Engaging Adolescents in Programming: A Multicultural Approach Meghan J. Fortner, PCC-S Director of Adolescent Outpatient and Prevention Program Meridian Community Care Adjunct Professor, Youngstown State University President, Ohio Counseling Association (2013 – 2014)
Objectives • Discussion of diagnoses and symptomology – what are we seeing and how are we addressing it in schools/communities? • Defining Culture - What does it mean to be culturally competent? • Presentation and discussion of techniques described in research articles by Fred Hanna and others.
Diagnosing Substance Use and Conduct Problems with Children and Adolescents • What are the diagnoses we hear of that are often association with youth who have anger, conduct and/or social problems?
• What substances are our youth are using?
Diagnoses in “Real Life” • How do these symptoms/diagnoses present themselves in “real” life. • What are we seeing?
• What are the issues?
• Difficulties in working with this population in a school setting?
Defining Culture • What is a culture?
• How do we learn?
• What is Multicultural Competence?
How are teens different “nowadays?” • What makes them so different from recent generations?
• Positive challenges vs. negative challenges this culture faces?
Interventions – What are we doing? • What do we do when working with clients who are dealing with conduct and aggression issues? • According to Karnik and Steiner (2007), professionals working in the field need to be comfortable in incorporating multifaceted strategies that make use of the full range of available therapeutic interventions. • They also note that the treatment of “young offenders” is a field where new interventions and treatment modalities are constantly being implemented.
Pushing Our Buttons • What do we do in response? • What have we seen in our work and other’s work with this population? • Countertransference • Defiant adolescents often feel that there is no difference between adults and adolescents. Therefore, the relationship being developed needs to focus on attaining contact with the client beyond “egocentric self-absorption.”
• According to Hanna and Hunt (1999), adolescents who are prone to defiance and aggression, with hostile and violent impulses, are one of the most difficult of all adolescent populations to work with in any setting.
The Counseling Relationship • “The importance of an empathic relationship is also vitally important for defiant and difficult adolescents and is the pivotal point that determines eventual success or failure in counseling” • View this “type” of client as a unique culture and adopt a multicultural perspective in working with this client. (Hanna, F.J., Hanna, C.A. & Keys, S.G., 1999)
Techniques for Establishing a Relationship • Ability to Laugh at Yourself • Adults who are arrogant, take themselves too seriously or are ignorant are often targets of hostility, violence or manipulation. • Adolescents are more likely to look differently at those adults who are able to laugh at themselves and can make light of themselves and their mistakes. • Hypocrisy is noted by defiant adolescents when they see an adult take personal offense to their criticism when the same adults ask these adolescents to ignore criticism/verbal assault from others. • This population quickly and accurately detects adults who are “phony” or who are not being genuine
Techniques for Establishing a Relationship • Humor – • Adolescents often believe that someone who is funny is someone who is trustworthy. • Ensure your use of humor is appropriate – not at the expense of others (which is common amongst adolescents with conduct problems) • Teaching adolescents how to be lighthearted is best taught through modeling. • Change process is enhanced when clients can laugh at the weaknesses of human nature without being sarcastic or spiteful.
(Hanna & Hunt, 1999)
Techniques for Establishing a Relationship • Gender and Cultural Issues • Gender, unless specifically stated by the client, does not seem to be an issue when pairing a client with a counselor. • Issues to consider – • History of Abuse (physical, emotional, sexual) • Views toward opposite or same sex
• Culture • Openly explore the impact of racial discrimination in their lives • Understand their impressions of and relationship with their own and other cultures
Techniques for Establishing a Relationship • Get to the Point… • Say what you need to say in as few words as possible • Hanna and Hunt (1999) have found that many defiant and aggressive adolescents’ minds tend to wander after the first few sentences an adult says and in counseling, the therapeutic message that is trying to be conveyed is diluted. • It is okay to oversimplify as long as the key point is made – meaning can be refined later.
