HSCO 509

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CULTURAL IDENTITIES AND VALUES ASSIGNMENT INSTRUCTIONS

OVERVIEW Valuing cultural diversity and honoring the cultural stories of the people we come into contact with begins with self-awareness and thoughtfulness. The purpose of this assignment is to encourage you to think about, define, and articulate your own cultural story and worldview, with the goal of identifying strengths and areas for growth. Understanding your own cultural beliefs and values can help to make you aware of potential bias and limitations. Culture is race and ethnicity, and also nationality, language, gender, religion and spirituality, sexual orientation, socioeconomic status, disability or ability, and size, to name just a few identities. Belonging to a cultural group influences every aspect of one’s life, including beliefs, values, attitudes, and worldviews. When we understand our own cultural backgrounds, we can better understand how these identities affect others. INSTRUCTIONS

Write a 4–5-page paper (not counting the title page and reference page) describing your culture and worldview. You do not need to write an abstract. Follow current APA professional style standards. Cite and reference our textbook, Cultural Engagement, by Chatraw and Prior (2019), as a source used for support in each main section of your paper. This is the only source required for this paper. You may use Scripture as well. Because you are writing about your personal culture and worldview, it is appropriate to use first person pronouns (I, me, my, for example) for this assignment. Begin your paper with a brief introduction (do not use a heading for the introduction). This is typically one paragraph that explains what the paper covers. Define what is meant by culture in the first main section, Defining Culture. Explain how culture is defined in our text, and then define and explain your own cultural identities in this context. There should be multiple citations for Cultural Engagement in this section. The next section of your paper should address Faith and Culture. This section is for you to articulate your faith beliefs and practices that you identify with. How important is your faith to you? It is important to know what you believe and be able to clearly state this. The third main section, Contemporary Issues, contains your exploration of your personal culture and worldview beliefs regarding contemporary issues (examples from our reading include sexuality, gender roles, abortion, reproductive technology, immigration, race, climate change, animal welfare, politics, work, arts, war, weapons, capital punishment). Do not use subheadings for this section; use paragraphs to separate main ideas. As you define your culture and worldview, focus on topics that are of the greatest significance to you personally (in our course reading, this concept is referred to as cultural salience). This is an important concept from our reading, that individuals place different priorities on aspects of their culture, and it is up to each person where this significance is placed. Explore at least three contemporary issues from our reading in this section. You must cite Cultural Engagement in this section multiple times to show how you are interacting with the text. End with a Conclusion where you summarize what the paper covered and include closing thoughts. Discuss how this paper helped you and what you learned from the experience.

HSCO 509

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Note: Your assignment will be checked for originality via the Turnitin plagiarism tool.

Superiority of group counseling to individual coaching for parents of children with learning disabilities

MALY DANINO1 & ZIPPI SHECHTMAN2*

1Nizan -The Israeli Association for Learning Disabilities & 2Faculty of Education, University of Haifa, Mount Carmel,

Haifa, Israel

(Received 24 October 2011; revised 3 May 2012; accepted 7 May 2012)

Abstract Two interventions for parents of children with learning disabilities (LD)*individual coaching and group counseling*were compared. Participants were 169 parents, non-randomly assigned to three experimental conditions: coaching (n�45), group counseling (n�93) and control (n�31). Variables included outcomes (parental stress and parental coping), personal (perceived social support) and process (bonding with therapist/group). Findings indicated more favorable outcomes for parents in both treatment conditions compared to control, more favorable outcomes on the stress index for parents treated in groups compared to individual coaching, and bonding was the most consistent predictor of outcomes. The discussion focuses on the power of group counseling for parents of children with LD.

