Topics in International School Counseling

Topics in International School Counseling Nick Ladany, Ph.D. Loyola Marymount University Los Angeles, California Nicholas.Ladany@lmu.edu Cheryl A. Brown Shanghai American School (Puxi), China cbrown451@usa.net

Institute Overview • Introductions • Elements of Effective and Ineffective School Counseling • Critical Mental Health Issues of Children in International Schools • Eating disorders, depression, anxiety, substance use and abuse, third culture kids • Multicultural Competence • Prevention Curricula • Effective and Ineffective Supervision • Model for International School Counselors • Job-A-Like Discussion Sessions • Marc Marier (American School of Dubai) • Jennifer Melton (Shanghai American School – Pudong)

Importance of International School Counseling • 273,000 students enrolled in one of the 520 overseas schools in 153 countries (2006-7). • Multinational student body • Unique challenges • transient and mobile family lifestyle • competing cultural practices • limited personnel resources • limited professional support • Unique demands • mental health needs • professional development • negotiating relationships with parents and school personnel

Needs Assessment Exercise • One-Two-Four-Eight Exercise • Identify mental health needs of students • Identify professional needs of counselors • Learn a method for intact working groups to identify and clarify issues of importance

Data Sources • Presentations at international school conferences (e.g., NESA, Tri-Association, etc.) • Research investigation of counselors in the international schools (Inman, Ngoubene, & Ladany, 2008) • Today’s discussion

Cultural shock and adjustment Eating Disorders Depression Stress & Anxiety Fears over peer/social acceptance Identity development Substance Abuse/Addictions Transition & Adjustment Security Conflict resolution Family Issues Parent Involvement Psychiatric Disorders (e.g., Bipolar) Anger Management/Relational Aggression Self-esteem Academic Advising Career Development Vocational Counseling Student Needs

Networking Less Isolation from Collegial Support/Networking Consultation & Supervision Academic Resources Referral Resources Technology Financial Resources Time Management Training Space Confidentiality/Privacy Professional Development Multicultural development Support from School Staff Referral Resources Roles & Responsibilities Clear Delineation Administrator & Teacher Understanding Counselor Professional Needs

Challenges with Principals, Teachers, & Parents • Lack of Knowledge of Counselor Role • Lack of Trust in Counselor • Lack of Teamwork and Communication • Complexity of Counseling Process • Lack of Respect for Student Confidentiality • Parental Involvement in Student’s Life • Scheduling Conflicts • Lack of Empathy for Student Needs • Multicultural Misunderstandings • Dual/Multiple Relationships

Counselor Activities & Roles • Premise: A child’s emotional needs must be met adequately before educational needs can be addressed • Individual counseling • Prevention workshops • Group counseling • Parent & Family consultation/counseling • Teacher consultation • Career development • Administration consultation • Crisis intervention • Assessment & referral • Minimum Recommended Counselor:Student Ratio = 1:250

Elements of Effective Counseling(Ladany, Walker, Pate-Carolan, Gray, 2008) • Empathy • Manage Countertransference • Ability to Tolerate Ambiguity • Working Alliance

Three Key Features of an Effective Counselor Empathy • a genuine feeling of care for the client’s situation, an ability to accurately perceive the client’s experience (both intellectually and emotionally), a capacity to not only imagine the self as the client, but to suspend one’s own experience and personal judgment to comfortably experience the client’s unique inner world “as if” the counselor were the client, a capability to predict the client’s reactions, and an ability to sensitively and accurately communicate this experience to the client (Banks, 2004).

Three Key Features of an Effective Counselor Countertransference • Present in all helping relationships • Pantheoretical • An exaggerated, unrealistic, irrational, or distorted reaction related to a counselor’s work with a client. This reaction may include feelings, thoughts, and behaviors that are likely to be in response to the client’s interpersonal style and presenting issues, and/or the counselor’s unresolved personal issues (e.g., family of origin, life experiences, or environmental stressors).

