and groups; and have the ability to employ culturally appropriate intervention skills and strategies with a diverse clientele (Sue & Sue, 2013).

The role that culture plays in crisis intervention has to do with what Savicki (2002) has termed uncer- tainty avoidance - and, as you will see in this book, at- tempting to avoid uncertainty and get back in control of a situation gets a lot of playing time . Uncertainty avoidance has to do with the degree to which cul- tu res feel threatened by uncertainty and ambiguous situations, so rules, procedures, rituals, and laws may be formulated to buffer uncertainties of individual judgment (Savicki, 2002, p. 27). What this means in crisis intervention is that a crisis worker who ventures into a different culture had better be aware that the residents of that culture are basing their ability to get though the crisis on their own set of cultural survival standards, and those don't necessarily square up with the worker's.

Core Multicultural Attributes Kiselica (1998, p. 6) identifies four attributes l!!JI that are widely accepted as necessary for crisis work- ers and other mental health workers who intervene with clients in the multicultural world in which we ~ork: (1) self-knowledge, particularly an awareness of one's own cultural biases; (2) knowledge about the status and cultures of different groups; (3) skills to effect culturally appropriate interventions-including a readiness to use alternative strategies that better match the cultures of crisis clients than do traditional strategies; and (4) actual experience in counseling and crisis intervention with culturally different clients .

Sue (1992, p. 12; 1999a, 1999b) reminds us that failure to understand clients' worldviews may lead human services workers to make erroneous interpre- tations , judgments, and conclusions that result in doing serious harm to clients, especially those who are culturally different. A vast majority of the world's population lives by non-Western perspectives, and a lot of those perspectives are making their way to the United States through immigration. Despite the fact that the world is culturally pluralistic, many of our books, professional teachings , research findings ,

and implicit theories and assumptions in the field of counseling and crisis intervention are specific to North American and European cultures. Such theo- ries and assumptions are usually so ingrained in our thinking that they are taken for granted and seldom challenged even by our most broad-minded lead- ers and professionals (Pedersen, 1998; Ponterotto & Pedersen, 1993; Ridley, 1995).

As an example, critics of "culture-blind" crisis in- terventionists propose that their reductionistic and outmoded logical positivism (based solely on observ- able scientific facts and their relationship to each other and natural laws of nature) has no place in deal- ing with widespread violence and social upheaval in large, ethnically different populations caught in long- term wars, rebellions, or other social disasters. They further believe that Western traumatologists adopt a naive view that trauma leads in linear fashion to PTSD in all people in all cultures. Social constructiv- ists in particular rail at this normative view of trauma. They believe it may be much more appropriate to look at trauma, and the crisis intervention that follows it, in much broader social terms, such as safety, grief, injustice, and faith , as opposed to distinct clinical categories of PTSD and depression (Silove, 2000).

There is also a great deal of debate on the validity of any measures that are used to ass ess the various as - pects of crisis that are dealt with in this book, b ecause cultural bias and cultural artifacts can skew results to make clients look very different from what they ac- tually are and lead to erroneous treatment decisions (Brown, 2008; Cokley, 2007). Further, the biggest mental health assessment measure of all, the D iagnos- tic and Statistical Manual of the American Psychiatric Association'(2000) , has come under fire (Brown, 2008; Zalaquett et al., 2008) for its limited inclusion of so- cial and cultural factors in the diagnoses of mental disorders. The newest version, the DSM-5 (American Psychiatric Association, 2013), has faired no better with Ratts and Pedersen (2014) severely castigating it by proposing that when helping professionals take it as dogma without taking cultural or systemic fac - tors into consideration, they are letting a small, self- interested medical profession dictate to the rest of the counseling profession what is normal and abnor- mal, which is both careless and dangerous for clients (p. 6). These critics believe that the normative, disease- based, medical model of the DSM, which emphasizes client deficits, top-down expert-professional-to -client relationships , medication as a major form of treat- ment, and universal interpretation for persons from

CHAPTER TWO Culturally Effective J:l elping in Crisis • 29

various cultures, flies in the face of a counseling view of idiosyncratic behavior and often leads to ethno- centric and grossly inaccurate diagnoses (Zalaquett et al. , 2008) .

Ivey (1987) and Arredondo (1999) emphasize that counseling and therapy should begin with coun- selors' awareness of their own assumptions, values, and biases regarding racial, cultural, and group dif- ferences before considering individual variations on those themes. Ivey (1987) states that "only by plac- ing multicultural counseling at the core of counsel- ing curricula can we as counselors truly serve and be with those whom we would help" (p. 169). That statement is probably exponentially true for crisis workers. Specifically in regard to crisis, Brown (2009, p. 167) believes that more than any other form of dis- tress, persons who have suffered complex trauma do so in relation to their psycho social cultural context, and to deny the social identities they bring out of that culture is a pretty effective way to stop intervention before it starts.

Culturally Biased Assumptions Unintentional and unexamined cultural and llml racial assumptions can impair functioning of coun- selors (Arredondo, 1999; Ober et al. , 2000; Ridley, 1995; Thompson & Neville, 1999). That statement holds doubly true for crisis workers given the cross - cultural circumstances within which they often operate-particularly in large-scale disaster relief The following culturally biased assumptions taken from Pedersen (1987) and Martin-Baro' (1996) are ones that crisis workers would do well to remember:

1. People all share a common measure of "normal" behavior (the presumption that problems, emo- tional responses, behaviors, and perceptions of crises are more or less universal across social, cultural, economic, or political backgrounds, and theories and concepts can be modified to fit all groups).

2. The definition of problems can be limited by aca- demic discipline boundaries (the presumption that the identity of the crisis worker is separate from the identity of the theologian, medical doc- tor, sociologist, anthropologist, attorney, or rep- res entative from some other discipline, and these have little applicability to methods of therapeutic intervention).

3 . Western culture depends on abstract words (the presumption of crisis workers and counselors

30 • PART ONE Basic Training: Crisis Intervention Theory and Application

in the United States that others will understand these abstractions in the same way as workers intend them).

4. Formal counseling is more important than natural support systems surrounding a client (the presumption that clients will be better-off with the support offered by professionals over the sup- port of family, peers, and other support groups).

5. Everyone depends on linear thinking (the pre- sumption that each cause has an effect, and each effect is tied to a cause-to explain how the world works-and that everything can be measured and described in terms of good or bad, appropriate or inappropriate, and/ or other common dichoto- mies, and there are no gray areas) .

6. Individuals need to fit into the system (the pre- sumption that the system does not need to change to fit the individual) .

7. The client's past (history) has little relevance to contemporary events (the presumption that cri- ses are mostly related to here-and-now situations, and that crisis workers should pay little attention to the client's background).

8. The belief that knowledge should be based on logic, facts , and empirical evidence alone (the pre- sumption that society operates much like the laws of physics and qualitative measures such as com- munity attitude should be rejected) .

9. The belief that all humans seek pleasure and hap- piness over pain and sorrow and these negative emotions should be avoided or sublimated (the presumption that human growth can never occur through suffering that is a natural aspect of all human development).

10. Independence is valuable and dependencies are undesirable (the presumption of Western individ- ualism that people should not be dependent on others or allow others to be dependent on them) .

11 . Individuals are the basic building blocks of all so- cieties (the presumption that crisis intervention is directed primarily toward the individual rather than units of individuals or groups such as the family, organizations, political groups, or society) .

12. Psychological homostatsis and balance must be maintained so people sail through life on an even keel (the presumption that disequilibrium, change, and crisis are always bad and cannot have seeds of growth in negative life events) .

13. Human sej vices workers already know all their assumptions (the presumption that if workers were prone toward reacting in closed, biased,

and culturally encapsulated ways that promote domination by an elitist group, they would be aware of it) .

All the foregoing assumptions are flawed and un- tenable in a pluralistic world. Cormier and Hackney (1987) warn that human services workers who do not understand their own cultural biases and the cultural differences and values of others may misinterpret the behaviors and attitudes of clients from other cultures. Such workers may incorrectly label some client behav- ior as resistant and uncooperative. They may expect to see certain client behaviors (such as self-disclosure) that are contrary to the basic values of some cultural groups (pp. 256 - 258). Specifically in the field of crisis intervention, there has been criticism of the Western- based trauma model and particularly the elevation of PTSD as a pathological entity that has been coined in self-serving ways by victims' groups, politicians, and profiteering lawyers and therapists when there is little empirical evidence to support such an assumption (Silove, 2000; Summerfield, 1999).

Universal Versus Focused Views There are both universal and focused views on IDJI multicultural counseling. A universal view considers not only racial and ethnic minorities, but other mi- nority or special populations as well. A focused view looks at multicultural couns eling in relation to "vis- ible and racial ethnic minorities" (Sue, Arredondo, & McDavis, 1992). We agree with Brown (2008 , p . 12) that using racial designation, ethnic label, or any one

• characteristic, trait, preference, or other category to identify people may have little or nothing to do with the crises they are encountering and is probably a pretty poor unimodal cultural lens through which to view a person who has been traumatized. To view culture from such a narrow perspective is, we believe, asking for a lot of trouble in crisis intervention.

