Topics in
International School Counseling
Nick Ladany, Ph.D.
Loyola Marymount University
Los Angeles, California
Nicholas.Ladany@lmu.edu
Cheryl A. Brown
Shanghai American School (Puxi), China
cbrown451@usa.net
Institute Overview
Introductions
Elements of Effective and Ineffective School
Counseling
Critical Mental Health Issues of Children in
International Schools
Eating disorders, depression, anxiety, substance use and
abuse, third culture kids
Multicultural Competence
Prevention Curricula
Effective and Ineffective Supervision
Model for International School Counselors
Job-A-Like Discussion Sessions
Marc Marier (American School of Dubai)
Jennifer Melton (Shanghai American School – Pudong)
Importance of International
School Counseling
273,000 students enrolled in one of the 520 overseas
schools in 153 countries (2006-7).
Multinational student body
Unique challenges
transient and mobile family lifestyle
competing cultural practices
limited personnel resources
limited professional support
Unique demands
mental health needs
professional development
negotiating relationships with parents and school
personnel
Needs Assessment
Exercise
One-Two-Four-Eight Exercise
Identify mental health needs of
students
Identify professional needs of
counselors
Learn a method for intact working
groups to identify and clarify issues
of importance
Data Sources
Presentations at international school
conferences (e.g., NESA, TriAssociation, etc.)
Research investigation of counselors in
the international schools (Inman, Ngoubene,
& Ladany, 2008)
Today’s discussion
Student Needs
Cultural shock and
adjustment
Eating Disorders
Depression
Stress & Anxiety
Fears over peer/social
acceptance
Identity development
Substance Abuse/Addictions
Transition & Adjustment
Security
Conflict resolution
Family Issues
Parent Involvement
Psychiatric Disorders (e.g.,
Bipolar)
Anger
Management/Relational
Aggression
Self-esteem
Academic
Advising
Career Development
Vocational Counseling
Counselor Professional Needs
Networking
Less Isolation from
Collegial
Support/Networking
Consultation & Supervision
Academic Resources
Referral Resources
Technology
Financial Resources
Time Management Training
Space
Confidentiality/Privacy
Professional
Development
Multicultural
development
Support from School
Staff
Referral Resources
Roles &
Responsibilities
Clear Delineation
Administrator &
Teacher
Understanding
Challenges with Principals,
Teachers, & Parents
Lack of Knowledge of Counselor Role
Lack of Trust in Counselor
Lack of Teamwork and Communication
Complexity of Counseling Process
Lack of Respect for Student Confidentiality
Parental Involvement in Student’s Life
Scheduling Conflicts
Lack of Empathy for Student Needs
Multicultural Misunderstandings
Dual/Multiple Relationships
Counselor Activities & Roles
Premise: A child’s emotional needs must be met adequately
before educational needs can be addressed
Individual counseling
Prevention workshops
Group counseling
Parent & Family consultation/counseling
Teacher consultation
Career development
Administration consultation
Crisis intervention
Assessment & referral
Minimum Recommended Counselor:Student Ratio = 1:250
Elements of Effective Counseling
(Ladany, Walker, Pate-Carolan, Gray, 2008)
Empathy
Manage Countertransference
Ability to Tolerate Ambiguity
Working Alliance
Three Key Features of an
Effective Counselor
Empathy
a genuine feeling of care for the client’s situation,
an ability to accurately perceive the client’s
experience (both intellectually and emotionally),
a capacity to not only imagine the self as the
client, but to suspend one’s own experience and
personal judgment to comfortably experience the
client’s unique inner world “as if” the counselor
were the client, a capability to predict the client’s
reactions, and an ability to sensitively and
accurately communicate this experience to the
client (Banks, 2004).
Three Key Features of an
Effective Counselor
Countertransference
Present in all helping relationships
Pantheoretical
An exaggerated, unrealistic, irrational, or
distorted reaction related to a counselor’s work
with a client. This reaction may include feelings,
thoughts, and behaviors that are likely to be in
response to the client’s interpersonal style and
presenting issues, and/or the counselor’s
unresolved personal issues (e.g., family of origin,
life experiences, or environmental stressors).
5 Step Approach to Manage
Countertransference
1. familiarize yourself with personal issues that may act
as a trigger for countertransference
2. identify cues that alarm you when
countertransference may be playing out in session
3. examine how countertransference influences the
therapeutic work
4. explore the origins of the countertransference
5. use supervision and consultation to develop a
therapeutic plan in the best interest of the client.
Three Key Features of an
Effective Counselor
Ability to Tolerate Ambiguity
Defining a Counseling
Relationship
Working Alliance (Bordin, 1979)
Key to positive outcomes
Culturally sensitive
Applicable across realms of helping
e.g., counselor-client; teacher-student;
supervisor-supervisee; etc.
3 Components of a Working
Alliance
Agreement on Goals of Counseling
decrease depression, enhance study skills,
decrease anxiety
Agreement on Tasks Counseling
explore past experiences, focus on cognitions,
learn skills, observe classroom teaching
Emotional Bond Between Counselor & Client
mutual caring, liking, trusting
Foundation upon which all helping is based
Elements of Ineffective Counseling
Systemic Factors
School culture
Parents
Contraindicated School Counselor Roles
Counselor Factors
Empathy challenged
Ignore Countertransference
Premature attempts to fix/problem solve
Inaccessibility to students
Weak Working Alliance
Children/students not included in goal and tasks, poor
bond
Eating Disorders
Some Facts
The typical model weighs 13-19% below the normal expected
body weight
The clinical criteria for anorexia nervosa is 15% below expected
weight
In the USA, half of adults are dieting. Children see and hear
this and internalize the cultural idea that to be thin is to be
successful and to be normal weight or fat is to fail.
By age 2, girls are watching TV and are starting to be exposed
daily to messages showing that women who are successful are
thin.
Before girls even go to elementary school they are exposed to
messages (from family and/or the media) that certain foods are
“bad” and that sugar and fat make people fat.
Additional Facts
Before girls go to elementary school they have heard
women (their mothers, older sisters, caretakers)
complain about their bodies and focus on weight loss
and dieting.
Weight preoccupation and body dissatisfaction is
occurring earlier and earlier.
40% of girls and 25% of boys in grades 1 - 5 reported trying to
lose weight.