5 Step Approach to Manage Countertransference • familiarize yourself with personal issues that may act as a trigger for countertransference • identify cues that alarm you when countertransference may be playing out in session • examine how countertransference influences the therapeutic work • explore the origins of the countertransference • use supervision and consultation to develop a therapeutic plan in the best interest of the client.

Three Key Features of an Effective Counselor Ability to Tolerate Ambiguity

Defining a Counseling Relationship Working Alliance (Bordin, 1979) • Key to positive outcomes • Culturally sensitive • Applicable across realms of helping e.g., counselor-client; teacher-student; supervisor-supervisee; etc.

3 Components of a Working Alliance • Agreement on Goals of Counseling • decrease depression, enhance study skills, decrease anxiety • Agreement on Tasks Counseling • explore past experiences, focus on cognitions, learn skills, observe classroom teaching • Emotional Bond Between Counselor & Client • mutual caring, liking, trusting • Foundation upon which all helping is based

Elements of Ineffective Counseling • Systemic Factors • School culture • Parents • Contraindicated School Counselor Roles • Counselor Factors • Empathy challenged • Ignore Countertransference • Premature attempts to fix/problem solve • Inaccessibility to students • Weak Working Alliance • Children/students not included in goal and tasks, poor bond

Eating Disorders • Some Facts • The typical model weighs 13-19% below the normal expected body weight • The clinical criteria for anorexia nervosa is 15% below expected weight • In the USA, half of adults are dieting. Children see and hear this and internalize the cultural idea that to be thin is to be successful and to be normal weight or fat is to fail. • By age 2, girls are watching TV and are starting to be exposed daily to messages showing that women who are successful are thin. • Before girls even go to elementary school they are exposed to messages (from family and/or the media) that certain foods are “bad” and that sugar and fat make people fat.

Additional Facts • Before girls go to elementary school they have heard women (their mothers, older sisters, caretakers) complain about their bodies and focus on weight loss and dieting. • Weight preoccupation and body dissatisfaction is occurring earlier and earlier. • 40% of girls and 25% of boys in grades 1 - 5 reported trying to lose weight. • 25% of the girls reported restricting or altering their food intake. (This was about two times as many girls as boys.) • By fourth grade, 40% or more of girls “diet” at least occasionally.

In a survey of over 400 fourth grade girls: • One third said they “very often worried about being fat” • Nearly half said they “very often wished they were thinner” • About 40% of the girls reported dieting “sometimes to very often”

In a study of fifth graders: • 40% felt too fat or wanted to lose weight, even though 80% were not overweight. • The researchers found children as young as 9 years old with severe eating disorders, including anorexia nervosa and bulimia.

Be Careful What You Wish For • A group of girls ages 11 – 17 were asked “If you had three wishes, what would you wish for?” • The #1 wish of nearly every girl was to lose weight. • More than two-thirds of high school girls are dieting and half are undernourished. • At the same time, one in five teenagers is overweight

Four Major Weight and Eating Problems • Dysfunctional Eating • Not regulated by hunger and satiety • Eating Disorders • Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorders • Overweight & Obesity • Size Prejudice • Oppression toward obese children • Accepting or promoting the cultural ideal of thinness

Signs and Symptoms of Eating Disorders • Labeling foods as good vs. bad • Skipping meals • Dieting • Feeling guilty for eating • Counting calories and/or fat • Depressed mood • Self-critical thoughts, words, or behaviors when she can’t exercise • Exercising in order to eat

Signs and Symptoms of Eating Disorders • Avoiding situations where she may be observed eating • Perfectionism • Hiding one’s body by wearing baggy clothing or layers • Preoccupied with models, actresses, their looks, body, weight • Feeling anxious or stressed about eating • Accepting or verbalizing the cultural ideal of thinness • Social isolation

Prevention of Eating Disorders • Creating a school environment that promotes health • Parental involvement • Preschool awareness • Children through the 3rd grade • Discussion focusing on health and wellness • Beginning in 4th grade • Health and wellness • Discussion of eating disorders