Working on the Individualist/Collectivist- High/Low-Context Continuum From a multicultural perspective, we may Im generally look at communication along an individ- ualist/ collectivist continuum . Individualism is a worldview that centrali zes the personal-personal goals , personal uniqueness, and personal control- and peripheralizes the social group or social context within which the individual operates. Collectivism is based on the assumption that groups bind and mutually obligate individuals, that the personal

is simply a component of the larger social group or context and subordinate to it (Oyserman, Coon, & Kemmelmeier, 2002). These concepts are important because they tend to dictate how the client sees him- self or herself in relation to self-concept, sense of well-being, emotional control, and relational and attributional styles (Williams, 2003), which are all critical components in how crisis intervention strat- egies are formulated and applied to traumatized individuals. For instance, a person who lives in a collectivist culture-and they certainly do exist in the United States-who suffers a traumatic event that may be construed as shameful may have that ex trapolate out to all members of the family, with family often defined as extending a good deal beyond a biological basis (Brown, 2009, p. 161).

In a meta-analysis of 170 studies on the individ- ualist/collectivist worldview, Oyserman, Coon, and Kemmelmeier (2002) found that individualism cen- ters on one's self-concept rather than one's family life, as opposed to collectivism, in which the opposite is true. In regard to "sense of well-being," individu- alists see well-being as related to a sense of personal control; collectivists do not. Even more important in terms of crisis intervention, individualism pro - ponents tend to see the event in terms of their own personal preferences, whereas collectivist proponents interpret the event in relation to what they believe the expectations of others might be. A rather startling discovery contradicts the accepted belief that people who are collectivist consider the group, and particu- larly the family, as taking precedence and obligation over individual well-being. They found essentially no difference between individualists and collectivists regarding "sense of family obligation." When a dilemma was presented, collectivists responded by identifying themselves as part of a cooperative group, whereas individualists considered themselves to be individuals participating as part of a team effort.

Finally, Osyerman and associates (2002) discov- ered that communication and conflict resolution styles were found to vary in relation to individualism andcollectivism.Individualismconsistentlypredicted goal-oriented, low-contex t, direct communication; collectivism opted for indirect, high-context commu- nication. In confrontational situations, individual- is ts adhered to a confrontational and arbitrational ap proach; collectivists preferred an accommodation and negotiation approach.

But how do people in a collective society operate under stress and traumatic conditions? The Heppners

CHAPTER TWO Culturally Effective Helping in Cris is • 31 ...

and their associates (2006) conducted research in establishing a collectivist coping styles inventory that attempts to discern how stressful and traumatic events are handled from an Asian perspective. Indeed, the 3,000 Taiwanese college students in the study endorsed coping strategies very different from those of their Western counterparts. Their acceptance, fa- talism, efficacy, and interpersonal harmony strate- gies when faced with stressful events are unlike any other factors endorsed on traditional coping strat- egy inventories in the Western world. Family support and religious and spiritual resources are also differ- ent from their Western counterparts. Filial piety and elder support are important, and advice is generally sought within the sanctity of the family.

The Chinese kanji characters of crisis and opportunity that appear on the cover of this book are evident in the Taiwanese students' approach to coping with crisis. The Confucian and Buddhist philoso- phies that one endures suffering, looks for positive meaning, and exercises control and restraint predom- inate in their responses. Finally, their avoidance and emotional detachment from the stressful event and private emotional outlets are also different. Whereas in the United States we might expect an outpouring of emotion and immediate public support and grief following a traumatic event (Halpern & Tramontin, 2007, p. 98), the results from this study suggest that these students seek outside help as a last resort, and when they do, it is most often in a confidential and anonymous manner. Their coping strategies revolved around avoiding shame and seeking help in safe, anonymous ways. The Heppners and their associates (2006) suggest that these students might go to a men- tal health professional who was unknown to them or their families or go into a chat room on the Internet to discuss their problems. The point is that, at least for these Taiwanese students, when under stress or traumatized, they might seek mental health help very differently than would their American counterparts.

High/Low-Context Approaches. To put the forego - ing analysis in operational terms useful to the crisis worker, the individualist/ collectivist continuum uses what Hall (1976) calls a high/ low-context approach. In low-context cultures, one's self-image and worth are defined in personal, individual terms . In high- context cultures, one's self-worth and esteem are tied to the group. In low-context cultures, information is generally transmitted explicitly and concretely through language; in high-contex t cultures, information is

32 • PART ONE Basic Training: Crisis Intervention Theory and Application

transmitted in the physical context of the interaction or internalized in the person. In high-context cul- tures, facial expressions, gestures, and tone of voice are as important as the meaning of words that are said. Thus, in high-context cultures, the individual will expect the other person to know what the prob- lem is so that he or she does not have to be specific and become embarrassed and lose face by talking directly about the issue. This communication style can be very problematic to a crisis worker who oper- ates from a low-context style in which specific and concrete information is sought to determine what is needed to take care of the problem.

From the high-context client's standpoint, the low-context worker's attempt to gather specific infor- mation about the client's personal and social status in relationship to the crisis may be seen as intrusive, rude, and offensive. A high-context culture uses sto- ries, proverbs, fables, metaphors, similes, and analo- gies to make a point (Augsburger, 1992). Thus, a high-context crisis worker might be very delicate, am- biguous, sensitive, and somewhat circumlocutory in discussing personal and social issues related to the crisis. In trying to help a low-context client, a crisis worker using such a communication style might be viewed as not being remotely aware of what the frus- trated client's needs are .

As a result, one of the major problems in crisis intervention with culturally different people lies in both sending and receiving communications that are understandable, clearly communicating what we are attempting to do while not exacerbating an already potentially volatile situation. While it is impossible to know the nuances of every culture arid the subtle- ties of the client's native language, one of our rules of the road in crisis intervention in which cultural dif- ferences are an issue is that there are these two broad camps, and we need to find out which one the indi- vidual is operating in and act accordingly.

Crisis worker: (speaking to an East African male, a recent immigrant, who has been injured in a train wreck and doesn't know what has happened to his family) I un- derstand you are from Somalia. I don't know a lot about your country or customs, so please let me know if what I am saying doesn't agree with what you think is right and I'll do my best to explain why that is so here in the U.S. and how we might be able to still fit your cultural background as we try to find out about your family and get you the medical hefP you need.

We also need to clearly own that we may be cul- turally ignorant and thus appear to be insensitive to the crisis client's needs . Such admissions early on go a long way in letting the client clarify what his or her needs are. Those owning statements are true whether we are dealing with survivors of an east Kentucky coal mine explosion, war refugees in Liberia, or survivors and their families from the 9/11 attacks.

High/Low-Uncertainty Avoidance Approaches. High- and low-context cultures get a lot of space in profes- sional human service publications. What doesn't, and is particularly appropriate to crisis intervention, is understanding whether the culture one is entering is operating on high or low uncertainty avoidance principles (Savicki, 2002 , p. 27). High uncertainty avoidance cultures develop a broad range of rules and regulations and procedures to cover a multitude of contingencies. In other words, if you are entering that high uncertainty avoidance culture, you had bet- ter understand they have a playbook of what is right and proper that will rival that of a playbook from the National Football League (if you are not a football fan , those books are huge and enormously compli- cated). If you don't understand and operate within it, you' ll wind up butting your head against a very large cultural wall. On the other hand, if you are entering a low uncertainty avoidance culture you may well be frustrated by a "Relax! Be happy! We're all alive! We have food and water! Hurricanes come and go! We'll rebuild tomorrow!" view. That sort of a "chill out" worldview can sabotage the herculean efforts of highly motivated disaster workers who are operating on short time frames and deadlines , leaving them em- bittered and burned out from the experience.

Meet the Super Multicultural Crisis Worker. Here's an abridged definition of what Sue and Sue (2013, p. 46) believe a competent multicultural human ser- vices worker should be. They should be able to use therapeutic modalities consistent with the life experi- ences and cultural values of their clients. They should include individual, group, and universal dimensions of the person. They should achieve a balance between individualism and collectivism in assessing, diagnos- ing, and treating their clients. That's a whole lot of "shoulds" and sounds like a human services worker straight out of Marvel comics superheroes. As of yet, we have not discovered that superworker, so how can a human services worker at least get close to what Sue and Sue are proposing. We believe workers can come

closest to that high standard when they operate from what cultural anthropologists call an emic model (Kottak, 2006) and what Brown (2008) calls social location when applied to people in trauma.

Ernie Versus Etic Models of Multiculturalism An emic model encompasses the smorgas- Im bord of components that make up individuals from their subjective view of who they are, not just what their individual parts are, but more the total gestalt of how they come together, while an etic model de- scribes traits and factors common to all within the group that can be objectively identified by outside ob- servers (Friedman & Schustack, 2010; Kottak, 2006). While both are important in obtaining what cultural and contextual factors are operating in the crisi•s, when face to face for the first time with a person in crisis, finding the parts of the individual that make up the total Gestalt of the crisis and fitting those to the worker are of critical importance. Why is this so?

There is a great deal of research that more than anything else, the strength of the therapeutic alliance or working relationship that is created between the worker and the client will determine how effective the outcome of therapy will be (Bernecker, Levy, & Elison, 2014; Falkenstrom, Granstrom, & Holmqvist, 2013, 2014; Kivlighan, Mamarosh, & Hilsenroth, 2014), and that may be particularly so with individuals suffering psychotic behaviors (Owens , Haddock, & Berry, 2013). One of the critical training components of the Memphis CIT training program is how the CIT officer makes initial contact with a consumer because those first few moments of contact have profound ramifications on the building of a working bond be- tween the ofijcer and the consumer and the ultimate positive resolution of the crisis (Kirchberg, 2014).

