April is the month of counseling awareness, and each year advisors strive to promote our profession by evaluating service delivery, promoting community, and increasing advocacy efforts. This year, consultants are facing an unprecedented challenge: promoting mental health in the transition to providing telemedicine sessions, modeling physical distance while closing cultural gaps in mental health, and connecting clients to services from their own home.
This is a critical time in the history of our profession, and we are needed now more than ever. Treatment is now largely shifting to a triage approach as psychosocial stabilization advisors move to the front in the midst of fear, isolation, anger, anxiety, and depression.
An alarmingly affected population is the Asian-American population. The novel global pandemic of the coronavirus has led to a sharp increase in violent attacks on people of Asian origin. Xenophobic racism against Asian Americans increased when the coronavirus struck the United States. According to Rep. Judy Chu (D-Calif.), We report hate crimes averaging 100 per day.
Consultants are now asked to address the concerns of this population in our practice. Knowledge of the multicultural considerations of this population and the prioritization of culturally sensitive treatment approaches has become an essential service for the foreseeable future.
Attorney's Office
Through legal practice, we can influence the creation and implementation of transformative initiatives and programs that offer our customers immediate and long-term benefits. For example, we can persuade legislators to target mental health screening for vulnerable populations, including clients with previous mental health diagnoses. The psychosocial needs and responses of the Asian population will be unique, and interventions should be trauma-focused, including components for building social support and community resources.
Address terminology: On March 20, the US Civil Rights Commission voted for a statement expressing "serious concern" about "growing anti-Asian racism and xenophobia" related to the coronavirus Pandemic. The commission proposed that the use of terminology such as "Chinese Corona Virus", "Wuhan Flu" and "Yellow Danger" fueled xenophobic hostility to Asian Americans. The use of a racist language to describe a pandemic links ethnicity to a virus outbreak and helps trigger racial attacks.
As consultants, we have an ethical obligation to redirect the language of our colleagues and to discuss this language with our customers if our approaches and framework conditions allow it. Using appropriate, professional terminology for this pandemic and directly combating defamatory language with clients can broaden a culturally humble dialogue and allow clients to explore their fears and fears in the security of our offices.
Offer training: We can also use our expertise to provide on-site training on trauma and crisis response, to educate the public and healthcare workers on how best to deal with the immense pressure and the fear of Asian Americans can handle families. This can help to minimize the harmful psychosocial reactions in these times of crisis.
The American Counseling Association has compiled a comprehensive database of trauma resources and training opportunities for consultants. ACA explains that "disasters tend to emphasize emotional, cognitive, behavioral, physiological, and religious / spiritual beliefs." Tools provided include external resources for trauma and disasters, resources for mental disasters, resources for on-site protection, and articles on counseling today traumas. The database also provides information on resilience, grief, and helping survivors deal with skills and healing.
The education of our colleagues about the disaster impact and recovery model currently has particularly relevant and important applications. This model involves several phases of assessing and identifying trauma stages before expected grief.
Customer Interventions
Asian Americans are exhausted from increased fears of damage that go beyond micro-aggression outside the home. Stress-based responses to dramatic environmental changes often lead to a resolution of coping skills that previously served as protective factors for Asian-American clients.
Since global attention is largely focused on the active physical treatment and recovery of patients at the medical level, the cultural considerations of certain population groups have been largely ignored. Many post-traumatic symptoms do not appear for several months. Until then, we can only rely on our knowledge of disaster models to meet the needs of these customers.
Currently, we should focus on intervention and prevention by building resilience, developing community support, and promoting social connectivity during physical distance. Consider the following suggestions:
Encourage people of Asian origin to reach each other through social media and other technologies to share experiences and feelings related to these fears and to be exposed to aggressive actions. It would be helpful to suggest joining an Asian-American online community or advocacy group to develop a sense of self-government and empowerment.
Introduce mindfulness. When our clients notice sensations in their bodies, such as For example, a tightening of the chest or an accelerated heart rate, observing these feelings can provide insight into the triggers. This helps clients to develop awareness and an increased sense of the connection between body and mind. Introduce mindfulness activities such as breathing, body mapping and concentration to help customers focus on emotional balance. In public, customers are more likely to take quick action options when they are calm, rather than relying on immediate defensive or avoidance impulses.
Treat symptoms related to depression, anxiety, and hypervigilance directly. Discussing these symptoms and suggesting evidence-based practices for restoring rituals, connecting with family and friends, and incorporating spirituality can be important tools for preventing symptom-related impairment.
Encourage customers to familiarize themselves with literature such as Grace Lee Boggs, Maxine Hong Kingston and Thich Nhat Hanh. Understanding how others of Asian descent have endured through pain and difficulty in a time of isolation and disenfranchisement.