25% of the girls reported restricting or altering their food
intake. (This was about two times as many girls as boys.)
By fourth grade, 40% or more of girls “diet” at least
occasionally.
In a survey of over 400 fourth
grade girls:
One third said they “very often worried
about being fat”
Nearly half said they “very often wished
they were thinner”
About 40% of the girls reported dieting
“sometimes to very often”
In a study of fifth graders:
40% felt too fat or wanted to lose
weight, even though 80% were not
overweight.
The researchers found children as
young as 9 years old with severe
eating disorders, including anorexia
nervosa and bulimia.
Be Careful What You Wish
For
A group of girls ages 11 – 17 were asked “If you had
three wishes, what would you wish for?”
The #1 wish of nearly every girl was to lose weight.
More than two-thirds of high school girls are dieting
and half are undernourished.
At the same time, one in five teenagers is
overweight
Four Major Weight and Eating
Problems
Dysfunctional Eating
Not regulated by hunger and satiety
Eating Disorders
Anorexia Nervosa, Bulimia Nervosa, Binge Eating
Disorders
Overweight & Obesity
Size Prejudice
Oppression toward obese children
Accepting or promoting the cultural ideal of thinness
Signs and Symptoms of
Eating Disorders
Labeling foods as good vs. bad
Skipping meals
Dieting
Feeling guilty for eating
Counting calories and/or fat
Depressed mood
Self-critical thoughts, words, or behaviors when
she can’t exercise
Exercising in order to eat
Signs and Symptoms of
Eating Disorders
Avoiding situations where she may be observed eating
Perfectionism
Hiding one’s body by wearing baggy clothing or layers
Preoccupied with models, actresses, their looks, body,
weight
Feeling anxious or stressed about eating
Accepting or verbalizing the cultural ideal of thinness
Social isolation
Prevention of Eating Disorders
Creating a school environment that promotes
health
Parental involvement
Preschool awareness
Children through the 3rd grade
Discussion focusing on health and wellness
Beginning in 4th grade
Health and wellness
Discussion of eating disorders
Role of School Counselor
Identify factors in the school that hinder
students’ development of positive ideas
about body image and health
Offer school-wide programs targeting weight
and eating issues
Educate and assist teachers and
administrators
Educate parents
Work individually with students
Refer students when possible
Depression in
Children and Adolescents
10-15% of children and adolescents has some
symptoms of depression (Surgeon General, 2000)
20-40% adolescents report feeling sad, unhappy, or
depressed over a 6 month period (Achenbach, 1991)
10-20% of parents report their adolescents have felt sad,
unhappy, or depressed over a 6 month period
(Achenbach, 1991)
As many as 20% of children experience a major depression episode
before graduating from high school, and between 7% and 9% of
children will experience a depressive episode by the time they are
14 years old (e.g., Garrison et al., 1989; Lewinsohn, Hops, Roberts,
& Seeley, 1993)
Symptoms of Depression in
Children and Adolescents
Sadness
Emptiness
Helplessness (nothing ever
works for me)
Diminished interest or
pleasure in most activities (I
don’t care anymore)
Significant weight loss or
gain
Poor appetite
Insomnia or hypersomnia
Marked restlessness or
slowness
Indecisiveness
School failure
Poor motivation
Concerns about aches
and pains
Lack of friends
Feels inferior
Noncompliant
Frequently gets into fights
Feels unloved
Symptoms of Depression in
Children and Adolescents (cont.)
Loss of energy/fatigue
Worthlessness
Guilt
Difficulty concentrating
Recurrent thoughts of
death
Thoughts of suicide
Self-loathing (I hate
myself)
Feeling bad
Irritableness or feeling
crabby
Isolation from peers
Loneliness
Frequent crying
Worries that bad things
will happen
Suicide
1.6 per 100,000 for 10-14 year-olds
9.5 per 100,000 for 15-19 year-olds
Boys four times more likely to commit
Girls twice as likely to attempt
Hispanic students most likely of all racial groups
90% of children who commit suicide have a mental
disorder prior to death (most common depression,
anxiety, substance abuse)
Suicidal Risk Factors
depressed mood
thoughts/feelings of
hopelessness or
helplessness
thoughts of hurting
yourself
plan
means
time
place
Contract*
what would prevent
past attempts
social
support/interpersonal
isolation
impulsivity
substance use
family member
Anxiety in Children and
Adolescents
1 year prevalence in children 9-13 years old is 13%
Separation Anxiety Disorder
Anxiety about being apart from parent(s)
Fear parent may become ill or have an accident
May develop after a move or trauma
Generalized Anxiety Disorder
Excessive worry about most things
Social Phobia
Persistent fear of being embarrassed in social situations
Young children tend to exhibit symptoms more
behaviorally (e.g., cry, tantrums, timid)
Anxiety and depression often coexist
Symptoms of Anxiety in
Children
and
Adolescents
Anxiousness
Difficulty concentrating
Fear
Worry
Panic
Nightmares
Avoidance
Thoughts of monsters
Thoughts of being hurt
Thoughts of danger
Increased heart rate
Thoughts of
contamination
Depersonalization
Stuttering
Swallowing
Avoid eye contact
Trembling voice
Nausea
Muscle tension
Role of School Counselor with
Depressed and Anxious Students
Availability and approachability
Identify depressed or anxious mood
Work with parents
Work individually with students
Receive consultation/supervision
Refer students when possible
Individual counseling/psychotherapy
Family counseling/psychotherapy
Substance Use & Abuse
Often increased accessibility and
availability in Overseas Schools
Middle school children 12-15
50% have tried alcohol at least once
Average age of first drink10.4 years
old
23% have been drunk
Substance Use & Abuse
U.S. High School Senior Lifetime Use
Alcohol 81%
Tobacco 64%
Marijuana 42%
Inhalants 17%
Hallucinogens 13%
Cocaine 6%
Often coexist with another mental health disorder
Substance Abuse & Dependence
Factors associated with SA & D
Stress
Family turmoil
Another mental health disorder
Physiological predisposition
Family member use and abuse
Peer use and abuse
Academic difficulties
Poor self-esteem
Poor coping resources
Family therapy most effective treatment for children
and adolescents
True for most childhood mental health issues
Eating Disorders
Some Facts
The typical model weighs 13-19% below the normal expected
body weight
The clinical criteria for anorexia nervosa is 15% below expected
weight
In the USA, half of adults are dieting. Children see and hear
this and internalize the cultural idea that to be thin is to be
successful and to be normal weight or fat is to fail.