So please meet the emic model of Dr. Dick James, 70-something, grandfather who is mostly happy about being above ground still, but worries about his grand- son, husband who thinks he's been married longer than he's been alive sometimes, hard of hearing from too many years in construction working his way through school and gets yelled at for not wearing his hearing aid enough, fisherman and hunter who pals around with one of his daughters doing those activities, white guy who grew up in a university town but had blue-col- lar parents, now has digestive trouble eating pizza and drinking beer, trains police officers to deal with the emotionally disturbed and severely agitated mentally ill, played baseball and ran track in an integrated high

CHAPTER TWO Culturally Effective Helping in Crisis • 33

school in the 1960s that he loved so has had some life- long friends who are both white and black, has been a school counselor in a blue-collar Midwestern town, a Presbyterian who goes pretty regularly to church but has been a Baptist and a Methodist and has a lot of friends who are Catholic and Jewish, writes books like this one instead of the great American novel he thought he would when he was an English major at Eastern Illinois University, has a sense of humor that leaks out and sometimes gets him in trouble and likes to send jokes over the Internet and make people laugh, and had his first real crisis when he got shot in the chest at age 21 while with a girl who he would have probably married . .. ifhe hadn't gotten shot, and so on.

These are what Laura Brown (2008, p . 24) calls social locations, the individual identifiers that go far beyond, race, sex, and skin tone that make us the specific and unique individuals that reside in a cul- tural group. Both she and we believe they are impor- tant from a multicultural standpoint when you are doing this work. So if you compare all that to just Dr.James old dude, or Dr.James professor, or Dr.James white guy, or any other unitary, focused etic view of Dr. James, you surely aren't getting the view you got a cou- ple of sentences ago and our guess would be you might not respond in quite the same way if you were doing crisis intervention with him. Thus, we take a universal / emic rather than a focused/etic view in crisis interven- tion. Therefore, when we speak of cultural diversity, we are speaking in the broadest possible terms in regard to all factors that somehow make clients "different" from the interventionist. Hopefully, the following analogies illuminate what is meant by a universal/emic view.

Your worldview, if you are a New York City social worker and you have spent your entire life in the city and are now trying to help a Midwestern farmer who has just lost everything in a flood, is going to be as different from his worldview as ours would be from Pakistani survivors of an earthquake we were attempt- ing to help. Or how about your first encounter (assum- ing you are heterosexual) with a gay man who has just discovered he is HIV positive from his longtime, supposedly faithful partner? Or consider a staunchly devout Baptist woman who believes divorce is a sin but who is being severely beaten by her preacher husband. Does that mean you will be ineffective and should not go to Keokuk, Iowa, or we should not go to Karachi, Pakistan? Never work with gay men or Baptist women? Certainly not! What it does mean is that "multicul- turalism" does not necessarily stand out in large neon lights saying "I am from Ethiopia or Nepal, and I am

34 • PART ONE Basic Training: Crisis Intervention Theory and Application

different from you" or "I have red, black, yellow, or green (there may be some of those aliens from Area 51 in Roswell, New Mexico, reading this, and we don't want to leave them out) skin." In a statement that ab- solutely captures the essence of what is meant by a uni- versal view, Halpern and Tramontin (2007) quote New York regional mental health officials: "In the large and diverse state of New York, when you know one county in the state you know one county" (p . 316). So how in the world do you do this business if there is that much diversity, not just in the world, but in one state?

Laura Brown (2008, p. 12) has used Hays's ADDRESSING model (2001 , 2008) as one of the bases for her book on multiculturalism and trauma. The ADDRESSING acronym encompasses Age, acquired and Developmental Disabilities, Religion, Ethnicity, Social class, Sexual orientation, Indigenous heritage, National origin, and Gender. D 'Andrea & Daniels (2005) have developed a comparable model called RESPECTFUL (Religious/spiritual, Economic class, Sexual identity, Psychological development, Ethnic/racial identity, Chronological age, Trauma and threats to well-being, Family, Unique physical issues, and Language and loca- tion of residence). From our own experience we would add geographic locale, living area (urban, suburban, ru- ral), occupation, education, and marital or partner sta- tus. We believe these variables are major components that start to capture the essence of how the crisis inter- ventionist needs to think about clients and work with the multiple identities that intersect with the crisis.

However, Brown is about the business of doing trauma therapy, and while crisis may certainly occur in the d elivery of trauma therapy, it isn't the same as doing crisis intervention with an out-of-control sui- cidal/ homicidal client who has just been dumped by the love of his life and is now standing on the guard- rail of the I-40 H ernado De Soto bridge over the Mississippi river. We believe that when such a crisis occurs, a more specific model to operationalize social locations is warranted.

The SAFETY Model. To that end Kristi IDiJ Nobbman of the University of Memphis Counseling Department Crisis Research team has developed a fur- ther iteration of social locations that we believe applies more specifically to the work of crisis intervention. Kristi has developed the SAFETY model (Stability, Affect , Friction, Environment, Temperament, and Yearning) (Nobbman et al., 2014). The SAFETY acro- nym is not happ enstance. Safety is the overriding task for everyone involved in a crisis. Please understand that

the SAFETY model is newly hatched, and we are still "fiddling" with it. Indeed, we certainly invite you to fiddle along with us as you read about it.

In terms of the SAFETY model here is a short defi- nition of the acronym:

Stability: Stability refers to consistency, logic, and strength of purpose in terms of thinking and behaving. Getting stability in the crisis is the pri- mary goal.

Affect: Affect is observed emotions, both verbal and nonverbal. Intent is to move the client from agitated and blunted locations to calm and tranquil ones.

Friction: Friction is identified by the triggers that escalate the situation, whether they are intra- personal, interpersonal, or systemic. Finding Friction locations and easing them is critical to stability.

Environment: Environment refers to the physi- cal and/ or personal setting, as well as the social aspects of what/ who is involved. Changing the environment by physically moving locations or removing individuals or other noxious stimuli that may agitate the individual are often critical.

Temperament: Temperament is how I and the con- sumer generally act based on all our cultural experiences and knowledge . Additionally, for the crisis worker, temperament is the specific cultural set of the mental health world and experience handling crises in that milieu.

Yearning: Yearning refers to what drives the client into crises and his or her attempt to alleviate it. It may be physical, psychological, social, and/ or spiritual desire/ longing. Most often the yearn- ing locations of clients are to ease frustrated attempts to obtain something ranging from drugs, a lost love, to getting rid of the coffin worms eating their brains out.

Compounding the issue even more is the fact that you, the interventionist, are bringing all these social locations into the equation too. Consider Figure 2.1 and how the social locations of Dr. James fit (or not) with Leron, an individual you will meet in Chapter 3, who is having a really bad day. Dr. James will do a quick assessment of Leron's affective, behavioral, and cognitive functioning and immediately start identify- ing his social locations, which he believes may affect his intervention with Leron. By owning who he is, he is attempting to engage the client, the first task of the crisis intervention model you will meet in Chapter 3. Besides

CHAPTER TWO Culturally Effective Helping in Crisis • 35

Dr. James's ADDRESSING social locations

Born and raised in Illinois

Lives in Memphis

Past middle age

Family raised , lives with wit~ \ Employod,. a p~ \ ~

Mentally alert

Health generally good, hard of hearing

Police consultant

Ph.D.

L '/"""'"''' Ang ry wi th housing authori ty

Depressed over loss of famil y and inability to find work

CRISIS SETTING

Middle of a major th oroughfare in rush hour traffic

Threatening, armed with two broken bottles

Lives in Memphis ~ ~ Poor history with police

Male /

Family left African American Out-of-work forklift operator

~ Lower middle class, moving to lower class --- /! Homeless

Health deteriorating Three years of high school

Drinking heavily

Leron's ADDRESSING social locations

ljtffimlll ADDRESS ING Socia l Loca[ ions: Dr. James and Leron

dealing with the very obvious social locations that dif. fer between crisis workers and their clients, you need to be aware of all the baggage you carry into this partic- ular environment that may hinder your efforts. Thus, Dr. James's social location of hearing impairment may not be visible, but on a noisy street it can b e problematic to say the least if he misinterprets what he hears and is too proud not to mention this fact early on to a cli- ent who may see him as a whole lot of other things that are not helpful if he can't respond clearly and correctly.

So he needs to be very aware of his own friction and the environment locations in the SAFETY model.

Likewise, he needs to b e sensitive to the fact that one of Lero n 's present social locations is intoxication and it may be more the whiskey than the man doing the talking in regard to his temperament location. So while our crisis interventionist may or may not have trouble because of his skin color, perceived so- cial class difference based on his clothes and the way h e talks, and the fact that h e is a police consultant, he

36 • PART ONE Basic Training: Crisis Intervention Theory and Application

needs to be cognizant that those factors may indeed be operating and may exacerbate the friction Leon is already feeling toward authority figures, the govern- ment, and the MAN. Thus, for the master practitio- ners of crisis intervention, it is critical to their success that they are sophisticated enough to know when so- cial locations they inhabit may become the major dy- namic they are dealing with (Brown, 2009, p. 40) and what they need to do about it.

It is of more than passing interest that in workshops we have conducted with three different groups of counselors (Nobbman, Skirius, &James, 2014), coun- selor educators (James, Myer, Skirius, & Nobbman 2013), and CIT police officers (James, Kirchberg, Nobbman, & Skirius, 2013) that involved identifying their social locations with videos of persons in crisis, the CIT officers were able to name more of their so- cial locations than either the counselors or counselor educators. Why do you suppose that is so? We believe it has a good deal to do with CIT officer training and their experience and ability to quickly assess the so- cial locations of consumers, and to broach the gap be- tween their own locations and those of the consumer and bond with them .

