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1. 1. CHAPTER 2: Culturally Effective Helping
   2. Multicultural Perspectives in Crisis Intervention

Laura Brown is the past president of Division 56, 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 therapy, 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 experienced 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 (Brown, 2008, 2009; D’Andrea & Heckman, 2008; Ponterotto & Mallinckrodt, 2007; 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 competency 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, whether we realize it or not, we live in a pluralistic culture (Sue & Sue, 2002), and the same 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?

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 of life of a group of people, the configuration of all the more or less stereotyped 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 be pretty much self-evident truths to live by, as a way of making 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.

The role that culture plays in crisis intervention has to do with what Savicki (2002) has termed uncertainty avoidance—and, as you will see in this book, attempting 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 cultures 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 

Kiselica (1998, p. 6) identifies four attributes that are widely accepted as necessary for crisis workers and other mental health workers who intervene with clients in the multicultural world in which we work: (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 interpretations, 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 theories and assumptions are usually so ingrained in our thinking that they are taken for granted and seldom challenged even by our most broad-minded leaders and professionals (Pedersen, 1998; Ponterotto & Pedersen, 1993; Ridley, 1995).

As an example, critics of “culture-blind” crisis interventionists propose that their reductionistic and outmoded logical positivism (based solely on observable scientific facts and their relationship to each other and natural laws of nature) has no place in dealing 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 constructivists 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 assess the various aspects of crisis that are dealt with in this book, because cultural bias and cultural artifacts can skew results to make clients look very different from what they actually are and lead to erroneous treatment decisions (Brown, 2008; Cokley, 2007). Further, the biggest assessment measure of all, the Diagnostic and Statistical Manual, Fourth Edition Revised (DSM IV-R), of the American Psychiatric Association (2000), has come under fire (Brown, 2008; Zalaquett et al., 2008) for its limited inclusion of social and cultural factors in the diagnoses of mental disorders. These critics believe that the normative, disease-based, medical model of the DSM IV-R, which emphasizes client deficits, top-down expert-professional-to-client relationships, medication as a major form of treatment, and universal interpretation for persons from various cultures, flies in the face of a counseling view of idiosyncratic behavior and often leads to ethnocentric and grossly inaccurate diagnoses (Zalaquett et al., 2008).

Ivey (1987) and Arredondo (1999) emphasize that counseling and therapy should begin with counselors’ awareness of their own assumptions, values, and biases regarding racial, cultural, and group differences before considering individual variations on those themes. Ivey (1987) states that “only by placing multicultural counseling at the core of counseling 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 distress, persons who have suffered complex trauma do so in relation to their psychosocial 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.

1. 1. Culturally Biased Assumptions

Unintentional and unexamined cultural and racial assumptions can impair functioning of counselors (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. Pedersen (1987) discusses the following 10 culturally biased assumptions that crisis workers would do well to remember:

• 1. People all share a common measure of “normal” behavior (p. 17) (the presumption that problems, 

  
  emotional responses, behaviors, and perceptions of crises are more or less universal across social, cultural, economic, or political backgrounds).

• 2. Individuals are the basic building blocks of all societies (p. 18) (the presumption that crisis intervention and counseling are directed primarily toward the individual rather than units of individuals or groups such as the family, organizations, political groups, or society).

• 3. The definition of problems can be limited by academic discipline boundaries (p. 19) (the presumption that the identity of the crisis worker or counselor is separate from the identity of the theologian, medical doctor, sociologist, anthropologist, attorney, or representative from some other discipline).

• 4. Western culture depends on abstract words (pp. 19–20) (the presumption of crisis workers and counselors in the United States that others will understand these abstractions in the same way as workers intend them).

• 5. Independence is valuable and dependencies are undesirable (p. 20) (the presumption of Western individualism that people should not be dependent on others or allow others to be dependent on them).

• 6. Formal counseling is more important than natural support systems surrounding a client (pp. 20–21) (the presumption that clients prefer the support offered by counselors over the support of family, peers, and other support groups).

• 7. Everyone depends on linear thinking (pp. 21–22) (the presumption by counselors and crisis workers 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 dichotomies).