By age 2, girls are watching TV and are starting to be exposed
daily to messages showing that women who are successful are
thin.
Before girls even go to elementary school they are exposed to
messages (from family and/or the media) that certain foods are
“bad” and that sugar and fat make people fat.
Additional Facts
Before girls go to elementary school they have heard
women (their mothers, older sisters, caretakers)
complain about their bodies and focus on weight loss
and dieting.
Weight preoccupation and body dissatisfaction is
occurring earlier and earlier.
40% of girls and 25% of boys in grades 1 - 5 reported trying to
lose weight.
25% of the girls reported restricting or altering their food
intake. (This was about two times as many girls as boys.)
By fourth grade, 40% or more of girls “diet” at least
occasionally.
In a survey of over 400 fourth
grade girls:
One third said they “very often worried
about being fat”
Nearly half said they “very often wished
they were thinner”
About 40% of the girls reported dieting
“sometimes to very often”
In a study of fifth graders:
40% felt too fat or wanted to lose
weight, even though 80% were not
overweight.
The researchers found children as
young as 9 years old with severe
eating disorders, including anorexia
nervosa and bulimia.
Be Careful What You Wish
For
A group of girls ages 11 – 17 were asked “If you had
three wishes, what would you wish for?”
The #1 wish of nearly every girl was to lose weight.
More than two-thirds of high school girls are dieting
and half are undernourished.
At the same time, one in five teenagers is
overweight
Four Major Weight and Eating
Problems
Dysfunctional Eating
Not regulated by hunger and satiety
Eating Disorders
Anorexia Nervosa, Bulimia Nervosa, Binge Eating
Disorders
Overweight & Obesity
Size Prejudice
Oppression toward obese children
Accepting or promoting the cultural ideal of thinness
Signs and Symptoms of
Eating Disorders
Labeling foods as good vs. bad
Skipping meals
Dieting
Feeling guilty for eating
Counting calories and/or fat
Depressed mood
Self-critical thoughts, words, or behaviors when
she can’t exercise
Exercising in order to eat
Signs and Symptoms of
Eating Disorders
Avoiding situations where she may be observed eating
Perfectionism
Hiding one’s body by wearing baggy clothing or layers
Preoccupied with models, actresses, their looks, body,
weight
Feeling anxious or stressed about eating
Accepting or verbalizing the cultural ideal of thinness
Social isolation
Prevention of Eating Disorders
Creating a school environment that promotes
health
Parental involvement
Preschool awareness
Children through the 3rd grade
Discussion focusing on health and wellness
Beginning in 4th grade
Health and wellness
Discussion of eating disorders
Eating Disorder Prevention
Program
Psychoeducation
Media literacy
“fat talk”
Size acceptance
Emotional eating
Stress management
Self-esteem
Promoting healthy body image
Social Norms
What are social norms?
What influences social norms?
What misperceptions exits within your school?
What are the consequences of these misperceptions?
Actual social norm data
E.g., in reality, diets don’t work
Role of School Counselor
Identify factors in the school that hinder
students’ development of positive ideas
about body image and health
Offer school-wide programs targeting weight
and eating issues
Educate and assist teachers and
administrators
Educate parents
Work individually with students
Refer students when possible
Depression in
Children and Adolescents
10-15% of children and adolescents has some
symptoms of depression (Surgeon General, 2000)
20-40% adolescents report feeling sad, unhappy, or
depressed over a 6 month period (Achenbach, 1991)
10-20% of parents report their adolescents have felt sad,
unhappy, or depressed over a 6 month period
(Achenbach, 1991)
As many as 20% of children experience a major depression episode
before graduating from high school, and between 7% and 9% of
children will experience a depressive episode by the time they are
14 years old (e.g., Garrison et al., 1989; Lewinsohn, Hops, Roberts,
& Seeley, 1993)
Symptoms of Depression in
Children and Adolescents
Sadness
Emptiness
Helplessness (nothing ever
works for me)
Diminished interest or
pleasure in most activities (I
don’t care anymore)
Significant weight loss or
gain
Poor appetite
Insomnia or hypersomnia
Marked restlessness or
slowness
Indecisiveness
School failure
Poor motivation
Concerns about aches
and pains
Lack of friends
Feels inferior
Noncompliant
Frequently gets into fights
Feels unloved
Symptoms of Depression in
Children and Adolescents (cont.)