Broaching. To that end crisis workers need to prac- tice what Day-Vines and her associates (2007) called broaching. Broaching refers to the crisis worker's consistent display of openness to invite the client to explore issues of diversity and a recognition that race, ethnicity, or some universal trait may be contributing to the crisis . Being able to assess for those individual social locations, fit them with the worker's and rap- idly tap into the client's social locations is critical in establishing an empathic working alliance.

Leron: What the hell you doin' out here you hankie, cracker? 'Lessen you from Channel Five I ain't got nuthin' fo' you. I wants the whole world to know about them Nazis down at the housin' 'thority what done kicked me out fo' no good reason.

Dr. James: I realize that I'm a white guy who isn't home- less and furthermore that I have a police T-shirt on that says I work for the man. I understand that may affect your ability to trust me that I can help you out, but the T-shirt also says CIT which means I am a person who trains police officers to deal with folks who have problems that frustrate them and cause them to take actions they normally wouldn't do unless they felt they had no other options, and that seems to be about where you are right now. So if you

have questions about who I am, I'll be glad to answer them. By the way, one of the "Who I ams" is that I'm a little hard of hearing and it's noisy out here so I'd appreciate it if you could speak up a bit so I am sure I get everything you are saying. So I wonder if you might not trust me enough to tell me what got you out here in the middle of one of the busiest streets in Memphis to get the attention you seem to need.

While making a number of owning statements to let Leon know what his social locations are both pro- fessionally and physically, our sweat-drenched doctor immediately attempts to find what Leon is yearning for and what the friction he is currently suffering is critical enough to put his life at risk by standing in one of the busiest streets in Memphis at rush hour.

To make things even more problematic, it isn't just "culture" that factors into this increasingly complex picture but the "ecology" you are working in as well. By "ecology" we mean the living environment in which the intervention occurs. It is 98 degrees Fahrenheit out on that street where Leron is. Do you suppose that adds to the problem? Your intervention will change and be influenced by a number of ecological variables. Are you working in a nice air-conditioned office with one per- son, or in an evacuation center with the power going on and off that is full of people 24/7 who haven't had a bath in a while and you haven't either? Are you working in the panhandle of Oklahoma in 100-degree weather in July with a blast furnace wind blowing all the time and you are from Minnesota? Or perhaps you are from an Iowa farming community where the tallest building is a grain elevator and you find yourself on Michigan Avenue in Chicago buried in the canyon of skyscrapers. So it isn't just culture by itself, it is also the ecological landscape you are operating in that is going to affect how and what you do.

Awareness of Both Ecology and Multicultural Competencies Figure 2.2 is a diagram of the effects of ecol- lml ogy/culture on client- worker interactions. Notice that the "crisis" triangle has a component at each cor- ner: the crisis worker, the client, and their ecological/ cultural determinants . The two-way arrows con- necting the three corners indicate the mutual and dynamic interaction that constantly occurs among all the possible ecological/cultural factors that af- fect both crisis worker and client: family, race, re- ligion, locale, physical ability, sex, economic class, vocation, physical needs, social affiliations, and so on.

·- .. ~""""

Ecological/cultural determinants

CRISIS

Crisis worker Client

U@imilj The Dynamic Effec t of Eco logy/Culture o n Cl ient-Crisis Worker Interacti o ns

The triangle itself represents the environment in which you are working and the ecological back- ground and cultural attitudes, beliefs, and heritages you and the client bring into that setting. Thus, for a therapy to be ecologically valid, it needs to correlate with clients' ethnocultural and linguistic experiences that they bring into therapy and the cultural struc- ture of the therapy provided for them (Rodriguez & Bernal, 2012). For this to happen, Rodriguez and Bernal (p. 25) propose that a complex constellation of language, persons, metaphors, content, concepts, goals , methods, and context need to be in place. Now add attempting to try to carry all these out in a crisis, and you may begin to understand how daunting eco- logically/ culturally valid crisis intervention can be.

Two examples illustrate this interaction well. The relationship of age to PTSD is an outstanding example of the effect of cultural context. Norris and Alegria (2006) report that among three samples of disaster survivors, manifesting PTSD occurred at higher rates in younger Mexicans, middle-age Americans, a nd older Poles. Clearly, there was no one consistent effect of disaster by age. Rather, the cultural context of the country and the variation in historical social roles that are dictated in those countries would seem to have a great deal of influence on how the crisis will unfold when age is a factor.

Ghafoori and Hierholzer (2010) studied personal- ity disorders (PDs) among black, white, and Hispanic combat veterans who were diagnosed with PTSD. They sought to examine whether there were differ- ences among the three groups on Cluster A PD (odd o r eccentric behavior, including paranoid, schizoid, and schizotypal disorders), Cluster B PD (dramatic o r erratic behavior, including histrionic, narcissistic, antisocial , and borderline disorders), and Cluster C (anxious or inhibited behaviors, including avoid- ant, dependent, and obsessive-compulsive disorders).

CHAPTER TWO Culturally Effective Helping in Crisis • 37

... Based on previous literature reviews, the researchers hypothesized that blacks would have more Cluster A symptoms, blacks and Hispanics would have an increased likelihood of manifesting Cluster B symptoms, and the association between race, ethnicity, and PD symptoms would not be fully explained by combat exposure, PTSD, or the poten- tial confounding variables of age, education, and income. What they found was in sharp contrast to what they had hypothesized. Their outcomes indi- cated that Hispanic veterans were significantly more likely to have personality disorders that fit under Category A compared to the other two groups. They also found that those veterans who had Cluster A symptoms were one and a half times more likely to have PTSD. Finally, they found that greater level of combat exposure was likely to manifest in Cluster C symptoms for all groups.

So if you are in the PTSD treatment business with combat veterans , it ought to become apparent that the interaction between environment and ethnicity will have some profound effects on what these clients bring into the therapeutic setting, and is certainly going to dictate that your treatment plan is most likely going to be different given the different clusters of PDs with which you are faced.

Locus of Control. When the crisis worker is factored into the equation, then intervention becomes even more complex. Internal versus external locus of con- trol is a particularly aggravating problem that may bedevil crisis workers . Most crisis workers have a high internal locus of control and believe that through personal effort, one can start to regain psychological homeostasis and equilibrium (Atkinson, Morten, & Sue, 1998). Understand, then, that no therapy is done in a sterile vacuum, free from the multiple effects of the ecological/cultural background. That statement is even truer in the highly charged emotional context of crisis intervention.

The wise crisis interventionist understands this complexity and, when faced with an out-of-control client whose ecological context and background may be extremely different from his or her own, goes slowly and carefully. The wise worker is highly sensitive· to and asks questions about the person's preferred mode of receiving assistance. As an example, Weisaeth (2000) reports on deciding not to do critical incident stress debriefing (CISD) with a U.N. peacekeeping bat- talion of Fiji Islanders who were doing duty in South Lebanon. After an artillery attack that left many dead

38 • PART ONE Basic Training: Crisis In tervention Theory and Application

and wounded civilians they had been sheltering in their compound, the Fijis worked through their stress by using a very intense and emotional group ceremo- nial ritual that involved a mildly intoxicating drink called kawa. Weisaeth wisely decided to drop any at- tempt at a standard CISD because it was apparent the Fijis had their own quite adequate way of dealing with the trauma. Any attempt to shoehorn CISD into the Fiji cultural tradition might have caused a great deal of resistance and done more harm than good.

A recurrent comment we are confronted with in our classes comes from an apparent belief that "to counsel one, you gotta be one! " We believe that this stance is neither true nor workable. Particu- larly in crisis intervention, we seldom have the free- dom to choose which clients we will get or take, and we generally do not have the luxury of mak- ing referrals simply because the client's ecological /cultural background does not fit nicely into our own. What we can do and must do is be acutely sensitive to the emerging needs of the individual, and in Carl Rogers's terms (Raskin & Rogers, 1995), prize that person in regard to his or her distinctive individu- ality in the context of the crisis situation. Above all else, research on the outcomes of therapy tells us that establishing a relationship built on trust and cred- ibility is far and away the most important condition for a successful outcome of any kind of therapeutic endeavor (Capuzzi & Gross, 1995, pp. 12- 25).

Shortcomings of a Multiculturalist Approach to Crisis Intervention First and foremost, there is a lot of contro- IDJJ versy over what the terms ethnicity) race, ethnic and ra- cial identity) and culture) as definable and measurable constructs, actually mean (Cokley, 2007). That's problematic for multiculturalism in general and mul- ticultural counseling in particular in trying to serve an increasingly culturally diverse society (Trimble, 2007), because if we can't define those words, then explaining what multicultural counseling is and how we go about doing it is really going to be difficult (Ponterotto & Mallinckrodt, 2007).

The multicultural approaches to crisis intervention described here do not have universal support among helping professionals. Those professionals are definitely not opposed to the concepts or the consideration of the various forms of diversity that are encountered in the helping and mental health services; nor are we. How- ever, several serio~s questions must be posed about the

current multiculturalist view of counseling. Those ques- tions particularly apply to crisis intervention.