• 8. Counselors need to change individuals to fit the system (p. 22) (the presumption that the system does not need to change to fit the individual).

• 9. The client’s past (history) has little relevance to contemporary events (pp. 22–23) (the presumption that crises are mostly related to here-and-now situations, and that crisis workers and counselors should pay little attention to the client’s background).

• 10. Counselors and crisis workers already know all their assumptions (p. 23) (the presumption that if counselors and crisis 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 10 assumptions are flawed and untenable 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 behavior 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. The culturally insensitive counselor or crisis worker may also stereotype, label, or use unimodal, inappropriate, or ineffective counseling approaches and concepts in an attempt to help clients from other cultures (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).

1. 1. Universal Versus Focused Views

There are both universal and focused views on multicultural counseling. A universal view considers not only racial and ethnic minorities, but other minority or special populations as well. A focused view looks at multicultural counseling in relation to “visible and racial ethnic minorities” (Sue, Arredondo, & McDavis, 1992). More encompassing parallel terms you may run into in a multicultural text for these views are the etic and emic models. An etic model views people one dimensionally—focusing, for example, on their race, sex, age, hair color, or preference for junk food. 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.

1. 1. Working on the Individualist/Collectivist–High/Low Context Continuum

From a multicultural perspective, we may generally look at communication along an individualist/collectivist continuum. Individualism is a worldview that centralizes the personal—personal goals, personal 

In a meta-analysis of 170 studies on the individualist/collectivist worldview, Oyserman, Coon, and Kemmelmeier (2002) found that individualism centers 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,” individualists see well-being as related to a sense of personal control; collectivists do not. Even more important in terms of crisis intervention, individualism proponents 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 particularly 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, communication and conflict resolution styles were found to vary in relation to individualism and collectivism. Individualism consistently predicted goal-oriented, low-context, direct communication; collectivism opted for indirect, high-context communication. In confrontational situations, individualists adhered to a confrontational and arbitrational approach; collectivists preferred an accommodation and negotiation approach.

But how do people in a collective society operate under stress and traumatic conditions? The Heppners 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, fatalism, efficacy, and interpersonal harmony strategies when faced with stressful events are unlike any other factors endorsed on traditional coping strategy inventories in the Western world. Family support and religious and spiritual resources are also different 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 philosophies that one endures suffering, looks for positive meaning, and exercises control and restraint predominate 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 mental 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.

1. 1. High/Low Context Approaches.

To put the foregoing 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; 

From the high-context client’s standpoint, the low-context worker’s attempt to gather specific information 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 stories, proverbs, fables, metaphors, similes, and analogies to make a point (Augsburger, 1992). Thus, a high-context crisis worker might be very delicate, ambiguous, 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 frustrated 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 and the subtleties of the client’s native language, one of our rules of the road in crisis intervention in which cultural differences are an issue is that there are these two broad camps, and we need to find out which one the individual 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 understand 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 help you need.

We also need to clearly own that we may be culturally 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.

1. 1. High/Low Uncertainty Avoidance Approaches.

High and low context cultures get a lot of space in professional 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 better 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 complicated). 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 embittered and burned out from the experience.

1. 1. Emic Versus Etic Models of Multiculturalism

An emic model encompasses the smorgasbord of components that make up individuals, not just what their individual parts are, but more the total gestalt of how they come together. So please meet the emic model of Dr. Dick James, 60-something, father soon to be grandfather who is mostly happy about it, 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-collar 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 

These are what Laura Brown (2008, p. 24) calls social locations, and both she and we believe they are important 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 view of Dr. James, you surely aren’t getting the view you got a couple 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 intervention. 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 attempting to help. Or how about your first encounter (assuming 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 “multiculturalism” does not necessarily stand out in large neon lights saying “I am from Ethiopia or Nepal, and I am 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 absolutely captures the essence of what is meant by a universal 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 location of residence). From our own experience we would add geographic locale, living area (urban, suburban, rural), occupation, education, and marital or partner status. We believe these variables are the major components that capture the essence of how the crisis interventionist needs to think about clients and work with the multiple identities that intersect with the crisis.