Loss of energy/fatigue
Worthlessness
Guilt
Difficulty concentrating
Recurrent thoughts of
death
Thoughts of suicide
Self-loathing (I hate
myself)
Feeling bad
Irritableness or feeling
crabby
Isolation from peers
Loneliness
Frequent crying
Worries that bad things
will happen
Suicide
1.6 per 100,000 for 10-14 year-olds
9.5 per 100,000 for 15-19 year-olds
Boys four times more likely to commit
Girls twice as likely to attempt
Hispanic students most likely of all racial groups
90% of children who commit suicide have a mental
disorder prior to death (most common depression,
anxiety, substance abuse)
Suicidal Risk Factors
depressed mood
thoughts/feelings of
hopelessness or
helplessness
thoughts of hurting
yourself
plan
means
time
place
Contract*
what would prevent
past attempts
social
support/interpersonal
isolation
impulsivity
substance use
family member
Anxiety in Children and
Adolescents
1 year prevalence in children 9-13 years old is 13%
Separation Anxiety Disorder
Anxiety about being apart from parent(s)
Fear parent may become ill or have an accident
May develop after a move or trauma
Generalized Anxiety Disorder
Excessive worry about most things
Social Phobia
Persistent fear of being embarrassed in social situations
Young children tend to exhibit symptoms more
behaviorally (e.g., cry, tantrums, timid)
Anxiety and depression often coexist
Symptoms of Anxiety in
Children
and
Adolescents
Anxiousness
Difficulty concentrating
Fear
Worry
Panic
Nightmares
Avoidance
Thoughts of monsters
Thoughts of being hurt
Thoughts of danger
Increased heart rate
Thoughts of
contamination
Depersonalization
Stuttering
Swallowing
Avoid eye contact
Trembling voice
Nausea
Muscle tension
Role of School Counselor with
Depressed and Anxious Students
Availability and approachability
Identify depressed or anxious mood
Work with parents
Work individually with students
Receive consultation/supervision
Refer students when possible
Individual counseling/psychotherapy
Family counseling/psychotherapy
Substance Use & Abuse
Often increased accessibility and
availability in Overseas Schools
Middle school children 12-15
50% have tried alcohol at least once
Average age of first drink10.4 years
old
23% have been drunk
Substance Use & Abuse
U.S. High School Senior Lifetime Use
Alcohol 81%
Tobacco 64%
Marijuana 42%
Inhalants 17%
Hallucinogens 13%
Cocaine 6%
Often coexist with another mental health disorder
Substance Abuse & Dependence
Factors associated with SA & D
Stress
Family turmoil
Another mental health disorder
Physiological predisposition
Family member use and abuse
Peer use and abuse
Academic difficulties
Poor self-esteem
Poor coping resources
Family therapy most effective treatment for children
and adolescents
True for most childhood mental health issues
Preventive Interventions with
School-Age Youth
Vera & Reese (2004)
Tripartite Concept of Prevention
Primary Prevention
Target children and adolescents who are currently
unaffected by a particular problem for the purposes of
helping them continue to function in healthy ways
E.g., anti-drug programs that are school-wide
Secondary Prevention
Targets children and adolescents exhibiting early stage
problems to forestall the development of more serious
difficulties
E.g., working with aggressive kindergartners to curb later
violent episodes
Tertiary Prevention
Targets children and adolescents with established problems
or disorders in order to reduce the dureation or
consequences of the problematic behavior
Risk and Protective Factors
Characteristics of children and adolescents and their
environment that influence their chance of developing
mental health problems
Biological predispositions, personality traits,
problematic behaviors, faulty beliefs, family processes
peer influences, school experiences, and community
variables
Risk factors
Negative aspects of the self or environment
Protective factors
Foster resilience to risk and promote competence and
adaptive outcomes
Types of Interventions
Person-centered
Offer services directly to the target population
E.g., communication skills training, self-esteem enhancement
Environment-centered interventions
Seek to modify the child’s social context
E.g., parental child rearing techniques, teacher’s classroom
management techniques
Need to understand developmental differences among
youth
Need to understand multicultural differences among
youth
Outcome Evaluation
Obtain multiple perspectives
Need to consider both proximal and distal goals and
Best Practices
Programs that attempt to affect multiple
risk and protective factors at both
person-centered and environmentcentered levels
Substance Abuse Prevention
Contextual risk factors
Norms regarding drug use
Accessibility
Physiological
predisoposition
Low bonding to family
Early persistent problem
behaviors
Academic failure
Low degree of
commitment to school
Peer rejection in
elementary grades
Alientation and
rebelliousness
Early onset of drug use
Family use of drug and
Protective factors
Membership in
structured, goaldirected peer groups
Strong attachment with
parents
Parental involvement
Substance Abuse Prevention
Early person-centered prevention efforts failed
“Just say no”
Increased knowledge and awareness but rarely changed
drug use
Oversimplified the complexity of drug use and abuse
Contemporary programs more effective
Combine person-centered and environmental-centered levels
of intervention
Assertiveness skills
Enhanced coping
Interpersonal self-efficacy
Alter norms in families and peer-groups regarding drugs
Multicultural Issues
"Travel is fatal to prejudice, bigotry, and
narrow-mindedness, and many of our
people need it solely on these
accounts. Broad, wholesome,
charitable views of men and things
cannot be acquired by vegetating in
one corner of the earth all one's
lifetime."
-- Mark Twain
Third Culture Kid (TCK)
Defined as
"a young person who has spent a
sufficient period of time in a culture other
than his/her own, resulting in the
integration and blending of elements from
both the host culture and his/her own
culture into a third culture."
Culture - Blend
intensity of exposure to a second or third
culture,
age at which child comes into contact with a
culture other than that of the parents,
amount of time a young person spends
within a second or third culture.
TCK
A TCK's roots are not embedded in a place,
but in people,
No two children/individuals are alike.
TCK Strengths
Independent
exercise leadership
increased maturity
cross cultural skills
broader world
view
TCK Challenges
Isolation
Unresolved grief or
sadness
Trust issues
Can never go back
home again
Repatriation
Feel cheated and
angry. . .
Delayed adolescence
Issues specific to different age
groups
Preschoolers
threatened by moving personnel packing
their bed, toys and personal belongings
Grade School Children
worry about details -- finding their way
home, finding a room in their new school
Issues specific to different age
groups
Teenagers
biggest fear is acceptance by their peers
College Students and Young Adults
distance can create sense of loss
instructors and schedule in overseas
schools will contrast
Adjustment issues manifest:
Drug use
Depression – acute
sense of isolation
Eating disorders
Involvement in
solitary pursuits
Anxiety
Identity Issues
What can you do?
Maintaining continuity
Watch for signs of adjustment problems
Listen carefully to child’s concerns
Approach teacher/counselor about concerns
Assign a few manageable chores
Work to develop a caring, nurturing
environment overseas
Recognize positive aspects of their life
Recognize and talk about losses
Value keeping in touch with life in the home
country
Repatriation
When returning to the home country, parents
may need to help teachers and administrators
in the new school understand the transition the
children will be going through in the first few
months.
If possible, money should be budgeted for
school clothing so that the student will ''fit in."
Returning children should be encouraged to
keep in touch with friends they made while
overseas.
Parenting/Teaching In A Stressful
World
Shifts in Socio-Political Climate
How do TCKs experience world changes?
How are these experiences reassessed?
How do TCk’s reassess the nation when it is
now the enemy?
How do TCKs evaluate shifts in home land
differently from Americans reared all their lives
within the U.S.?
How is the threat of terrorism handled?
Multicultural Counseling
Counselor Multicultural
Competence
(Ancis & Ladany, 2010)
Multicultural
Issues related to multiple cultures that include
gender, race, sexual orientation, ethnicity,
disability, socioeconomic status, nationality, age,
religion, etc.
Counselor Multicultural Competence
Knowledge
Self-Awareness
Skills
Counselor/Psychologist
Multicultural Competence
Consists of three interrelated subconstructs:
1. Multicultural Knowledge- general knowledge about
multicultural issues such as an academic or intellectual
understanding of how factors such as gender, race,
sexual orientation, disability, nationality, religion, and so
forth, may influence a clients life; and multicultural
knowledge unique to the specific clients.
