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Flashcards in Psychosocial Deck (45):

Cultural competence

a set of cultural behaviors and attitudes integrated into the practice methods of a system, agency, or its professional, that enables them to work effectively in cross cultural situations

Intervening factors:
- education level
- income level
- geographic residence
- religion
- political views
- individual experiences
- length of residence in the United states
- Age


Cultural sensitivity

The ability to be open to learning about and accepting of different cultural groups



A generalization of characteristics that is applied to all members of a cultural group


Internalized oppression

A subconscious belief in negative stereotypes about one’s group that results in an attempt to fulfill those stereotypes and a projection of those stereotypes onto other members of that group



a system of attitudes, bias, and discrimination in favor of opposite-sex sexuality and relationships



To make a difference in treatment on a basis other than individual character



The recognition and acknowledgement that society is pluralistic. In addition to the dominant culture, there exists many other cultures based around ethnicity, sexual orientation, geography, religion, gender, and class



An attitude, opinion, or feeling formed without adequate prior knowledge, thought, or reason



A body of learned beliefs, traditions, principles, and guides for behavior that are shared among members of a particular group



To judge other cultures by the standards of one’s own, and beyond that, to see one’s own standards as the true universal and the other culture in a negative way



As a biological concept, it defines groups of people based on a set of genetically transmitted characteristics



Sharing a strong sense of identity with a particular religious, racial, or national group


Multicultural counseling

Process by which a trained professional from one ethnocultural background interacts with a client from another for the purpose of promoting the client’s cognitive, social, emotional, and spiritual health and development


Individualism vs. Collectivism

In collectivistically organized cultures, counseling is never an encounter between two individual, even if the meeting is one-on-one; it always includes a whole family or group of people.
- The client is an integral member of a group and does not feel, think, or make decisions as a single individual.
- The counselor should support the development of plans in collaboration with the whole group


Egalitarianism versus Hierarchical Thinking/Authoritarianism

- Most Americans firmly believe that all people are born equal. Therefore, everyone should be treated the same and should have equal opportunities for achievements and success. (Patients prefer simple manners, a high level of informality, and directness)

- Many other cultures are hierarchically organized, with clear distinctions between higher and lower classes, between superior and inferior status or position
This by extension means the layperson (the patient or client) will show great deference to the expert (the counselor)


Time and Task Orientation versus Event and Person Orientation

From the American perspective, time equals money. We do our best not to “waste time” We are extremely task-oriented , and value the efficient use of the limited amount of time we have

Many other cultures conceive time as cyclical; the past is seen as a recurring event, not a cause that impacts the future
- Clients have different attitudes towards punctuality
- May interpret counselor’s time constraints in the following ways:
- The counselor is not really interested in us and our problems
- The counselor is not taking us and our problems seriously


Masculinity versus Femininity

Masculine traits: independence, individualism, aggressiveness, self-confidence, and ambition

Feminine traits: a greater tendency toward caring and nurturing, more concern about establishing and maintaining social relationships, a preference for group orientation over individual orientation, stronger inclination to help others, and the demonstration of empathy.


Ways to facilitate communication across cultural boundaries

- recognize differences
- build your self-awareness
- describe and identify, then interpret
- don't assume your interpretation is correct
- verbalize your non-verbal signs
- share your experience honestly
- acknowledge any discomfort, hesitation, or concern
- practice politically correct communication
- give your time and attention when communicating
- don't evaluate or judge


Continuum of Cultural Competency

Negative to positive:
- cultural destructiveness
- cultural incapacity
- cultural blindness
- cultural pre-competence
- cultural competence
- cultural proficiency


ABC'S of Psychiatric Assessment

Affect and Appearance
- Appearance: Hair, eyes, stature, dress, grooming, appropriateness, attractiveness
- Affect/mood: Anxious, depressed, sad, worried, belligerent, etc.

- By report/by observation of movement, body position, speech, bizarre, self-abusive, hyperactive/agitated, psychomotor retardation, impulsive, unstable, dramatic gestures, altered sleep, eating, intoxicated, or sexual patterns

Cognition and Coping
- Cognitive thinking: Disorganized, distorted, irrational, defensive, memory, concentration, attention, distractibility, delusions, hallucinations
- Coping style: Intellectualize, concrete, problem solving, diffuse

Suicide risk
- Present ideation, plans, actions


Communication styles

- Open
- Secretive
- Ambiguous
- Mixed
- Withdrawn
- Silent


Relationship qualities

- Mutual
- Egalitarian
- Empathetic
- Supportive
- Abusive
- Disconnected


Four basic domains of family functioning

- family structure/organization
- communication process
- multi-generational patterns across the family life cycle
- family belief patterns, attitudes, reality


Family constellation

members of a household, extended family, and others who are frequently involved


Family homeostasis

Requires both stability and flexibility - These are counterbalancing needs along continuum from extremes: rigid to chaotic
E.g., How has the family had to reorganize itself? What pre-illness roles have changed? How much and what types of responsibilities do family members have?