Keywords: parents; treatment; learning disabilities

Introduction

The study focuses on treatment for parents of

children with learning disabilities (LD). Some of

these children constitute a daily challenge for their

parents, due to academic, social, emotional and

behavioral difficulties (McPhail & Stone, 1995;

Morrison & Cosden, 1997; Turnbull, Hart, &

Lapkin, 2003). Parents of these children are under

great stress (Adelizzi & Goss, 2001; Al-Yagon, 2007;

Brannan, Heflinger, & Bickman, 1997), often feel

helpless and depressed (Bandura, Barbaranelli,

Caprara, & Pastorelli, 1996; Turnbull & Turnbull,

1986) and, as a result, their parental functioning is

less effective (Barkley, Fischer, Edelbrock, &

Smallish, 1991; Stone, 1997). Assisting these

parents is important for the parents’ sake as well as

for the child. Indeed, research supports interventions

to improve parents’ coping skills; however, less

attention is given to their feelings and well-being.

This raises the question: What constitutes an

effective intervention for parents? In the current

study we compare group counseling and individual

coaching*two formats of treatment within a similar

theoretical model (expressive supportive)*in respect

of outcomes, and attempt to explain these outcomes

in terms of individual and process variables.

Literature review

Learning disabilities are neurological dysfunctions

that affect cognitive and affective aspects of human

beings. As a result, some learning functions, cogni-

tive information processing, and interpersonal skills

may be affected (Turnbull et al., 2003). Indeed,

children with LD, particularly those who have

ADHD symptoms, were found to have lower aca-

demic self-concept and achievements than children

without LD (Leichtentritt & Shechtman, 2009).

They were also found to have higher levels of

loneliness and depression (McPhail & Stone, 1995)

and more frequent interpersonal conflicts and de-

linquency (Barkley, 1997).

Parent-child relationships directly affect the level

of problems that children demonstrate (Barkley,

1997). The more parents are attuned to their

children’s needs, and the more supportive and

warm they are, the fewer the child’s emotional

and social difficulties (Morrison & Cosden, 1997;

Spekman, Goldberg, & Herman, 1992). In contrast,

the more parents are authoritarian and punitive, the

greater the child’s adjustment symptoms (Eisenberg,

Fabes, & Murphy, 1996; Stone, 1997).

Parents of children with LD have adjustment

problems as well. Compared to parents of non-LD

Correspondence concerning this article should be addressed to Zippi Shechtman, University of Haifa, Faculty of Education, Mount

Carmel, Haifa 31905, Israel. Email: [email protected]

Psychotherapy Research, September 2012; 22(5): 592�603

ISSN 1050-3307 print/ISSN 1468-4381 online # 2012 Society for Psychotherapy Research

http://dx.doi.org/10.1080/10503307.2012.692953

children, they are under higher stress, tend to blame

themselves more often, express less satisfaction with

their parental role (Smith, Majeski, & McClenny,

1996), demonstrate a lower level of self-efficacy and

a sense of helplessness (Bandura et al., 1996), and

feel more anxious and depressed (Al-Yagon, 2007;

Veisson, 1999). Consequently, they tend to be less

supportive of their children and more punitive

(Barkley et al., 1991). Assistance for these parents

is not very common, as most attention is directed to

the children, primarily their academic difficulties.

Nonetheless, there are parental interventions re-

ported in the literature. These are mainly educa-

tional, aimed at training parents to cope with their

children with LD. Reported outcomes of these

interventions have been positive. Educational in-

terventions with parents of autistic children, for

example, showed a decrease in parental stress

(Baker-Ericzen, Brookman-Frazee, & Stahmer, 2005;

Feldman & Werner, 2002; Koegel, Bimbela, &

Schreibman, 1996). Another cognitive group inter-

vention with parents of children who are intellec-

tually challenging (Nixon & Singer, 1993) indicated

a decrease in parental self-blame, negative thoughts,

and depression symptoms. Barkley and colleagues

(1992) compared three types of treatments for

parents of children with ADHD: behavioral manage-

ment treatment, training in problem solving and

communication, and family therapy. All three were

effective in reducing negative communication, con-

flict, anger, and mother’s level of depression, as well

as in improving the adjustment of the children.