Perhaps the most prevalent alleged shortcoming is the flawed assumption on the part of many "multi- culturalists" that the current theories of counseling, psychotherapy, and crisis intervention are inherently biased and oppressive (Weinrach & Thomas, 1998; Wubbolding, 2003). Another critique asserts that many of the current "cultural competency" practices are themselves too exclusive (Weinrach, 2003). Still another alleged shortcoming of the current multi- culturalist approach is that much of the pertinent literature on multicultural competencies has not been subjected to peer review or empirical research (Brandsma, 2003; Sullivan & Cottone, 2010). A pretty sophisticated study by Owen and his associates (2011) that had clients rate therapist multicultural compe- tencies along with the outcome of therapy found that multicultural competency didn't account for very much of therapy success, although their study has certainly been taken to task by other multicultural re- searchers (Ridley & Shaw-Ridley, 2011; Worthington & Dillon, 2011). As such, critics of the current mul- ticultural movement believe that they are merely the unfounded views of those disaffected with the cur- rent theories and practices of mental health, and their complaints are expected to be accepted on faith with no evidence to back up their claims . Trimble (2007) puts the issue straight forward when he states that if we can't define these concepts clearly and concretely we have no business trying to measure them.

As a very vivid example, there has been a major as- sumption that certain Asian and Latino cultures have a much more collectivist view than Americans or Western Europeans in regard to how issues and prob- lems are handled. The belief has long been held that Americans and Western Europeans are much more in- d ividualistic in their worldview. In a very large meta- analysis of this worldview hypothesis, Oyserman, Coon, and Kemmelmeier (2002) found that Indonesians were not significantly different from European Americans, Australians, and Germans in regard to individualism, and that European Americans were lower in individu- alism than people from more than half the countries in Latin America. A truly startling finding was that Americans were significantly higher in collectivism than the Japanese and no different in collectivism than Kore- ans. Oyserman and his associates' meta-analysis of 170 multicultural studies raises critical questions about the blind acceptance and division of cultures into collectiv- ist and individualist camps.

Kim, Liang, and Li (2003) found that Asian American counselees responded more positively to European American counselors than to Asian American counselors. In attempting to unravel this puzzling outcome, the researchers found that European Americans displayed more positive animation (smil- ing, postural shifts), which seemed to lead to more positive attribution to the counseling by the Asian American clients, as opposed to less positive ratings for the Asian American counselors, who were more passive and unemotional. This finding brings into question whether being passive, noncommittal, and seemingly uninvolved is indeed the best approach to take with a client who is Asian-or at least one who is Asian American.

Shectman, Hiradin, and Zina (2003) examined the notion of group self-disclosure in Israeli Jewish, Muslim, and Druze adolescents. They hypothesized that because of the standard view that Muslims come from a collectivist culture and the Druze come from a very tightly knit rural collectivist culture far removed from the cultural mainstream, both groups would be far less likely than Jewish adolescents to self-disclose in group counseling. What they unexpectedly found was that while, true to form, the Druze adolescents self-disclosed little, the Muslim adolescents self- disclosed a great deal more than the Jewish ado- lescents. They hypothesized that these results may be due to the biculturation of Muslim youth, who may have a much greater need for an avenue to self- disclose than their Jewish counterparts . The behav- ior of the adolescents in this study does not operate along a linear pattern of the stereotypical notion of how ethnic groups self-disclose. It appears that if there is a moderately strong bicultural identity, par- ticipants may take advantage of the communication possibilities they are offered.

What these studies indicate is that to arbitrarily organize worldview differences-and therefore coun- seling approaches - along racial, ethnic, and nation- ality lines is indeed questionable and is likely to cause the very stereotyping of individuals that mul- ticulturalism rails against (Cohen, 2009). Parallel to this criticism, questions arise as to how and to what extent validated cross-cultural studies are conducted to provide a solid research base for such competencies (Wubbolding, 2003), particularly when small sam- ples of undergraduate foreign students are used as the basis to extrapolate questionable interpretations to entire ethnic populations (Oyserman, Coon, & Kemmelmier, 2002). Oyserman and his associates'

CHAPTER TWO Culturally Effective Helping in Crisis • 3 9

(2002) meta-analysis confronted multicultural coun- seling with a number of uncomfortable facts. One in particular was debunking the notion that the in- dividualist-collectivist construct is a valid means of understanding how cultures operate. That notion is a sacred cow to many multiculturalists and assumed to be self-evident. While there are certainly general dif- ferences between ethnic, racial, and national groups, and we see the individualist-collectivist concept as a nice theoretical model, we would argue that the dif- ferences within groups are just as critical.

Because this book is used in a number of coun- tries (for example, there is a Chinese translation), it is worth mentioning that multiculturalists in the United States seem to be unaware or unwilling to state how the multicultural competencies apply to those working in contexts outside the United States (Johannes, 2003), and very few studies are looking at cross comparisons of cultures. Perhaps even more problematic is that little research has been done on determining how effective counselors are in putting their learning to work in the real world of concep- tualizing client concerns and formulating effective treatment plans that factor in culture (Worthington, Soth-McNett, & Moreno, 2007).

In the new millennium therapy business, evi- dence-based therapies (EBTs) have become the gold standard for treatment. In other words if there is not hard research evidence that a therapy works , then it shouldn't be used. However, as Bernal and Rodriguez (2012 , p. 12) report, the National Institutes of Health's 1994 (NIH,1994) mandate on inclusion of minority populations in testing EBTs has seen little progress in regard to their inclusion in EBT studies nor has any guidance been offered on how to adapt EBTs to minorities. We bring these issues up because we are a long way from knowing what we need to know about multiculturalism and how it operates in crisis intervention. Thus, you should be a very discerning consumer of what proponents of a multicultural counseling view extol as ultimate truth and beauty when they are arbitrarily generalized to all therapeutic situations and settings .

Culturally Effective Helping During a Crisis The plain and simple truth is that we don't lmiiJ know a lot about how culture, crises, and crisis intervention interact (Brown, 2008, pp. 256-257). Very little research has been done in the area . Certain

40 • PART ONE Basic Training: Crisis Intervention Theory and Application

cultures don't even have words for trauma (Silove, 1998)! However, we do know that deeply held cultural beliefs and previously learned ways of dealing with the world rapidly surface when individuals are placed in a crisis situation (Dass-Brailsford, 2008). When a traumatic event occurs, there is a high probability that people will revert to their long-held cultural be- liefs no matter where they live and work at the mo- ment (Brown, 2009, p. 154).

There is a good deal of evidence that minorities in the United States use mental health services a great deal less than European Americans do (Breux & Ryujin, 1999; Chen & Mak, 2008; Sue, 1977). That underuti- lization becomes very problematic when a disaster strikes, because research indicates that ethnic minor- ities tend to suffer more in a disaster than the major- ity group (Norris & Alegria, 2006).

Certainly much human-made crisis revolves around lack of cultural understanding and conflicts between cultures. Eidelson and Eidelson (2003) have documented how distorted beliefs may produce exces- sive death, suffering, and displacement as a result of conflicts among and between groups regarding ethnic- ity, nationality, religion, or other social identities and issues. These researchers focused on five core belief domains that propel both individuals and groups to make dangerous assumptions about people who are different from themselves. The domains are identified as revolving around assumptions regarding superior- ity, injustice, vulnerability, distrust, and helplessness. Deeply entrenched patterns for understanding, per- ceiving, and interpreting events appear to govern and produce emotions and behaviors that may ultimately lead to conflicts and problematic and destructive cri- ses. Distorted and dysfunctional beliefs appear to be at the core of many of the problems that crisis interven- tionists and other helping professionals face.

An example of such a distortion is the widespread belief among New Orleans African Americans that levees were blown up to save white residential dis- tricts from Hurricane Katrina's floodwaters. There is, in fact, a historical precedence for blowing up New Orleans levees to save parts of the city. The fact that it did not happen in Katrina's case makes little dif. ference to those people who lost everything but the shirts on their backs. How do you think you would be received if you attempted to do crisis intervention with these individuals-particularly if you were white, and more particularly if you told them you didn't be- lieve that the levees were intentionally blown up? Do you give up before you start? Not hardly!

Past history and experience may play a pivotal role in how recipients of service perceive crisis intervention. Mexican American families whose homes had been damaged in the 1989 Northern California Loma Prieta earthquake refused to go to mass shelters in schools and auditoriums. They continued to live in tents and also refused to go back to their damaged homes. The same was true after the 1995 Northridge earthquake near Los Angeles, even after authorities assured the Mexican Americans that it would be safe. The reason for their refusal was that aftershocks from the 1985 earthquake in Mexico City had killed and injured many people who had gone to such shelters or had returned to damaged homes. It finally took bicultural, bilingual "assurance teams" of crisis workers to convince the recent immi- grants in California to go to shelters or return to their homes (Myers & Wee, 2005, pp. 59-60).

Positive Aspects of an Effective Multicultural Counselor

Sue (1992) states that multicultural helping is en- hanced when the human services worker "uses meth- ods and strategies and defines goals consistent with the life experiences and culture values of the client" (p. 13). Belkin (1984) points out that cross-cultural counseling need not be a negative experience; that it may effectively resolve client problems as well as provide a unique learning experience for both client and helper; and that the main "barrier to effective cross-cultural counseling is the traditional counsel- ing role itself, which is not applicable to many cross- cultural interactions" (p. 527). Belkin further states that the principal cross-cultural impediments are (1) language differences, (2) class-bound values, and (3) culture-bound values (p. 534). Belkin concludes that perhaps the most positive discovery and/or belief of the effective cross-cultural counselor is that hu- mans everywhere are more alike than they are different (p. 543).