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 identifying 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 dealing with the very obvious social locations that differ between crisis workers and their clients, you need to be aware of all the baggage you carry into this particular 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 be problematic to say the least if he misinterprets what he hears and is too proud not to mention this fact early on to a client who may see him as a whole lot of other things that are not helpful if he can’t 

1. 1. FIGURE 2.1

ADDRESSING Social Locations: Dr. James and Leron

Lo that end crisis workers need to practice what Day-Vines and her associates (2007) called broaching. 

• Leron: What the hell you doin’ out here you honkie, 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 homeless 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.

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? As we will see in Chapter 17, long-term residence in a displaced persons facility wears very thin when it is hot, there are no bathing facilities, and head lice are rampant. Your intervention will change and be influenced by a number of ecological variables. Are you working in a nice air-conditioned office with one person, 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.

1. 1. Awareness of Both Ecology and Multicultural Competencies

Figure 2.2 is a diagram of the effects of ecology/culture on client-worker interactions. Notice that the “crisis” triangle has a component at each corner: the crisis worker, the client, and their ecological/cultural determinants. The two-way arrows connecting the three corners indicate the mutual and dynamic interaction that constantly occurs among all the possible ecological/cultural factors that affect both crisis worker and client: family, race, religion, locale, physical ability, sex, economic class, vocation, physical needs, social affiliations, and so on. The triangle itself represents the environment in which you are working and the ecological background and cultural attitudes, beliefs, and heritages you and the client bring into that setting.

1. 1. FIGURE 2.2

The Dynamic Effect of Ecology/Culture on Client-Crisis Worker Interactions

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, and 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 personality disorders (PDs) among black, white, and Hispanic combat veterans who were diagnosed with PTSD. They sought to examine whether there were differences among the three groups on Cluster A PD (odd or eccentric behavior, including paranoid, schizoid, and schizotypal disorders), Cluster B PD (dramatic or erratic behavior, including histrionic, narcissistic, antisocial, and borderline disorders), and Cluster C (anxious 

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.

When the crisis worker is factored into the equation, then intervention becomes even more complex. Internal versus external locus of control 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 battalion of Fiji Islanders who were doing duty in South Lebanon. After an artillery attack that left many dead and wounded civilians they had been sheltering in their compound, the Fijis worked through their stress by using a very intense and emotional group ceremonial ritual that involved a mildly intoxicating drink called kawa. Weisaeth wisely decided to drop any attempt 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. Particularly in crisis intervention, we seldom have the freedom to choose which clients we will get or take, and we generally do not have the luxury of making 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 individuality 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 credibility is far and away the most important condition for a successful outcome of any kind of therapeutic endeavor (Capuzzi & Gross, 1995, pp. 12–25).

1. 1. Shortcomings of a Multiculturalist Approach to Crisis Intervention

First and foremost, there is a lot of controversy over what the terms ethnicity, race, ethnic and racial identity, and culture, as definable and measurable constructs, actually mean (Cokley, 2007). That’s problematic for multiculturalism in general and multicultural 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. However, several serious questions must be posed about 

Perhaps the most prevalent alleged shortcoming is the flawed assumption on the part of many “multiculturalists” 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 multiculturalist 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 competencies 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 researchers (Ridley & Shaw-Ridley, 2011; Worthington & Dillon, 2011). As such, critics of the current multicultural movement believe that they are merely the unfounded views of those disaffected with the current 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 assumption that certain Asian and Latino cultures have a much more collectivist view than Americans or Western Europeans in regard to how issues and problems are handled. The belief has long been held that Americans and Western Europeans are much more individualistic 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 individualism 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 Koreans. Oyserman and his associates’ meta-analysis of 170 multicultural studies raised critical questions about the blind acceptance and division of cultures into collectivist 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 (smiling, 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 adolescents. They hypothesized that these results may be due to the bi-culturation of Muslim youth, who may have a much greater need for an avenue to self-disclose than their Jewish counterparts. The behavior 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, participants may take advantage of the communication possibilities they are offered.