Webster-Stratton (1984, 1985) used video presenta-

tions to train parents of children with conduct

disorder. Results pointed to improved parental cop-

ing skills and enhanced problem solving skills among

the children. Finally, Shechtman and Gilat (2005)

conducted expressive-supportive groups with

mothers of children with LD. The mothers showed

a reduction in stress, an improved perception of the

child, and higher parental sense of control. In the

current study we use this same type of group, but go

a step further by comparing outcomes to individual

treatment of a similar orientation. This is the first

paper to compare outcomes of individual and group

treatment of the same orientation for the target

population. Considering the emotional needs of

parents of children with LD and the high demand

for services of this population, it is important to

know which intervention is the most helpful as well

as the most cost-effective.

Past comparisons of individual and group treat-

ments have shown similar outcomes for both types

of treatment (Fuhriman & Burlingame, 1994;

McRoberts, Burlingame, & Hoag, 1998; Shecht-

man, 2004). Conclusions in the literature suggest

that, at least in terms of cost effectiveness, groups are

preferable to individual treatment, but group and

individual treatment formats for parents of LD

children have not previously been compared.

Research also points to different processes in

these types of treatments. Holmes and Kivlighan

(2000) indicated that climate and interpersonal

learning are more frequent in groups, whereas self-

awareness, identification, and problem solving are

more frequent in individual treatment. Fuhriman

and Burlingame (1990) also stipulated that

different therapeutic factors operate in each type of

treatment.

The therapist-client relationship seems to be an

important factor in both treatments. In individual

treatment, it is so highly appreciated that it is

referred to as the ‘‘common factor’’ (Greenberg &

Pinsof, 1987; Horvath, 2005). In groups, too,

relationships are critical, but in this case it is the

bond with both the group members and the therapist

that enhances outcomes (Johnson, Burlingame,

Olsen, Davies, & Gleave, 2005; Burlingame et al.,

2007; Piper, Ogrodniczuk, Lamarche, Hilscher, &

Joyce, 2005).

The therapist-client relationship is considered a

process variable, but there are also individual differ-

ences among clients, such as perceived social sup-

port (Boutin, 2007; Cheung & Sun, 2001;

Lieberman &Golant, 2002). Perceived social sup-

port is an important factor: the greater it is, the

better the outcome (Hanks, Rapport, & Vangel,

2007). In the current study, the focus of treatment

is on support; therefore, it could be expected

that increased support will have an impact on

the outcomes.

Based on this literature, we expected: (a) Positive

outcomes in both treatment types compared to non-

treatment/control. Specifically, we expected a reduc-

tion in parental stress and improvement in parental

coping, in the two treatment groups. (b) Based on

the inconsistent results in the literature regarding the

superiority of group treatment over individual treat-

ment, we hypothesized that no difference in out-

comes between the two treatments would be found.

(c) Based on the literature suggesting that process

and individual variables affect outcomes, and con-

sidering the different type of treatment, we hypothe-

sized that different process and individual variables

will predict the outcomes in each treatment type; and

(d) based on the literature, we expected different

therapeutic factors in the two treatment types:

emotional awareness-insight, self-disclosure, and

problem definition-change will be more frequent in

individual coaching, while relationships-climate and

other- versus self-focus will be more frequent in

group counseling.

Treatment of parents 593

Method

Participants

Participants included 169 parents of children with

LD: 93 in group counseling, 45 in individual coaching

and 31 parents on a waiting list. Of these, 70% were

mothers. Children’s ages ranged between 6 and 18,

and 70% of them were boys. All came from middle-

class families residing in cities in central Israel. No

differences were found in demographic characteristics

between parents in the three conditions.

In addition, there were 42 therapists (ages 31�55):

30 coaches and 12 group therapists. All were

professionals with an educational background in

psychology, social work, school counseling, and

learning disabilities. In addition, they were trained

in the same institute in either group counseling (the

expressive-supportive model) or coaching (same

model), at least for one academic year (56 hours),

and were supervised by experts in group counseling

or coaching every two weeks, throughout the

intervention.