Cormier and Hackney (1987) cite several strate- gies that culturally effective helpers use. For instance, such helpers (1) examine and understand the world from the client's viewpoint, (2) search for alternative roles that may be more appealing and adaptive to cli- ents from different backgrounds, and (3) help clients from other cultures make contact with and elicit help from indigenous support systems (p. 259). Cormier and Hackney also specify that to be culturally effec- tive, helpers should not (1) impose their values and expectations on clients from different backgrounds, (2) stereotype or label clients, client behaviors, or

--- ... · " ....

cultures, and (3) try to force unimodal counseling ap- proaches upon clients (pp. 258 - 259).

As an example of such unimodal expectations, Sue (1992) notes that traditional helpers may tend to emphasize the need for clients to verbalize their emo- tions. He points out that some clients (such as tradi- tional Japanese) may have been taught as children not to speak until addressed; that many cultures highly value restraint in expressing strong feelings ; and that patterns of communication, contrary to ours in the United States, may "tend to be vertical, flowing from those of higher prestige and status to those of lower prestige and status" (p. 12). The unenlightened worker seeking to help such a client may perceive the client to be inarticulate, unintelligent, lacking in spontaneity, or repressed (p. 13).

School crisis worker: (speaking softly to a recently im- migrated Japanese family whose son has just been severely injured in a high school football game and is going to be out of school for an extended period) I would like to be helpful to your family in this difficult time for you, not knowing how well your son will recover from his injuries and what that means as far as his aca- demic work and chances of going on to college are. I have had experience in dealing with these kinds of issues with a number of students and their par- ents and could certainly act as your advocate if you would like someone from the school to do that. It is what I do, and it would be my pleasure and honor to do it for you if you so desire. I'll leave my business card and you may call me at any time.

At the other end of the continuum, Dass-Brailsford (2008) notes that African American culture, par- ticularly in the South, uses physical contact to establish conneG:tions, so hugging, ritual handshakes, demonstrative grieving, and joyful exclamations all have healing and bonding power.

School crisis worker: (speaking animatedly and emphat- ically to an African American family whose son has just been severely injured in a high school football game and is going to be out of school for an extended period) (Gives mother a heartfelt embrace and then shakes father's hand and grasps his forearm.) I hate this for you and Rashad. It is a terrible blow, not know- ing how this will affect his football career and chances for college. You must be really scared and anxious to know how this will all play out. If you would let me be the point man on this with the school, I'd appreciate the opportunity to help you. I've done this with a lot of kids . I know Rashad

CHAPTER TWO Culturally Effective Helping in Crisis • 41

;,.

and can get things coordinated with his teachers and see that the college applications go out like they're supposed to. I'll get on that tomorrow, or if you want to think on it I'll wait for your call, but understand you and Rashad are important to this school and we' ll be with you. You are part of the Arlington High School family and that's how it is.

If the parents of our football player happen to be Hispanic, and the parents don't speak English and you took French in high school, you are going to need a translator you can trust who has the cultural back- ground to know exactly how to put your words in tone, decibel level, gestures, body language, and directed to mom, dad, or both so that you convey your intent as closely as possible (Zalaquett, Carrion, & Exum, 2010). That means you are going to have to do a little planning ahead if you are counseling individuals who don't speak the language that most people in your country do.

So now you are thinking, "This is impossible. I can't begin to know the words and the culture of everyone I meet, so I'm bound to screw up." Not so! If you pay attention to Cormier and Hackney's points a few para- graphs back, you are going to be pretty much on course. The major themes in both of the foregoing examples are that the worker demonstrates empathy, caring, and positive regard while searching for a role that is com- patible with the client's worldview, and offers to act as advocate without injecting his or her own values or con- ditions into the situation. While at times we do make mistakes in entering into clients' cultural worlds, there are very few clients who do not respond positively when these general facilitative conditions are in operation.

When in Rome, Italy ... or Georgia Understanding the cultural milieu in which he or she operates is of critical importance to the crisis worker who performs fieldwork or outreach services. The crisis interventionist's notion of what kind of help is needed and what is or is not appropriate help is a manifestation of his or her own cultural and soci- etal upbringing, education, and views (Kaniasty & Norris, 1999). Cultural differences are particularly problematic when the worker is transported to and works on the "turf" of the client and has little time to become attuned to the cultural and ecological frame- work within which the client operates. We are not simply talking about "foreigners," either. Within the United States, residents ofJackson, Tennessee, made homeless by an F4 tornado; survivors of those killed in the Oklahoma City federal building bombing; American Indian families whose children were killed

42 • PART ONE Basic Tra ining : Cris is Intervention Theory and Application

in the school shooting at Red Lake, Minnesota; or transient street people in dire need of social, medical, and mental health services may have views about what constitutes helpful intervention that are very different from the crisis worker's. Such individuals may take umbrage at the crisis worker's attempts to intrude into their world (Hopper, Johnston, & Brinkhoff, 1988). It is absolutely incumbent upon workers to be aware of these cultural subtleties, because victims and survivors will be (Golec, 1983).

Language Barriers Although it may be difficult enough to work l!!D] with people in crisis from the same generic cultural background and who speak the native language as a first language, the manifestation and communica- tion of first-generation Americans' or immigrants' personal problems may be very different from what the crisis worker is used to handling. As a result, as - sessment and intervention become more complex and difficult. Confidentiality issues are also problematic because translators or children of parents who do not speak English have to act as interpreters. People in the United States with "green cards" or student visas run the risk of having information about their men- tal health status given to government agencies, which may then make negative evaluations about their im- migration status. This issue is further compounded by language problems that make communicating clients' needs and crisis workers' offers of services subject to misinterpretation. Particularly for foreign students, having to leave school because of "mental problems" may cause tremendous loss of face in their families and in their home countries. If not handled sensitively, the worker's attempts to provide help may exacerbate rather than mollify the crisis (Oropeza et al. , 1991).

If the crisis worker is not fluent in the native lan- guage, how can information be conveyed? Whi le not the ideal, a good translator is critical to this endeavor, as opposed to using a family member as translator- particularly since the children, who because of their schooling know more English than their parents do, would probably serve as family translators. The need to discuss intimate details and preserve family roles makes it paramount that third-party translators be available (DeWolfe, 2000).

Crisis worker: (speaking through a translator to a Pakistani family who lost all their belongings in a house fire and whose1 only members who are fluent in English are their children) Please tell Mr. and Mrs . Maqsood that I apologize for not speaking Urdu. I can

either speak through you or through their children, and I would like to know which they might prefer.

Religion and Spirituality Religion and spirituality are so loaded with IDJD emotionality that many human services workers re- gard it as an exposed electrical wire, not to be touched on pain of death for fear they will be seen as either pros- elytizing for their religion or insensitive to other spiri- tual beliefs. However, to deny or act as if religion, faith, and spirituality are not part of any crisis is to neglect a large part of a crisis response for most people. Exclusive of pastoral counseling, it is interesting that little space is given to the effects that religion has in the counsel- ing business (Schlosser et al., 2010). Yet for most people trauma is the ultimate challenge to meaning making, and for most people, that meaning making is attached to some kind of faith (Brown, 2009, p. 228).

Perilla, Norris, and Lavizzo (2002) found that after Hurricane Andrew, besides being exposed to more of Andrew's wrath because of their poor eco - nomic state, Latinos and non-Hispanic blacks showed differential vulnerability to traumatic effects com- pared to whites . That is, they were more traumatized than whites, and at least part of this difference related to their fatalistic view that they had little control over the situation. They believed that whatever God willed would happen. Crisis workers who face such fatalism do themselves and their clients no service when they attempt to persuade clients to change their worldview from an external to an internal locus. In fact, the cri- sis workers would do far better to use the religious and spiritual beliefs that minorities have to guide their intervention (Myers & Wee, 2005, pp. 60-61).

There is a reason that the triage assessment sys- tem you will encounter in Chapter 3 has a spiritual/ moral component. Religious and spiritual beliefs play a huge role in the outcome of a crisis as people at- tempt to make sense of events that seemingly make no sense at all. Faith plays a large part in how peo- ple try to come to terms with a randomly cruel uni- verse that crashes down on the notion of a supreme being that runs a just and moral world. As Bingham (2010) states for African Americans, "What is diffi- cult to understand is that the church is far more than family" (p. 22), and if you are not attuned to the importance of their church and faith for many African Americans (Grills, 2004), numerous other ethnic mi- norities (Taylor, Chatters, & Levin, 2004) and for that matter many Southern whites, you are probably going to have trouble helping them through the crisis .

It should not be surprising that recent immigrants who have seemingly adapted to the culture of their new country rapidly revert to old and customary ways of behaving in a crisis (Augsburger, 1992), just as the Caribbean and Latin American clients of Shelby and Tredinnick (1995) did after Hurricane Andrew struck south Florida. Shelby and Tredinnick spent consid- erable space reporting on the cultural differences t hey encountered doing disaster relief work in the af- termath of Hurricane Andrew. The large Caribbean and Latin American populations they dealt with had punitive religious interpretations of the disaster and punitive child-rearing practices, particularly under stress, that differed greatly from what the crisis work- ers believed to be ethically and morally right. The workers had to be very sensitive in not challengin g t hese deeply held beliefs. In short, while it may appear to you to be voodoo, if it is bringing solace and re- spite, crisis workers need to put their own beliefs on the shelf and encourage spiritual coping behaviors that help people heal (Dass-Brailsford, 2008).