Be ready to discuss and disseminate resources related to financial aid, professional disruptions, academic problems, and maintaining a cohesive family environment. Provide handouts and web links, emergency response and response phone numbers, and community locations to help customers when they're in an active crisis and can't reach authorities or hospital treatment centers near them. As this public health crisis escalates, it is important that Asian American customers have multiple resources they can rely on to gain a sense of security.
Suicide Prevention
The suicide potential cannot be overlooked in this vulnerable, targeted population. Suicide exams should be done early and frequently. Warning signs of suicidal thoughts due to stereotypes associated with Asian ethnicity are often ignored in Asian American clients. Consultants should approach the topic from a culturally informed perspective and take into account cross-generational influences, pressure to perfect, collectivist values and the attributed image of an "exemplary minority". The pressure of cultural expectations is increased in times of high stress and trauma exposure, and counselors should be direct in assessing risk factors, protective factors and treatment options.
According to the United States Department of Health and Department of Health for Minorities:
Asian-American women in grades 9 through 12 are 20% more likely to attempt suicide than non-Hispanic white students.
Southeast Asian refugees are at risk for post-traumatic stress disorder (PTSD), which is associated with trauma before and after immigration to the United States. A study found that PTSD was diagnosed in 70% of Southeast Asian refugees receiving psychiatric care.
The American Psychological Association offers additional data:
Suicide is the second leading cause of death for Asian Americans ages 15 to 34, which is consistent with national data across all racial / ethnic groups (the second leading cause for people aged 15 to 24 and the third leading cause for those 25-34) .
Of all Asian Americans, 20-24 year olds have the highest suicide rate (12.44 per 100,000).
Asian women have the highest suicide rate among women of all races between 65 and 84 years.
Consultants should remember the importance of confidentiality and informed consent as a delicate balance between report and mandatory reporting. Two tools that should be considered in suicide screening are the model of collaborative evaluation and management of suicidality and the Suicide Intervention Response Inventory – 2.
Further considerations of the consultant
Compassion Fatigue. The effective management of our own emotional responses to trauma was a focus of training for professional advisers. To date, the majority of consultants have switched to providing online telebehavioral health services for their regular case numbers and have taken on additional tasks in their communities, including providing crisis interventions to people whose sudden violence has replaced their ability to cope effectively.
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This presents consultants with unique challenges that are under multiple pressures to fulfill additional responsibilities for customer decompensation and new recommendations. It is not uncommon for consultants to experience physical, emotional, and psychological fatigue on a daily basis, as we are very concerned about the safety and well-being of our Asian-American clients under the current circumstances. Dennis Portney (2011) described compassion fatigue as "burnout plus the accumulation of stress that comes from empathizing with customers over time". Compassion fatigue can suddenly appear and feel ubiquitous, affecting the normally attributed self-care routines. To combat compassion exhaustion, counselors must themselves confirm that commitment, not perfectionism, is the key to maintaining energy during this time.
Self Care. Consultants should consider their work essential, necessary and sacred. And we cannot minimize, trivialize or reject our own emotional trauma-based reactions through over-identification and countertransference. We should commit to honoring ourselves and our mental health, just as we do with our Asian American customers, and monitor our investments in their care as part of this. As our resilience wears off, our usual compartmentalization skills may return to fatigue, anxiety, sleep disorders, and less investment in customer care.
Another important use of self-care is to remind us diligently to practice what we preach. During this time, we need to apply our prescribed coping skills to our own daily routines. Yoga, breathing techniques, visualization and the connection to positive, supportive groups strengthen our resilience and remind us of Irving Yalom's key principle of universality. The inclusion of coping skills that Asian cultures possess is applicable to our own lives and will facilitate our own trauma-based reactivity during this time.
Promoting Post-Traumatic Growth for Us and Our Customers In Counseling Today's article “The Transformative Power of Trauma” (2012), Lea Flowers and Gerard Lawson suggest that positive psychological changes are the result of a struggle Having very challenging life circumstances can lead to personal transformation as a by-product of the traumatic experience itself.
Focusing on the growth of the client, not just on the circumstances of xenophobic violence, can help Asian American clients deliberately build a repository of proven strengths and skills to redesign their experiences. These changes will affect their reactions to future traumatic events and build emotional, psychological and mental resilience.
In Lawson's words: “This is correct in our wheelhouse as a consultant. What strengths does this person continue to show despite their traumatic experience? We have to be careful to highlight these for our customers. "
And we as consultants.
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Adrianne L. Johnson is a licensed professional clinical advisor and associate professor at Wright State University in Dayton, Ohio. She is the former president (2018-2019) of the Ohio Counseling Association and editor-in-chief of the Journal of Counselor Practice. Contact her at [email protected].
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