The Interventions

The interventions in both formats followed the

expressive-supportive modality (Shechtman, 2007).

This modality focuses on emotional expressiveness

in a highly supportive climate. In terms of group

counseling they may be characterized as ‘‘affective-

support’’ groups (see Kivlighan & Holmes, 2004, for

the categorization), which is similar to expressive

supportive modality. The counseling groups were

process-oriented, but semi-structured. All groups

followed a structured manual, to permit universality

among group therapists. In each session, a specific

topic was introduced and participants shared their

experiences. Topics included: The meaning of being

a parent of a child with LD; the difficulties of the

child with LD; the dialogue between parent and

child; day-to-day dilemmas within the family; the

parent’s vision of the child’s future; confrontation

with the educational system; the parent as a case

manager; and parents’ advocacy. Individual coaching

followed the same expressive therapy principles. A

strong focus was placed on the exploration of

parents’ emotions regarding their child with LD.

Similar topics came up, but the intervention was

tailored to the specific difficulties of the parent or

child, and more attention was given to analyzing

behavior patterns and guiding parents toward

change. No formal supervision of study therapists

took place; however, we believe that therapists were

adherent to the treatment manual because they were

supervised in a group format in weekly sessions

during the intervention.

Instruments

Parental stress in parent-child interactions was

measured by the Parenting Stress Index (PSI)�short

form (Abidin, 1995).The short form includes 36

items, such as ‘‘I find myself giving up more of my

life to meet my children’s needs than I ever ex-

pected.’’ Responses are given on a 5-point scale

(strongly agree, agree, not sure, disagree, strongly

disagree), with a high score indicating higher levels

of parental stress. Test-retest reliability over a 1-year

interval ranged from .55 to .70, and reported internal

consistency ranged from a� .80 to a�.87 (Abidin,

1995). Validity of the short form was based on a

comparison with the full scale (r ranged from .73 to

.92) (Moran, Pederson, Pettit, &Krupka, 1992).The

scale has been used in Hebrew (e.g., Shechtman &

Gilat, 2005) with reported good internal consistency

(a�.78�.92).

Parental coping was measured by the Coping with

Children’s Negative Emotions Scale (CCNES)

(Fabes, Eisenberg, & Bernzweig, 1990), which

measures parents’ responses to 12 difficult situations

that their child may face (such as being teased by

peers or embarrassing oneself in public). The scale

contains three negative responses (distress, punitive,

minimization; for example: ‘‘I tell my child that if he/

she starts crying, he/she will have to go to his/her

room right away’’), and three positive responses

(encouraging, emotion-focused, and problem fo-

cused, for example: ‘‘I comfort my child and try to

make him/her feel better’’). For each situation,

mothers were asked to rate on a 7-point scale how

likely they would react with a negative or positive

response.

Construct validity has been demonstrated in

several studies: Eisenberg and Fabes (1994) found

associations between parental reactions and chil-

dren’s social competence. Shechtman and

Birani-Nasaraladin (2006) found correlations be-

tween children’s reduced aggression and change in

mothers’ responses (e.g. r�.60 with encourage-

ment). Test-retest reliability ranged from .56

to .83, and internal consistency ranged from

a� .60 to a�.90 (Fabes et al., 1990).

Perceived social support was measured by the

Social Provisions Scale (SPS; Cutrona & Russell,

1987), which examines six components of perceived

support. It consists of 24 items, with four items per

subscale: attachment (emotional support), reassur-

ance of worth (esteem support), social integration

(membership in a group of people with similar

interests and concerns), guidance (information sup-

port), reliable alliance (tangible support), and the

opportunity to provide nurturance (giving support

to others). Examples of items include, "There are

594 M. Danino and Z. Shechtman

people I can depend on to help me if I really need it.’’

‘‘There are people who depend on me for help.’’