So just what do you do when you are confronted with spiritual issues? What the workers did with Andrew survivors was allow them to process feelings of guilt and responsibility in line with their religious interpretation of the event, without passing any judg- ments on the merit of those beliefs. Furthermore, educating parents with ethnically different views of child rearing about the ways children generically re- spond after a trauma, along with the normal devel- opmental issues they face , may indeed be a tall order given the brevity of crisis intervention. Such inte rven- tions, although needed, may be something the crisis worker wishes to consider very carefully.

To offload this tricky issue by merely suggest- ing that persons consult with their minister, priest, rabbi, or imam is to abdicate your responsibility as the crisis worker. Further, while you may certainly seek advice and counsel from a religious leader of a particular person's faith, that by no means guaran- tees that you will be congruent with that particular individual's sense of meaning making. There is also no way in the world you can become an expert in all the religions and practices of people in crisis that you will encounter. What we believe is that you can do what Schlosser and his associates (2010) propose and what has worked for us by making an owning state- ment that directly addresses the issue.

Crisis worker: (working with a client whose family mem- bers have just been killed and injured in a landslide) You have not mentioned your faith or religious

CHAPTER TWO Culturally Effecti ve He_lping in Crisis • 43 ...

affiliation. When I have been involved in similar situations with people who have lost loved ones, for many people faith is an important part of how they deal with such terrible tragedies. Even though one's faith is a deeply personal matter, and I may know very little about your religious faith, I am wondering if you would like to talk about that with me, or perhaps I can find a leader of your faith with whom you can talk if you would pre- fer that. One way or the other, I want you to know that I am going to be here with you to help you work your way through this difficult time .

After that, you generally need to practice the listening and responding skills you will encounter in Chapter 4. For people who are in a transcrisis state due to a loss of faith and have unresolved grief, we will have more to say about spirituality and faith in Chapter 12, Personal Loss: Bereavement and Grief.

Support Systems As you will soon see, providing support is lmlJ so critical that we designate it as a separate task in our crisis intervention model (Chapter 3). Social supports-family, friends , peers, and professionals when no other supports are there or those former social support systems have been abandoned-are critical because they work (Taylor, 2007)! However, how people in crisis utili ze social support systems is not always linear or direct. Shelby and Tredinnick (1995) found that African American and Hispanic populations tended to rely on extended support systems much more heavily than did European Americans . Dass-Railsford (2008) had a number of conversations with social service authorities, convincing them that children whose biological parents were missing post-Katrina were not aban- doned but in the care of other competent adults who would care for them and keep them safe. For some cultures, "family" means a lot more than the residents in the house at 708 S. Grove Street. There- fore , the workers' efforts needed to focus more on systemic approaches that dealt with extended fam- ily networks rather than individuals.

As helpful as social support may be, for some peo- ple the cultural prohibitions against opening oneself up to receive social support may be like going from the frying pan into the fire . In their research on Asians and Asian Americans , Kim, Sherman, and Taylor (2008) found that the college students they studied were far more hesitant than their European American counterparts to seek any support systems because

44 • PART ONE Basic Training: Crisis Intervention Theory and Application

their inability to handle the crisis would bring shame not only on themselves but on their families as well. One reason for this reluctance, they suggest, may be that the very act of seeking support would require the students to self-disclose personal issues , which would put even more stress on them. Reframing such sup- port in more culturally acceptable terms may be one way of allowing individuals to receive help. Organista and Munoz (1996) suggest using manuals and home- work assignments, much like a teacher and a class- room assignment, to avoid the stigma ofbeing seen by a mental health worker and receiving psychotherapy.

Crisis worker: (dealing with a female Asian college student who is tho usands of miles from home and who has been sexually assaulted and is largely noncommittal or oblique in her response to the assault) Li Mai, suffer- ing and enduring what you have is hard for any woman. It is very difficult to speak of such per- sonal violations for almost every woman I have en- countered who has undergone what you have. It is very common to not want to talk about a sexual assault because of all the negative emotions that go with it-particularly the guilt for thinking you were not cautious enough or the shame if it becomes known. However, I also know there are some things that you need to know about and could use some help with. You might wish to think of me more as a teacher who can give you important information which you can then use as you see fit. Or perhaps a coach who can help you make adjustments, just like a soccer player or a figure skater so that they are able to perform better. I hope you will think about what I have said and perhaps frame this incident in that manner and see me as that teacher or coach.

The shame of self-disclosure about a perceived moral or personal failing is not to be taken lightly. One of the hallmarks of domestic violence is the embarrassment and shame if word gets out that the person is being physically abused. Certainly no Jewish women are ever beaten by their spouses because that does not happen in the Jewish religion/ culture. Whoa! Unless the city of Memphis has a different Jewish population than most other places in the world, the domestic violence reports that flow into our Family Trouble Center would indicate otherwise. However, such myths have a powerful social influence and pressure people not to seek support (Zimberhoff & Brown, 2006). Myth busting is part and parcel of a lot of the crises in this book, and providing education is a primary task of the worker.

Crisis worker: I want you to be aware that there's a notion that Jewish women do not get beaten by their husbands. Or at the very least good Jewish wives and mothers don't get beaten. Yet the fact is that we have many, many reports that in Memphis, Tennessee,Jewish women do get beaten, and I don't think there are that many bad Jewish wives and mothers around, so I want you to un- derstand that is a myth and you are not the only Jewish wife who has been beaten. In fact , I would like you to come to a group of women in a support group who are coming out of the kind of battering relationship you have been in. It may interest you to know that there are three women in the group I am thinking of that are in fact Jewish.

Occupation as a Cultural Barrier The ecological model in Chapter 1 may also rmll be applied to the "culture" of particular occupations. It is interesting that most multiculturalists, with the exception of Laura Brown (2008, p. 25), give little or no acknowledgment to occupation as a major social location. An occupation is inextricably tied to most of our lives and is how we identify ourselves. Go to a party, meet a stranger, and after some initial pleas- antries , we'll bet that somewhere in there will be a "So what do you do?" or "Where do you work?" question.

The occupational agriculture of Chandler Moun- tain, Alabama, is far different from the financial culture of Wall Street, New York. We believe that to not take occupation into consideration as a defin- ing part of one's culture and ecosystem is to be abso- lutely oblivious to a major contributing factor in how one lives. Police work is an excellent example. Police officers might be thought of as psychologically at risk due solely to the high stress and potentially lethal sit- uations they face. However, that is far from true.

Any crisis worker who proceeded to deal with a police officer based on the erroneous notion that high stress caused by exposure to lethal situations was the sole factor contributing to a crisis would be very mis- taken. Police officers constitute a distinct occupational culture and closed ecosystem because of their author- ity roles, their segregation from the rest of society, their irregular work schedules, the reactive nature of their job, the constant exposure to the negative side of life, the constant emotional control they must maintain, and the definitive manner in which they must judge right and wrong (Winter & Battle, 2007).

A major issue that bedevils law enforcement offi- cers is their married life. They have one of the highest

divorce rates of any occupation. They do not usually calk about their jobs or their feelings because they sense their spouses are uncomfortable hearing about such matters. Their job stress occurs because of"burst stress." That is, they may go from a long period of tedium a nd boredom to an immediate high-adrenaline m oment. Over the long run, that psychological roller- coaster ride is extremely stressful. Furthermore, be- cause law enforcement officers see the failure of the m ental health system every day in the United States, t hey are likely to have a very jaundiced view of the mental health profession as a whole (Hayes, 1999).

It is not to seek thrills that trainers of the Memphis Police Department Crisis Intervention Team (CIT) ride patrol shifts with CIT officers. Although those rides pro- vide us with valuable on-the-scene experience, they also help us appreciate the ecosystem within which the offi- cer operates. The alliance with CIT officers that emerges from riding the Saturday night shifts with them helps break down occupational barriers and establish our own "bona fides" as being "culturally aware" of what t he officers are going through. No amount of reading or expertise that we know of compensates for lack of k nowledge and sensitization to this cultural milieu.

Geographic Locale as a Cultural Barrier Lenihan and Kirk (1999) have developed a l!iJB rural, community-level crisis intervention plan for very small towns and rural areas that lack the typi- cal crisis infrastructure and support systems avail- able to even medium-sized communities. Many small communities and isolated rural areas are assailed by crises, yet these crises are not large enough to call for fe deral responses. However, the state emergency man- agement agency may send crisis workers from neigh- boring counties and state agencies to assist the target community. Or the community itself may request volunteer help from universities, charities, civic groups, and local governments in close proximity. People in t hese areas may be very suspicious of outsiders, even t hose from neighboring communities, attempting to "tell them what to do." Yet collective fear, rumor, paro- chialism, and inaccessibility to services can keep the community traumatized and immobile without such help. Lenihan and Kirk propose that intervention strat- egies must absolutely address the cultural issues that will exist between outside service providers and recipi- ents of service before any meaningful work can be done. They advocate an immediate assessment of the trau- matic event's effect not only on individuals, but on the culture as well. In a sense, they are "triaging" the whole

CHAPTER TWO Culturally Effective Helping in Crisis • 45

community. They propose that no outside cns1s re- sponse team can do an adequate job if it does not first seek out, identify, and consult with a broad cross section of community leaders about how and with whom crisis intervention should proceed.