2. Multicultural Self-Awareness- ability to reflect upon and
understand one’s own multiple multicultural identities,
and how these identities are expressed in a counseling
relationship.
3. Multicultural Skills- reflected in multicultural counseling
self-efficacy (i.e., confidence to perform particular
multicultural skills) along with the adeptness to carry out
these multicultural skills.
Models of
Multicultural Identity Development
Knowledge of simple demographic or nominal variables (e.g., race)
insufficient to predict behavior.
More Explanatory Models:
Racial Identity (e.g., Cross, 1971, 1995; Helms, 1990, 1995; Helms &
Cook, 1999)
Gender Identity (e.g., Downing & Roush, 1985; McNamara & Rickard,
1989; Ossana, Helms, & Leonard, 1992)
Sexual Orientation Identity (e.g., Cass, 1979; Chan, 1989; Rust, 1993;
Troiden, 1988)
Ethnic Identity (e.g., Phinney, 1989, 1992; Sodowsky, et al., 1995)
Needed:
Scheme to help organize and manage multiple models
Apply across multiple demographic variables
gender, race, sexual orientation, ethnicity, disability, socioeconomic status
Heuristic Model of Non-Oppressive
Interpersonal Development
(Ancis & Ladany, 2001, 2010)
Socially Oppressed Groups (SOG)
Female
Person of color
Gay/Lesbian/Bisexual/Transgendered
Non-European American
Person with a Disability
Working Class
Socially Privileged Groups (SPG)
Male
White
Heterosexual
European American
Physically Abled
Middle to Upper Class
Means of Interpersonal
Functioning (MIF)
For each demographic variable, people progress through similar phases
thoughts and feelings about oneself, as well as behaviors based on ones
identification with a particular demographic variable
Common Features Between SOG & SPG
e.g., ., both women and men will exhibit complacency regarding societal
change in the less advanced stages of MIF
Unique Features Within Socially Oppressed and Socially Privileged Groups
e.g., generally, women feel less empowered and men will perceive
greater entitlement
People can be more advanced in terms of their MIF for one demographic
variable (e.g., sex) than their MIF for another variable (e.g., race).
e.g., a White woman may have an understanding of the limiting effects of
sex role socialization but lack an awareness of White privilege
Social Context: Initial model restrictively applied to people who live in the
United States, however, expanded and emic applications currenltly under
development
4 General Stages of
Means of Interpersonal Functioning
(1) Adaptation
Features: apathy regarding the socially oppressive environment,
superficial understanding of differences among people,
endorsement of oppressive contingencies, active participation in
oppressive acts
(2) Incongruence
Features: previous beliefs about oppression and privilege seem
incongruent; conflict; confusion; dissonance; some awareness; no
real commitment to advocacy
(3) Exploration
Features: anger may be a prominent emotion, some of which is
founded on current recognition of oppressive situations but also
fueled by guilt or shame for not having recognized the oppressive
state of affairs previously; hypervigilance, hyperawareness, seek
“encounter-like” events.
(4) Integration
Features: proficiency in associating with multiple SOGs & SPGs,
insight into oppressive interactions, committed pursuit of nonoppression in the environment
Stages of
Means of Interpersonal
Functioning
(Gender:
Female)
(1) Adaptation
Believes equality exists and oppression doesn’t
(2) Incongruence
Event occurs such as reading about salary
discrepancies between men and women
(3) Exploration
Engages in reflection and seeks out information about
feminism and women’s roles
(4) Integration
Able to make realistic appraisals of types of gender
oppression and sorts through possible advocacy
stances
Stages of
Means of Interpersonal
Functioning
(Gender:
Male)
(1) Adaptation
Over-attributes gender differences to genetics, “I’m not
privileged”
(2) Incongruence
Okay with having women around at work but less inclined to
have partner work outside the home
(3) Exploration
Engages in exploring how being a man has advantages in
our culture
(4) Integration
Is able to function interpersonally with men and women who
are at various stages of interpersonal functioning
Stages of
Means of Interpersonal
Functioning
(Race:
Person
of
Color)
(1) Adaptation
Identification with White people, denigration of People of
Color
(2) Incongruence
A White friend tells an African American person that she
never thought of her as African American
(3) Exploration
Associate with groups or organizations that strongly identify
with people who are Hispanic
(4) Integration
Engages in multiple forms of advocacy for people who are
Asian
Stages of
Means of Interpersonal
Functioning
(Race:
White)
(1) Adaptation
Colorblind perspective, we all belong to the human
race
(2) Incongruence
Intellectual understanding of racism but no real
advocacy to change matters or White privilege
(3) Exploration
Actively considers what it means to be White
(4) Integration
Adept at interacting with People of Color at various
stages of interpersonal functioning
Stages of
Means of Interpersonal Functioning
(Sexual Orientation: Gay, Lesbian, Bisexual,
Transgendered)
(1) Adaptation
Identifies with heterosexual norms in the US
culture
(2) Incongruence
Recognition that sexual feelings cannot easily be
ignored; Tension between being out versus
closeted becomes difficult to maintain
(3) Exploration
Joins GLBT organizations or reads about others
who proudly proclaim their sexual orientation as
GLBT
(4) Integration
Adept at living in multiple worlds of people with a
variety of sexual orientations
Stages of
Means of Interpersonal Functioning
(Sexual Orientation: Heterosexual)
(1) Adaptation
Gay-bashing; Homosexuality is a sin
(2) Incongruence
Questions unhealthy heterosexist stance
based on contact experiences
(3) Exploration
Actively examines the privileges associated
with being heterosexual
(4) Integration
Able to advocate for and associate with
people who have diverse sexual
4 Stages of
Means of Interpersonal
Functioning
(1) Adaptation
Features: apathy regarding the socially
oppressive environment, superficial
understanding of differences among people,
endorsement of oppressive contingencies, active
participation in oppressive acts
Client: :unlikely to be aware of multicultural
dynamics between the counselor and client
Counselor: unlikely to attend to multicultural
issues in conceptualizing clients
4 Stages of
Means of Interpersonal
Functioning
(2) Incongruence
Features: previous beliefs about oppression
and privilege seem incongruent; conflict;
confusion; dissonance; some awareness; no
real commitment to advocacy
Client: present with some conflict related to a
recent multicultural event
Counselor: may include demographic
information in case conceptualizations,
however, the information is not well
differentiated or integrated
4 Stages of
Means of Interpersonal
Functioning
(3) Exploration
Features: anger may be a prominent
emotion, some of which is founded on
current recognition of oppressive situations
but also fueled by guilt or shame for not
having recognized the oppressive state of
affairs previously; hypervigilance,
hyperawareness, seek “encounter-like”
events.