Role of School Counselor • Identify factors in the school that hinder students’ development of positive ideas about body image and health • Offer school-wide programs targeting weight and eating issues • Educate and assist teachers and administrators • Educate parents • Work individually with students • Refer students when possible

Depression in Children and Adolescents • 10-15% of children and adolescents has some symptoms of depression (Surgeon General, 2000) • 20-40% adolescents report feeling sad, unhappy, or depressed over a 6 month period (Achenbach, 1991) • 10-20% of parents report their adolescents have felt sad, unhappy, or depressed over a 6 month period (Achenbach, 1991) • As many as 20% of children experience a major depression episode before graduating from high school, and between 7% and 9% of children will experience a depressive episode by the time they are 14 years old (e.g., Garrison et al., 1989; Lewinsohn, Hops, Roberts, & Seeley, 1993)

Sadness Emptiness Helplessness (nothing ever works for me) Diminished interest or pleasure in most activities (I don’t care anymore) Significant weight loss or gain Poor appetite Insomnia or hypersomnia Marked restlessness or slowness Indecisiveness School failure Poor motivation Concerns about aches and pains Lack of friends Feels inferior Noncompliant Frequently gets into fights Feels unloved Symptoms of Depression in Children and Adolescents

Loss of energy/fatigue Worthlessness Guilt Difficulty concentrating Recurrent thoughts of death Thoughts of suicide Self-loathing (I hate myself) Feeling bad Irritableness or feeling crabby Isolation from peers Loneliness Frequent crying Worries that bad things will happen Symptoms of Depression in Children and Adolescents (cont.)

Suicide • 1.6 per 100,000 for 10-14 year-olds • 9.5 per 100,000 for 15-19 year-olds • Boys four times more likely to commit • Girls twice as likely to attempt • Hispanic students most likely of all racial groups • 90% of children who commit suicide have a mental disorder prior to death (most common depression, anxiety, substance abuse)

depressed mood thoughts/feelings of hopelessness or helplessness thoughts of hurting yourself plan means time place Contract* what would prevent past attempts social support/interpersonal isolation impulsivity substance use family member Suicidal Risk Factors

Anxiety in Children and Adolescents • 1 year prevalence in children 9-13 years old is 13% • Separation Anxiety Disorder • Anxiety about being apart from parent(s) • Fear parent may become ill or have an accident • May develop after a move or trauma • Generalized Anxiety Disorder • Excessive worry about most things • Social Phobia • Persistent fear of being embarrassed in social situations • Young children tend to exhibit symptoms more behaviorally (e.g., cry, tantrums, timid) • Anxiety and depression often coexist

Anxiousness Fear Worry Panic Nightmares Avoidance Thoughts of monsters Thoughts of being hurt Thoughts of danger Increased heart rate Difficulty concentrating Thoughts of contamination Depersonalization Stuttering Swallowing Avoid eye contact Trembling voice Nausea Muscle tension Symptoms of Anxiety in Children and Adolescents

Role of School Counselor with Depressed and Anxious Students • Availability and approachability • Identify depressed or anxious mood • Work with parents • Work individually with students • Receive consultation/supervision • Refer students when possible • Individual counseling/psychotherapy • Family counseling/psychotherapy

Substance Use & Abuse • Often increased accessibility and availability in Overseas Schools • Middle school children 12-15 • 50% have tried alcohol at least once • Average age of first drink10.4 years old • 23% have been drunk

Substance Use & Abuse • U.S. High School Senior Lifetime Use • Alcohol 81% • Tobacco 64% • Marijuana 42% • Inhalants 17% • Hallucinogens 13% • Cocaine 6% • Often coexist with another mental health disorder

Substance Abuse & Dependence • Factors associated with SA & D • Stress • Family turmoil • Another mental health disorder • Physiological predisposition • Family member use and abuse • Peer use and abuse • Academic difficulties • Poor self-esteem • Poor coping resources • Family therapy most effective treatment for children and adolescents • True for most childhood mental health issues