What these studies indicate is that to arbitrarily organize worldview differences—and therefore counseling approaches—along racial, ethnic, and nationality lines is indeed questionable and is likely to cause the very stereotyping of individuals that multiculturalism 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 samples 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’ (2002) meta-analysis confronted multicultural counseling with a number of 

Because this book is used in a number of countries (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. 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. To that point, if you are reading this book in Korean or any other translation, we would be very interested in hearing from you on how you believe your particular culture views helping people in crisis and whether what this book has to say about crisis agrees with your society’s views on the matter.

1. 1. Culturally Effective Helping

The plain and simple truth is that we don’t 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 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 beliefs no matter where they live and work at the moment (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 underutilization becomes very problematic when a disaster strikes, because research indicates that ethnic minorities tend to suffer more in a disaster than the majority 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 excessive death, suffering, and displacement as a result of conflicts among and between groups regarding ethnicity, 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 superiority, injustice, vulnerability, distrust, and helplessness. Deeply entrenched patterns for understanding, perceiving, and interpreting events appear to govern and produce emotions and behaviors that may ultimately lead to conflicts and problematic and destructive crises. Distorted and dysfunctional beliefs appear to be at the core of many of the problems that crisis interventionists and other helping professionals face.

A current example of such a distortion is the widespread belief among New Orleans African Americans that levees were blown up to save white residential districts 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 difference 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 believe 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 

1. 1. Positive Aspects of an Effective Multicultural Counselor

Sue (1992) states that multicultural helping is enhanced when the human services worker “uses methods 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 counseling 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 humans everywhere are more alike than they are different (p. 543).

Cormier and Hackney (1987) cite several strategies 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 clients 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 effective, 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 approaches 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 emotions. He points out that some clients (such as traditional 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 immigrated 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 academic 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 parents 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, particularly in the South, uses physical contact to establish connections, so hugging, ritual handshakes, demonstrative grieving, and joyful exclamations all have healing and bonding power.

School crisis worker: (speaking animatedly and emphatically 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 knowing 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 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 background 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 

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 paragraphs 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 compatible with the client’s worldview, and offers to act as advocate without injecting his or her own values or conditions 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.

1. 1. 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 societal 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 framework within which the client operates. We are not simply talking about “foreigners,” either. Within the United States, residents of Jackson, 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 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).

1. 1. Language Barriers

Although it may be difficult enough to work with people in crisis from the same generic cultural background and who speak the native language as a first language, the manifestation and communication of first-generation Americans’ or immigrants’ personal problems may be very different from what the crisis worker is used to handling. As a result, assessment 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 mental health status given to government agencies, which may then make negative evaluations about their immigration 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 language, how can information be conveyed? While 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 whose 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.

1. 1. Religion and Spirituality

Religion and spirituality are so loaded with emotionality that many human service workers regard it as an exposed electrical wire, not to be touched on pain of death for fear they will be seen as either proselytizing for their religion or insensitive to other spiritual 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 counseling business 

Perilla, Norris, and Lavizzo (2002) found that after Hurricane Andrew, besides being exposed to more of Andrew’s wrath because of their poor economic state, Latinos and non-Hispanic blacks showed differential vulnerability to traumatic effects compared 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 crisis 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 system 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 attempt to make sense of events that seemingly make no sense at all. Faith plays a large part in how people try to come to terms with a randomly cruel universe 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 difficult 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 minorities (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 considerable space reporting on the cultural differences they encountered doing disaster relief work in the aftermath 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 workers believed to be ethically and morally right. The workers had to be very sensitive in not challenging these deeply held beliefs. In short, while it may appear to you to be voodoo, if it is bringing solace and respite, 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 judgments on the merit of those beliefs. Furthermore, educating parents with ethnically different views of child rearing about the ways children generically respond after a trauma, along with the normal developmental issues they face, may indeed be a tall order given the brevity of crisis intervention. Such interventions, although needed, may be something the crisis worker wishes to consider very carefully.

To offload this tricky issue by merely suggesting 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 guarantees 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 statement that directly addresses the issue.

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

1. 1. Support Systems

As you will soon see, providing support is 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 utilize 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. Dais-Railsford (2008) had a number of conversations with social service authorities, convincing them that children whose biological parents were missing post-Katrina were not abandoned 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. Therefore, the workers’ efforts needed to focus more on systemic approaches that dealt with extended family networks rather than individuals.