Client: heightened awareness of
multicultural issues for self or between the
counselor and client
Counselor: eager to “cause insight”
4 Stages of
Means of Interpersonal
Functioning
(4) Integration
Features: proficiency in associating with
multiple SOGs & SPGs, insight into
oppressive interactions, committed pursuit of
non-oppression in the environment
Client: seek counselors who are advanced in
their MIF
Counselor: accurate empathy with clients that
are from multiple SOG & SPG groups,
conceptualizations cognitively and
integratively complex with respect to
multicultural issues
4 Types of Client-Counselor
Interpersonal Interaction Dynamics
Similar to Racial Identity Interactions (Cook, 1994; Helms, 1990; Helms & Cook,
1999)
Progressive
the counselor is at a more advanced stage than the client (e.g.,
counselor-integration, client-adaptation)
Parallel-Advanced
the counselor and client are at comparable advanced MIF stages (e.g.,
integration, exploration)
Parallel-Delayed
the counselor and client are at comparable delayed MIF stages (e.g.,
adaptation, incongruence)
Regressive
client is at a more advanced stage than the counselor (e.g., clientintegration, counselor-adaptation)
Implications for Client Outcome
Counseling Process
Counseling Outcome
Best to Worst Outcomes:
Parallel-Advanced or Progressive
Parallel-Delayed
Regressive
Implications for Societies and Cultures
Social structures can be classified as
operating within a dominant stage of
functioning
Sexual Abuse Prevention
General Session
Nick Ladany, Ph.D. & Roger Douglas, Ed.D.
Clare Burgess, Shana Flicker, & Lauren Kulp
Most Common Social-Emotional-Behavioral
Issues in the International Schools
Cultural Adjustment
Eating Problems
Depression & Suicidality
Stress & Anxiety
Substance Abuse
Transition & Adjustment
Diversity
Crisis Management and Response
Family Issues & Parent Involvement
Learning Disabilities
Anger Management
Mental Health Disorders (e.g., Bipolar)
Self-esteem
Career Development
Sexual Safety, Sexual Assault, and Sexual Awareness
Program Philosophy
The Sexual Safety and Sexual Awareness Program
is designed for teaching professionals, counselors,
staff, administrators, and parents to
(1) create a sexually safe environment for children and
adolescents
(2) prevent incidents of sexual abuse and violence
(3) offer resources in the event that abuse or violence
occurs
Sexual Abuse and Assault
Child Sexual Abuse is the exploitation or coercion of a child by an older
person (adult or adolescent) for the sexual gratification of the older person.
Child sexual abuse involves a continuum of behavior ranging from verbal,
nonphysical abuse to forcible touching offenses. It can take the form of a single
encounter with an exhibitionist, occasional fondling by a casual acquaintance,
years of ongoing abuse by a family member, rape, or exploitation through
pornography and/or prostitution.
Sexual Assault occurs when one of the following conditions exist
Force, even if there is no bruise or injury
Fear, even if the victim didn’t fight back
A person is disabled and cannot give consent
A person is severely intoxicated or unconscious as a result of drugs or
alcohol
The victim is under the age of 18
Sexual Abuse and Assault Occurs
20% of women and 5-10% of men have experienced
some form of sexual abuse as children and
adolescents
Peak ages: 7-13 years old
Up to one half of victims under the age of 7
70-90% of the time the perpetrator is known
Kept secret through bribes and threats
The Scope of Sexual Victimization in Germany
(Kury, Chouaf, Obergfell-Fuchs, & Woessner, 2004)
Sample of 309 women university students
27% reported at least one experience with unwanted
sexual intercourse because it was hopeless to stop
the man
40% reported unwanted touching of breasts or
genitals
58% reported at least one experience of stalking
Alcohol and drug use increases risk (Krahe, Scheinberger, &
Waizenhoter, 1999)
United States vs. Germany
Teen Pregnancy Rates
U.S. 5 times higher than in Germany
Sexually Transmitted Infection Rates (HIV, Syphilis,
Gonorrhea, Chlamydia)
U.S. 5-66 times higher than in Germany
Reasons
Unwritten Social Contract: “We’ll respect your right to act
responsibly, giving you the tools you need to avoid unintended
pregnancy and sexually transmitted infections, including HIV.”
Societal openness and comfort with sexuality and pragmatic
governmental policies.
Prevention Programs
Best Practices involves programs that attempt to
affect multiple risk (self-esteem) and protective
factors (resilience) at both person-centered (skills
training) and environment-centered (school, family)
levels
Most effective when learning takes place over time with
practice.
Child abuse prevention programs lead to greater knowledge
and skills regarding sexual safety.
Curriculum Overview
Kindergarten:
Giving and getting safe touches
Dealing with unsafe touches
Learning the touching rule
Learning the safety steps
Grade 1:
Identifying touches: safe touches/unsafe touches
Safety: Physical abuse-Telling an Adult
Learning the touching rule
The always ask first rule (this is stranger danger basically)
Grade 2:
The touching rule
The always ask first rule
Secrets about touching-telling a grown-up
Identifying touches safe touch/unsafe touch
Curriculum Overview
Grade 3:
The touching rule and safety steps
The always ask first rule
Identifying touches safe / unsafe / unwanted touch
Cyber safety: Go Places Safely
Grade 4:
Harassment-knowing what to do
Cyber safety - What's Private?
Defining and Understanding Sexual Safety
Grade 5:
Safety with cyber pals
Keeping Out of Danger
Defining and Understanding Sexual Safety
Curriculum Overview
Grade 6:
Grade 7
Cyber safety: Personal information and meeting up
Refusal Skills
Defining and Understanding Sexual Assault
Grade 8:
Safe talking in cyberspace
Knowing Who You Can Ask and Tell
Defining and Understanding Sexual Safety
Cyber safety: Online chat/messaging
Signals of Intent to Have Sex
Defining and Understanding Sexual Assault
Grade 9:
Cyber safety: Grooming and luring
Dating violence
Reducing Risk of Sexual Assault
Defining and Understanding Sexual Assault
Curriculum Overview
Grade 10
Grade 11:
Cyber safety: Cyber stalking
Date rape
What is sexuality?