Family Cohesion

- Closeness and connection
- affected by separateness and individual differences

How have these patterns changed in different parts of lifecycle, e.g., single, coupled, having small children, with adolescents?


Family Boundaries: Interpersonal

- Refer to the rules determining who does what, where, when?
- Define and separate individuals members and promote their differentiation and autonomous functions
- Extremes are enmeshment or disengagement


Family Boundaries: Generational

- Refer to the rules determining who does what, where, when?
- Generational boundaries
- Violated by parentification of children


Family Boundaries: Family-Community

- Refer to the rules determining who does what, where, when?
- Family-community with school, church, workplace
- Rigid, isolated, fixed, impermeable or chaotic


Defense Mechanisms

- Denial
- Intellectualization
- Regression
- Repression
- Sublimation
- Reaction formation



- defense mechanism
- reverting back to behaviors that one has outgrown
- ex: a child wetting the bed again



- defense mechanism
- pushing away painful thoughts/memories



- defense mechanism
- take aggressive/sexual behaviors and energy and using them in normal life
- ex: The STILLERS/athletes & sexual assault


Reaction formation

- defense mechanism
- when one expresses the opposite feeling from what she/he is actually feeling
- ex: Collette would laugh about ghosts, when really she was afraid


Intervention techniques

- focus the client's behavior and attention to these issues
- implicit/subtle intervention: silence, normalizing
- explicit/overt intervention: actually state something that you notice is bothering them
- transference (taking the role of someone else, like the psych in Ordinary People)


Stages in Coping

- denial
- guilt
- depression
- anger
- acceptance



- first stage of coping
- Characterized by statements like “there is nothing wrong”; “not me”
- Parents refuse to acknowledge the presence of an anomaly or minimize its extent.
- No difference in development is noted. Normal development may be perceived to be present.
- Denial is a protective device very often prompted by self-preservation especially of one’s mental health
- True denial is rare - mostly people are just not in a place where they can process the information (a mimic of denial)

defense mechanism
- shutting one's eyes to reality
- types of denial: dismissal, disbelief, deferral



- second stage of coping
- Characterized by statements like “what have I done?”; “why me?”; “what did I do to deserve this?”; “why am I being punished?”
- Parents may incriminate one another – assign blame
- Parents may condemn themselves or each other
- Guilt often is motivated by misinformation, unfounded suspicion, irrelevant concerns, or events.



- third stage of coping
- a time of great sadness, remorse, tears, and an attitude or sense of worthlessness.
- the most recognizable stage of grief and the mourning process.
- characterized by a time of confusion, may involve self-pity, and is probably the most difficult stage to work through.
- Couples must grieve the loss of the “expected or perfect” baby and their ability to produce it.



- fourth stage of coping
- Characterized by statements like “you are wrong”; “you don’t know what you are talking about”; “You’re crazy”; “I really can’t stand this.”
- There is the sense of hoping that it happened to the “other guy” or “I never thought it would be our child.”
- usually includes envy.
- may be directed to any object or person. Transference of anger is extremely common



- You never know you are there until you are there.
- In accepting the death of a loved one or accepting a child with health problems, time is distorted. Months may feel like years; years may feel like moments.
- No two individuals cope at the same pace. Do not encourage unrealistic timetables and accept that men and women react differently to the same information


Obstacles to coping

- medical costs
- medical needs
- cosmetic significance
- frequency of acute episodes
- chronicity of a problem
- duration (life span)
- recurrence risks
- cohesiveness of family
- state of marriage
- reaction of family and friends
- availability of support system
- emotional toll
- biological clock
- sex, number, and relationship to normal sibs
- religion
- view of quality of life
- educational background
- cultural practices


Main goals of interviewing clients/talking to patients

- comfortable setting (noise level, privacy, feel safe)
- get accurate information (non-judgemental, normalize)
- explore feelings, beliefs, and perceptions
- build rapport and trust (contracting)
- preserve autonomy
- identify support systems & unmet needs
- identify readiness to engage in follow-up and management


Three types of questions

- open-ended (invites a broad response)
How did you feel when you first learned about the diagnosis?

- narrow focus (guiding the response to specific info)
What did your brother tell you when he heard the news?

- closed ended (yes/no answer, best for fam hx)
Did you tell your sister?


Red flags

- gaps (typically associated with an issue that has not been raised)
- omissions (patient doesn't include something relevant about personal experience)
- shifts in conversation
- changes in body language/non-verbals