Particularly important is ascertaining what the community's belief systems are and if there are sub- cultures within the system that may have differ- ent responses from those of the community at large (Chemtob, 2000). Any crisis response must be inte- grated into the community leadership and organi- zations such as social clubs, churches, civic groups, and fraternal organizations. Providing sensitive con- sultation for community leaders without "ramming it down their throats" is imperative. The same is true of using basic listening skills in hearing what the community has to say, instead of a bull-in-a-china- shop, officious, expert, "we know what's best for you" approach (van den Eynde & Veno, 1999).

Evaluating and finding the natural leaders of the community and teaming up with them are important in forming workable alliances and providing the cit- izens an anchor of familiarity, security, and control at the scene. Any action plans should be developed cooperatively and should be concrete, doable, and manageable, considering the available community financial and human resources (Lenihan & Kirk, 1999). In short, outside interventionists in such com- munities do best when they function as guides and helpers who operate along a continuum of directive to nondirective intervention. That is , the interventionist should be only as directive as the degree to which the client (the community) is immobilized.

The Dilemma of Local Consultation A real dilemma occurs in consulting and working with the local authorities. On the one hand, they know best the infrastructure and needs of the community. Involv- ing community representatives and leaders as interme- diaries and consultants can give workers much easier access to the population and can provide helpful tips in regard to local taboos or cultural artifacts that can interfere with service delivery (Chemtob, 2000).

On the other hand, because outside workers are not invested in the local infrastructure and are not en- culturated, they may blithely go about their business and in the process attempt to redress a variety oflong- held social injustices and practices (Golec, 1983). The wise crisis worker who goes into a different geographi- cal area needs to understand that this dilemma always exists, whether the location is Kabul, Afghanistan,

46 • PART ONE Basic Training: Crisis Intervention Theory and Application

or Collettsville, North Carolina. We are absolutely not propo sing that crisis workers go about the business of changing and redressing all th e perceived evils and shortcomings they may run into. However, as with Shelby and Tredinnick 's (1995) report on the cultural reaction s of their clients to a di sa ster, we are not so sure that one should stand pas sively by while victims proj ect their fru strations by b eating their children. What we do urge is that crisis workers absolutely need to be aware of this dilemma.

So should crisis workers leave well enough alone? Certainly the ability of a community to take care of itself is paramount. Members of the community understand the political, religious, and cultural roots and infrastruc- ture far better than outsiders. Yet when a disaster strikes, and the community's resources are exceeded, there is a good deal of research that indicates such altruism does not extend to the poor, the elderly, the less educated, and ethnic minorities. Such groups m ay be disenfranchised and d enied a part in the "democracy of a common di- saster" (Kaniasty & Norris, 1995). Although the elderly, in particular, may be seen as n eeding assistance with physical complaints or illness, such attention does not n ecessarily extend to dealing with property damage or keeping a roof over their heads, food on the table, and m edicine in their cabinets (Kaniasty & Norris, 1997; Kaniasty, Norris, & Murrell, 1990).

Kilijanek and Drabek (1979) coined the term "pat- tern of neglect" in regard to the lack of aid received by the elderly in their study of a Kansas tornado's devasta- tion ofTopeka. The "squeaking wheel gets the grease" is probably even more true in the wake of a disaster. YA VIS clients-those Young, Attractive, Verbal, Intelligent, and Socially well-connected clients from higher socio- economic backgrounds-get better service because they have the power, influence, technical savvy, and verbal articulation to get help. People whose social locations differ from those of YAVIS clients tend to do less well and a re not knowledgeable enough, not verbal enough, not able enough, not young enough, not technologically sophisticated enough, and not assertive enough to get the help they need (Brown, 2009). Crisis interventionists need to be acutely aware of this pattern and take pains to ensure that all individuals who seek and desire assis- tance in the traumatic wake of a disaster obtain it.

The Necessity of Acting When we are in the heat of the moment in a Imm crisis, observing the "niceties" of another culture that tends to deal obliquely and subtly with problems may not be in the b es t safety interes ts of those clients.

The foregoing statement is made very conditionally. That is , whenever possible we want to take as much time as we can to understand the client's issues and perceptions, and that holds true of the collective pop- ulace as well. Certainly, being sensitive to the clients' cultural and ecological background is part of a pa- tient and thorough problem exploration.

We further believe that one of the worst therapeu- tic errors a worker can make is to attempt to "hurry" the process. Crisis intervention should never be hur- ried. Although it may seem paradoxical, the fastest way to resolve a crisis is to take your time to under- stand what is going on. Still and all, if we have a client who is "running amok" (a Filipino cultural term for going absolutely, violently crazy), his cognitive pro- cesses are going to be seriously impaired, his behavior is going to be threatening, and his emotions will be out of control. What that means in the reality of the situation is acting rapidly and in a very concrete man- ner to assure his and others' safety. Finally, helping anybody, no matter how culturally different, is com- plex in a crisis. So take your time .

Many culturally diverse families have years of cop- ing with crisis and are extremely resilient. If a person from a different cultural background is a recent immi- grant, these successes may be minimized in the immi- grant's new country or territory and seen as irrelevant or inconsequential. They are not! The astute crisis worker will attempt to recognize and marshal these past suc- cesses to the current dilemma. Normalizing the crisis experience is particularly important for the culturally diverse who may already be isolated socially and believe no one else is having similar responses. Empowerment, particularly for the culturally diverse, is the watchword in crisis intervention (Congress, 2000).

There is a delicate balance b etween helping and interfering. This is a constant bipolar dilemma for both recipients and providers of service after a disaster. On the one hand, the recipient appreciates the help, good intentions, and sincere concern. On the other hand, those same providers may be met with confusion, skep- ticism, and perceived psychological threat by the same recipients (Wortman & Lehman, 1985). Our experience has b een that this bipolar dilemma can occur not only on the same day but in the same hour!

Training The American Red Cross training for mental health disaster relief certification has course work in diversity training and cross-cultural differences. The National Institute of Mental Health (2002) report

and recommendations for dealing with the traumatic wake of mass violence cautioned practitioners that disaster mental health training needs to incorporate cross-cultural training, because variations in under- standing the meaning of thoughts, behaviors, and feelings by ethnically different persons can influence the validity of assessments, treatment protocols, and general interaction with survivor populations. Whether the crisis worker is going to Kobe, Japan, or Long Beach, Mississippi, understanding that it is cul- turally alien turf is critical to crisis work . The U.S. Department of Health and Human Services' Devel- oping Cultural Competence in Disaster Mental Health Pro- grams: Guiding Principles and Recommendations (2003) contains a variety of helpful suggestions for working with people in a large-scale disaster.

Where It Stands Now ... Sorta Multiculturalism has evolved through stages of rais- ing consciousness levels . At present, the criticisms leveled in the past about treatment modalities that are biased toward ethnocentric European American populations seem unfounded or questionable at best. What does seem reasonable and shows some success is cultural adaptation that modifies evidence -based treatments to accommodate the cultural beliefs, at- titudes, and behaviors of the cultural group to whom

While not a great deal is yet known about exactly how ecological/cultural determinants interact with crisis, it is clear that they do. This interaction has significant implications for crisis interventionists as they work with people from different cultural backgrounds. One of the major differences interventionists need to recognize is the different methods of communi- cation and allegiances between individualist/ col- lectivist-high/low-context systems. Social locations, the many facets that make up each person's life, are as important "within" culture/ ethnicity variables as the "between" variables that differentiate one group from another. This chapter espouses a more universal/ emic as opposed to a focused etic view in defining multiculturalism and cautions the reader to be a dis- cerning consumer in regard to what prevailing mul- ticultural views may hold for the practice of crisis intervention. We have generated a new SAFETY social

CHAPTER TWO Culturally Effect ive Helping in Crisis • 47

one is providing services (Whaley & Davis, 2007). To that end-and this is certainly easier said than done in the field of crisis where chaos theory tends to run rampant when service delivery is most critical- care- fully controlled studies need to occur that measure both traditional therapeutic approaches against well-described cultural adaptations of those thera- pies and cultural specific practices that look noth- ing like our current intervention models. Moreover, there need to be more ethnic minorities involved in those studies (Atkinson, Bui, & Mori, 2001)-in itself a tall order since, as previously stated, minorities are not overly keen on using mental health services. Rodriguez and Bernal (2012) have compiled and re- ported on a variety of models that are attempting to culturally adapt evidence-based treatments. It will be interesting to see which, if any of these models emerge as valid and if they have transferability to crisis inter- vention. It would also be very interesting to see what effect client-interventionist congruency, in terms of Brown's (2008) social locations hypotheses, has on treatment. To this point we have been unable to find any research that asks the most essential question arising from this chapter: "How sensitive was the in- terventionist in regard to your social locations, and was it helpful when she was?"

locations model that we believe seems to fit the spe- cific environment of a crisis setting.

Particularly important to crisis interventionists is disabusing themselves of tunnel vision perspectives, assumptions, and unconscious biases they may have about people from different cultures. If you want to get a really good multicultural cross section of how people around the world deal with trauma, then read Ani Ka- layjian and Eugene Dominique's (2010) two volumes on Mass Trauma and Emotional Healing Around the World: Rituals and Practices for Resilience and Meaning Making.

Visit CengageBrain.com for a variety of study e tools and useful resources such as video ex- ~ amples, case studies, interactive exercises, f'las~~~ W I cards, and quizzes. __J