Decision Making
Defining and Understanding Sexual Assault
Sexual harassment
Gender roles/stereotypes
Assertive Communication
Defining and Understanding Sexual Assault
Grade 12:
Sexual orientation
Setting Sexual Limits
Defining and Understanding Sexual Assault
Date rape drugs
Instructional Considerations
Create a Support Team
Staff support important
Teachers are in best position to implement program
and make a difference
Student access
Consistency of information
Knowledge of individual students
Best position to assess learning
Classroom Guidelines
Setting up the classroom
Circles and horseshoes
Can use a “station”
Establishing ground rules
Behavioral conduct rules
Encourage students to participate in making the
rules
Frame rules in the positive
Instead of “Don’t talk out of turn” say “Raise your hand
and wait until you’re called on.”
Classroom Guidelines
Setting the pace
Encouraging participation from all
Wait time (5-10 second rule)
Attend to nonparticipators
Handling disruptive behavior
Follow-up later as may be a sign of abuse
Lesson Highlights
Grade Level
Content Areas
Materials
Procedures (teaching steps)
Reflection
Resources
Sample Lesson Plan
Grade Level: Elementary School – Grade K
Content Area: Getting and Giving Safe Touches
Objectives:
Students will be able to identify safe, caring touches
Materials:
Precut magazine photos of safe touches
Construction paper for each student
Paste
Doll
Procedure (Teaching Steps):
1. Warm-up / Review
2. Story and Discussion (Safety rules for touching)
Review some of the rules that the children have learned that keep them safe. For example:
Always ask you parents / guardian if someone wants you to go with him or her. Always ask
your parents / guardian if someone wants to give you a gift.
Explain that there are many different types of touch. There are safe touches and there are
unsafe touches. Safe touches are good for your body. They make you feel cared for, loved,
and important.
3. Show and Explain photograph A (or use a picture of a parent and child hugging)
*Photograph A is on the back of card 8, Preschool/Kindergarten, unit II Touching Safety.
Explain who / what is in the picture. For example, “This is a picture of Chris and his dad.”
Discuss the following questions with the class:
a) Does this look like a safe or an unsafe touch? (Safe touch) How can you tell? (By the faces of
the two people. They look happy.)
b) Why do you think the parent is hugging the child? (He loves Chris. He is happy. They haven’t
seen each other in a while.)
Procedure (Teaching Steps):
4. Introduce a doll or puppet and ask the students to give the doll or puppet
safe touches (pats on the head, holding hands, shaking hands.)
a) Ask the class who gives safe touches likes the safe touches they gave the doll
or puppet.
b) Demonstrate a safe touch with the students by shaking their hands.
5. Activity: Safe Touch Collage
Have each student choose several pictures of safe touch that he or she likes and
glue them onto a piece of construction paper. In a sharing circle, ask the
children to say why they like the touches they’ve chosen and from whom they
like to receive such touches.
6. Summarize the lesson
Remind the students that they have learned about different kinds of touch and
that safe touches are good for your body and make you feel cared for, loved, and
important.
Reflection
Students will be able to recognize safe touches
Resources:
Video: Joey Learns the Touching Rule
Book: Sam’s Story. A Committee for Children Publication
Questions and Reactions
Teacher Training
Guidelines for Appropriate Touching
of Students
Evaluate
What is your preferred style of touching?
Appropriate Touch
Children need appropriate touching
Should originate from student needs
Give options
Talk
Establish appropriate boundaries that are sensitive to
culture, beliefs, and person history
Recognizing Disclosures of Child Abuse
Teachers are in a unique position to
recognize and help abused children
Signs of Abuse
Sudden changes in behavior
Inappropriate sexualized behavior
Excessive play with private body parts
Disclosure
Types of Disclosure
Direct Disclosure
Indirect Hints
“My brother wouldn’t let me sleep last night.” “Mr. Jones
wears funny underwear.” “My babysitter keeps bothering
me.”
Disguised Disclosure
“What would happen if a girl told her mother she was being
molested, but her mother didn’t believe her?”
Disclosure with Strings Attached
“I have a problem, but if I tell you about it, you have to
promise not to tell anyone else.”
Responding to a Disclosure
Find a private place to talk with the child
Remain calm
Do your best not to express panic or shock
Express your belief that the child is telling the truth
Use the child’s vocabulary
Reassure the child that it is good to tell
Reassure the child that it is not her or his fault and that he or she is
not bad
Determine the child’s immediate need for safety
Let the child know that you will do your best to protect and support her
or him
Tell the child what you will do
Seek assistance
If a child discloses during a lesson, acknowledge the child’s disclosure
and continue the lesson. Later find a place where you can talk to the
child alone.
Questions and Reactions
Parent Workshop
Protection Guidelines
Establish a Safe Environment
Babysitters
Day care
After school friends
Dating relationships
Relatives
Observe Patterns of Others
Adults focused on child relationships more than
adult relationships
Adults singling certain children out for attention
Guidelines for Choosing Babysitters
Ask each prospective babysitter for names and phone numbers
of other families for whom he or she has worked. Call the
parents and find out what they think of the babysitter. Ask
whether there were ever any problems.
Let the babysitter know your family safety rules, including
touching safety rules. Tell her or him that you have taught your
child to tell you when any of the rules are broken, even if the
child has been told to keep it a secret.
Occasionally return home early or unexpectedly so you can
see firsthand how things are going. You could also call your
child sometimes while you are out.
Ask your child whether he or she likes the babysitter. If your
child does not like the babysitter, ask for more information. Do
not leave your child with someone that he or she doesn’t like.
Never leave a child in the care of someone who is using drugs
or alcohol. Drugs and alcohol undermine a person’s judgment.
Touching Rules
Touching Rule #1
No one should touch your private body parts
except to keep you clean and healthy
If someone does:
Say words that mean “no”
Get away
Tell a grown-up
Touching Rule #2
Don’t keep secrets about touching
Teach Safety Rules
Introduce touching rules along with other
safety rules.