As helpful as social support may be, for some people 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 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 support in more culturally acceptable terms may be one way of allowing individuals to receive help. Organista and Munoz (1996) suggest using manuals and homework assignments, much like a teacher and a classroom assignment, to avoid the stigma of being seen by a mental health worker and receiving psychotherapy.

Crisis worker: (dealing with a female Asian college student who is thousands of miles from home and who has been sexually assaulted and is largely noncommittal or oblique in her response to the assault) Li Mai, suffering and enduring what you have is hard for any woman. It is very difficult to speak of such personal violations for almost every woman I have encountered 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 understand 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.

1. 1. Occupation as a Cultural Barrier

The ecological model in Chapter 1 may also 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 

The occupational agriculture of Chandler Mountain, Alabama, is far different from the financial culture of Wall Street, New York. We believe that to not take occupation into consideration as a defining part of one’s culture and ecosystem is to be absolutely 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 situations 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 mistaken. Police officers constitute a distinct occupational culture and closed ecosystem because of their authority 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 officers is their married life. They have one of the highest divorce rates of any occupation. They do not usually talk 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 and boredom to an immediate high-adrenaline moment. Over the long run, that psychological roller-coaster ride is extremely stressful. Furthermore, because law enforcement officers see the failure of the mental health system every day in the United States, they 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 provide us with valuable on-the-scene experience, they also help us appreciate the ecosystem within which the officer 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 the officers are going through. No amount of reading or expertise that we know of compensates for lack of knowledge and sensitization to this cultural milieu.

Indeed, this cultural bonding practice is now being field-tested by Winter and Battle (2007) on police officers who have had disciplinary referrals or bad conduct complaints. In this practice, called “embedded therapy” by Dr. Betty Winter of the Memphis Police Department, crisis workers ride in patrol cars with these troubled officers. As one might imagine, the officers initially exhibit a great deal of suspicion and hostility toward the workers. However, an eight-hour shift in the same patrol car breaks down barriers as the crisis worker empathically listens and responds to the officer’s concerns. Fairly quickly, gripes about the officer’s uncaring commanders turn to more personal and interpersonal issues as the crisis worker bonds with the officer and gains his or her trust. Early reports of improved conduct and lack of further disciplinary action for these targeted officers are encouraging (Winter & Battle, 2007).

1. 1. Geographic Locale as a Cultural Barrier

Lenihan and Kirk (1999) have developed a rural, community-level crisis intervention plan for very small towns and rural areas that lack the typical crisis infrastructure and support systems available 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 federal responses. However, the state emergency management agency may send crisis workers from neighboring 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 these areas may be very suspicious of outsiders, even those from neighboring communities, attempting to “tell them what to do.” Yet collective fear, rumor, parochialism, and inaccessibility to services can keep the community traumatized and immobile without such help. Lenihan and Kirk propose that intervention strategies must absolutely address the cultural issues that will exist between outside service providers and recipients of service before any meaningful work can be done. They advocate an immediate assessment of the traumatic event’s effect not only on individuals, but on the culture as well. In a sense, they are “triaging” the whole community. They propose that no outside crisis response team can do an adequate job 

Particularly important is ascertaining what the community’s belief systems are and if there are subcultures within the system that may have different responses from those of the community at large (Chemtob, 2000). Any crisis response must be integrated into the community leadership and organizations such as social clubs, churches, civic groups, and fraternal organizations. Providing sensitive consultation 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 citizens 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 communities 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.

An ecological model posits that the efficacy of trauma-focused interventions depends on the degree to which those interventions enhance the person–community relationship and achieve a fit both within and between individual and cultural contexts (Harvey, 1996). If you view the ecology of such rural communities as having a great deal of resiliency, self-reliance, and belief in the community as the primary source of support, then you should also get a vivid picture of how delicately you intrude on such a community. The road to hell is paved with good intentions, so you need to know what road you are traveling on as you go into crisis intervention!