(Hanna & Hunt, 1999)
Tips for Establishing Rapport
• Remember that many of these adolescents have not had relationships with people who act as models for appropriate relationships with others. • • • • • • • • • • • • • • •
Offer a Snack Avoid Desks Be familiar with popular music Allow the client to occupy their hands while talking with you Get out of the office Be genuine, respectful Educate the client about counseling Avoid the expert stance, asserting credentials, and thinking in clinical labels Genuinely emphasize similar experiences you may have had Convey a “brief” attitude Use media, art, activities, music Admiration can cut through hostility and defiance Address positive personality characteristics Encourage the resistance Acknowledge hurt, then address the anger (Hanna, F.J., Hanna, C.A. & Keys, S.G., 1999)
Coutertransference Issues • “It is important to note that the difference between a highly competent therapist (counselor) and a mediocre therapist (counselor) lies in his or her ability to manage countertransference” (Hanna & Hunt 1999)
• Commending Skilled Manipulations • “call the game” – unravel the game before the client can reset it • Lies and manipulation = misguided managerial skills
• Dealing with Intimidation • Commend the clients skill in being able to produce this feeling in others – but don’t let them know if it works on you as it reduces your credibility • These clients are skilled at recognizing intimidation • Exploring how they do it, its usefulness in the clients life, where they learned it from and how it is or isn’t getting them what they want • Opens the door for social skills training (Hanna & Hunt, 1999)
Motivation Strategies • Motivating defiant adolescents can be a very difficult task. • They perceive counseling as an attempt to undermine their freedom, self-will and autonomy. • Work with their willingness – increase awareness of the benefits of counseling/talking with you
• Dealing with Apathy • Acknowledge apathy – accept its presence in order to build empathy and avoid a power struggle with the client • Take the Sub personality approach
(Hanna & Hunt, 1999)
Motivational Interviewing • Basic Principles • • • • •
Express Empathy Develop Discrepancy Roll with Resistance Support Self-Efficacy Avoid Argumentation
(Miller& Rollnick, 2002)
Motivation Strategies • The Freedom Challenge • The desire for freedom and autonomy is very strong with adolescents • The more the counselor acknowledges and respects this, the more likely an adolescent is to ask and listen to support and guidance • Higher success rates have been correlated with counselors emphasizing the clients freedom to choose and personal choice
• Managing countertransference is imperative – • Many adolescents involves frequently blaming others for negative behaviors and attitudes • Directly challenge this as blaming others means that they have allowed someone else to have control over their life • Freedom = self-control over their own action’s and thoughts (Hanna & Hunt, 1999)
When enough is enough… • When is it time to refer a student for services? • Collaboration with other Counselors/Agencies/Probation Departments.
References • Hanna, F.J., & Hunt, W.P. (1999) Techniques for psychotherapy with defiant, aggressive adolescents. Psychotherapy, 36, 56 – 68. • Hanna, F.J., Hanna, C.A., & Keys, S.G. (1999)Fifty strategies for counseling defiant, aggressive adolescents: reaching, accepting and relating. Journal of Counseling and Development, 77, 395404. • Miller, W. R., & Rollnick, S. Motivational interviewing: Preparing people for change (2nd ed.) (2002). New York: Guilford Press. • Knorth, E.J., Klomp, M., Van den Bergh, P.M., & Noom, M.J. (2007) Aggressive adolescents in residential care: A selective review of treatment requirements and models. Adolescence, 42, 461 – 485. • Niranjan, S.K., & Steiner, H. (2007) Evidence for interventions for young offenders. Child and Adolescent Mental Health, 12, 154 – 159. • Singh, N.N., Lancioni, G.E., Singh Joy, S.D., Winton, A.W., Sabaawi, M.,Walher, R.G., & Singh, J. (2007) Journal of Emotional and Behavioral Disorders, 15, 56 – 63.
Contact Information • Meghan Fortner •
[email protected] • 330-270-5323 • Meridian offers • Mental Health Counseling for children, adolescents and adults • Substance Abuse Counseling • Prevention Services to schools in Trumbull and Mahoning Counties • Education groups to children, adolescents, families, adults and parents. • Free consultations to parents • Walk-in assessments (330-797-0070 Front Desk) • Drug Testing