Talk about the rules often and practice them
with your child.
Agree on family touching rules to use with
other children and adults. Decide how you
will teach these rules based on your child’s
age, developmental level, and your own
family values.
Examples of Talking about
Safety Rules
If someone is touching you and you want her or him
to stop, say words that mean “No” (like “I don’t like
that” or “Stop that”). Then he or she needs to stop. If
you are touching someone and he or she says “No,”
you need to stop.
A bigger person should not touch your private body
parts except to keep you clean and healthy. No one
should touch your penis, vulva, vagina, or bottom
except to keep you clean and healthy. If someone
does, say words that mean “No.” Then get away and
tell a grown-up.
Do not keep secrets about touching.
Discuss Touching Safety
Answer your child’s questions
Take advantage of natural teaching moments
Give age-appropriate answers
Be approachable. Tell your child:
If you ever have any questions, just ask me
It’s never too late to tell
Read a children’s book about touching safety
together
Start a conversation with your child:
Let’s review the Touching Rules today
Before you go, let’s practice what you would do if
someone tried to break the Touching Rules
Signs of Abuse
Sudden changes in behavior
Inappropriate sexualized behavior
Excessive play with private body parts
Responding to a Disclosure
Remain calm
Reassure your child by saying:
I’m glad you told me
It’s not your fault
I am always here for you
Seek help for your child and yourself
Professional counselors
Healing takes time
Questions and Reactions
Elements of Effective Supervision
(Ladany, 2005; Ladany & Inman, 2010)
Attend to the Supervisory Relationship
Apply Models of Supervision (e.g., Critical-Events Model)
Attend to Unique Features of Supervision
Evaluative
Educative
Involuntary
Engage in Role Induction
Differentiate Supervision from Psychotherapy
Attend to Supervisee-focused and Client-focused Outcomes
Recognize the importance of Covert Processes
Keep abreast of Ethical and Legal Issues
Offer Evaluations that include Goal-Setting and Feedback
Enhance Multicultural Competence
Tend to Administrative Responsibilities (e.g., note-taking, s’ee oversight)
Consider Group Supervision and Peer Supervision as important adjuncts
Secure Supervision Training
A Critical Events-Based
Model of Supervision
Ladany, Friedlander, & Nelson (2005)
The Supervisory Working Alliance
Marker
Task Environment
Consists of Interaction Sequences
Resolution
Successful or Unsuccessful
Purpose and Scope
Theoretically- and empirically-informed guide to
practice
Pantheoretical, contextual, interpersonal
Useful for supervisors and supervisors-in-training
across mental health disciplines
What is an “Event”?
An event or episode is a period of time in the process
of therapy/supervision during which a specific task is
addressed
Events have an identifiable beginning, middle, and
end
Events occur within and across sessions
Events can occur within events
Critical Events
Common, possibly universal,
challenging
despite theoretical differences
despite differences in setting, professional
specialty, etc.
Pose a dilemma that cannot/should not
be ignored by the supervisor
Events-Based Model
Supervisory events are qualitatively
different from therapy events because
supervision is…
explicitly evaluative
explicitly educational
typically involuntary
A Critical Events-Based
Model of Supervision
Ladany, Friedlander, & Nelson (2005)
The Supervisory Working Alliance
Marker
Task Environment
Consists of Interaction Sequences
Resolution
Successful or Unsuccessful
The Supervisory Working Alliance
(Bordin, 1983)
Mutual Agreement about the Goals of Supervision
e.g., mastery of specific therapy skills
e.g., understanding how the trainee’s personal issues influence work
with clients
Mutual Agreement about the Tasks of Supervision
e.g., review therapy session tapes
e,g., trainee is responsible for initiating supervisory discussion
Emotional Bond
Mutual caring, liking, trusting
Critical Events
Remediating Skill Difficulties and Deficits
Heightening Multicultural Awareness
Negotiating Role Conflicts
Working Through Countertransference
Managing Sexual Attraction
Repairing Gender-Related Misunderstandings &
Missed Understandings
Addressing Problematic Supervisee Emotions and
Behaviors
Marker
Supervisee’s behavior, statement, or series of
statements signaling the need for a specific kind of
help
“Informs” the supervisor of the task to be addressed
Can be explicit or implicit
Different dilemmas can be signaled with similar
Markers (e.g., prolonged silence)
Task Environment
Interaction Sequences
Focus on the Supervisory Working Alliance
Normalize Experience
Attend to Parallel Process
Focus on Skill
Focus on Self-Efficacy
Exploration of Feelings
Focus on Supervisee’s Dynamics
Assess Knowledge
Focus on Evaluation
Case Discussion
Focus on Multicultural Awareness
Focus on Countertransference
Careful of too much Case Review
Resolution
Self-Awareness
Knowledge
Skills
Supervisory Alliance
Continuum of Successful to
Unsuccessful
Marker
Resolution
Ineffective Supervision
Reviews of the supervision literature
Not all supervision is rosy
Supervisees get harmed
Supervision failures are a result of:
Supervisor factors
Supervisee factors
Dyadic factors
(Inman & Ladany, in press; Ladany & Inman,
2008)
Degree of Trainee Openness to Learning
and Supervisor Competence
Competence of Supervisor
Incompetent
Neutral
Competent
Active Learner
11.1%
11.1%
11.1%
Passive Learner
11.1%
11.1%
11.1%
Indifferent
Learner
11.1%
11.1%
11.1%
Elements of Ineffective
Supervision
Supervisor Factors
Inclination to infantalize supervisees
Incompetent evaluation
Too positive --- Gatekeeping
No valid or reliable instruments
Multiculturally misguided (i.e.,racist, sexist,
homophobic)
Ethically challenged in relation to supervision
Inadequate Training
Supervisor specific training
Misapplication of theory (unique features of
supervision)
Supervisee Factors
Openness to learning
Receptivity to feedback
Training in helping skills
Capacity to learn helping skills
Capacity for deep self-awareness
Capacity for knowledge acquisition
(perhaps over-rated)
Dyadic Factors
Supervisory alliance
Too much case discussion
Over indulgence in client-focused
outcomes
Recommendations
Recognize the value of post-degree
supervision
In the international schools, be innovative
Increase supervisor accountability
Supervisor training
Reconsider the role of evaluation in
supervision
Peer Supervision
Thank You!