1. 1. 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. Involving community representatives and leaders as intermediaries 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 enculturated, they may blithely go about their business and in the process attempt to redress a variety of long-held social injustices and practices (Golec, 1983). The wise crisis worker who goes into a different geographical area needs to understand that this dilemma always exists, whether the location is Kabul, Afghanistan, or Collettsville, North Carolina. We are absolutely not proposing that crisis workers go about the business of changing and redressing all the perceived evils and shortcomings they may run into. However, as with Shelby and Tredinnick’s (1995) report on the cultural reactions of their clients to a disaster, we are not so sure that one should stand passively by while victims project their frustrations by beating 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 infrastructure 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 may be disenfranchised and denied a part in the “democracy of a common disaster” (Kaniasty & Norris, 1995). Although the elderly, in particular, may be seen as needing assistance with physical complaints or illness, such attention does not necessarily extend to dealing with property damage or keeping a roof over their heads, food on the table, and medicine in their cabinets (Kaniasty & Norris, 1997; Kaniasty, Norris, & Murrell, 1990).

Kilijanek and Drabek (1979) coined the term “pattern of neglect” in regard to the lack of aid received by the elderly in their study of a Kansas tornado’s devastation of Topeka. The “squeaking wheel gets the grease” is probably even more true in the wake of a disaster. “YAVIS” clients—those young, attractive, verbal, intelligent, and socially well-connected clients from higher socioeconomic backgrounds—get better service because they have the power, influence, and verbal articulation to get help. People whose social locations differ from those of 

1. 1. The Necessity of Acting

When we are in the heat of the moment in a crisis, observing the “niceties” of another culture that tends to deal obliquely and subtly with problems may not be in the best safety interests 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 clients issues and perceptions, and that holds true of the collective populace as well. Certainly, being sensitive to the clients’ cultural and ecological background is part of a patient and thorough problem exploration.

We further believe that one of the worst therapeutic errors a worker can make is to attempt to “hurry” the process. Crisis intervention should never be hurried. Although it may seem paradoxical, the fastest way to resolve a crisis is to take your time to understand 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 processes 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 manner to assure his and others’ safety. Finally, helping anybody, no matter how culturally different, is complex in a crisis. Something that is a crisis for one family may not be for another.

Many culturally diverse families have years of coping with crisis and are extremely resilient. If a person from a different cultural background is a recent immigrant, these successes may be minimized in the immigrant’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 successes 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 between 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, skepticism, and perceived psychological threat by the same recipients (Wortman & Lehman, 1985). Our experience has been that this bipolar dilemma can occur not only on the same day but in the same hour!

1. 1. 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 understanding 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 culturally alien turf is critical to crisis work. The U.S. Department of Health and Human Services’ Developing Cultural Competence in Disaster Mental Health Programs: Guiding Principles and Recommendations (2003) contains a variety of helpful suggestions for working with people in a large-scale disaster.

1. 1. Where It Stands Now . . . Sorta

Multiculturalism has evolved though stages of raising 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, attitudes, and behaviors of the cultural group to whom 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—carefully controlled studies need to occur that measure both traditional therapeutic approaches against well-described cultural adaptations of those therapies and cultural specific practices that look nothing like our current 

1. 1. SUMMARY

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 communication and allegiances between individualist/collectivist–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 universal/emic as opposed to a focused view in defining multiculturalism and cautions the reader to be a discerning consumer in regard to what prevailing multicultural views may hold for the practice of crisis intervention.

 To see some of the concepts discussed in this chapter in action, refer to your Crisis Intervention in Action DVD, or see the clips online on the Counseling Course-Mate website. To access this site, go to www.cengagebrain.com, where you’ll also find an eBook, additional study tools, quizzes, and more. As you watch the scenario, think of your own social locations. How do you think they might be an asset or a hindrance? When you get to the PTSD chapter, you are going to run into something called a traumagram. It might well be called your trauma social locations. How do you think those might affect what you would do with this young Kenyan, or for that matter anybody else in crisis? Even though the counselor is an African American, what advantage or disadvantage does that give her in working with an African?

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 Kalayjian and Eugene Dominique’s (2010) two volumes on Mass Trauma and Emotional Healing Around the World: Rituals and Practices for Resilience and Meaning Making.

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