Reliability for the total scale is .91 and subscale

reliabilities range from .66 to .76 (Cutrona &

Russell, 1987). The SPS correlates significantly

with measures of social network size, satisfaction

with social network, and attitudes toward support. It

correlates negatively with loneliness and depression

across a range of populations. A Hebrew version of

this scale has been used (Harel, Shechtman, &

Cutrona, 2011) with an internal consistency of

a� .90 for the total score, which was used in the

current study.

Therapeutic bonding was measured by the Work-

ing Alliance Inventory (WAI; Horvath & Greenberg,

1989) which consists of 36 items in three categories:

task, goal, and bonding, with 12 items per category.

Internal consistency ranged from a� .87 to a�.93.

In line with aims of the present study, we used

only the bonding scale, with the therapist and

group members. Sample items include: ‘‘I believe

the therapist cares about my health’’ and ‘‘I don’t

feel comfortable with group members.’’The scale

has been used in a Hebrew version (Toren &

Shechtman, 2011) with an internal consistency of

a�.89 and a�.91 for the therapist and group

members, respectively. Responses were given on a

7-point scale, with higher scores representing higher

bonding.

The Critical Incident Questionnaire (CIQ; Yalom

& Leszcz, 2005) was used to identify the most

important events and meaningful processes for

participants in each type of treatment. The question

is open-ended and reads as follows:

Of the events which occurred in the sessions,

which one do you feel was the most important for

you personally? Describe the event, what actually

took place, the group members involved, and your

own reaction. Why was it important for you? How

was it helpful?

The content has been analyzed with the Group

Counseling Helping Impact Scale (GCHIS)

(Kivlighan, Multon, & Brossart, 1996) in order to

capture the therapeutic factors in the therapy pro-

cess. The original scale is composed of 28 items in

four components: emotional awareness-insight;

relationships-climate; other- versus self-focus; and

problem definition-change. A fifth component* self-disclosure*was added in the present study.

Each critical incident was assigned by two indepen-

dent raters, to one or more of the five categories. Full

inter-rater agreement (for all five components) was

achieved for 77% of the cases; in the other cases they

agreed on four of these five.

Procedure

‘‘Nizan’’ is a national institute for children with LD.

In 2008 a decision was made by the staff to provide

help to parents as well. Two groups of professional

workers received a year of training to assist parents in

small groups or in individual coaching. There was no

cross-over of therapists and intervention conditions.

In the second year parents were offered12 weekly

sessions in one of the methods of assistance.

Individual coaching was 1 hour long and group

sessions were 2 hours long. All sessions were

administered in the evenings. Parents were recruited

through published flyers in the schools and in various

agencies of ‘‘Nizan.’’ Parents who felt a need for

assistance were admitted with no special criteria.

Parents were referred to group intervention when a

group was available in their geographical area. All the

others were referred to individual coaching. Only a

few parents (three) preferred individual coaching

over group; in such case they were referred to the

coaching conditions. In both types of treatment

parents were encouraged to attend as couples;

however, in most cases, only one parent attended

(70% of participants in both treatments; this in-

cludes 10% of single mothers). Attendance rates

were very high, which we attribute to their high need

for assistance and the cost of treatment.

The outcome questionnaires (parental stress and

coping) were administered at three different points

of time: before treatment (following the intake

interview in Nizan), immediately after treatment

(following termination) and 6 months later (when

the participant met again with the group or indivi-

dual coach). Parents on the waiting list completed

the questionnaires at two times only*pre and post.

The process questionnaires (perceived social sup-

port, and therapeutic bonding) were administered

twice (at the third session and at termination) and

the CIQ (therapeutic factors) was administered

once, at termination. All questionnaires were com-

pleted anonymously, but with an identification

symbol (identification number) to permit a compar-

ison between time measurements. Table I presents

the number of participants in the three research

conditions, and return rates of questionnaires.

Table I. Participants in the research conditions and return rates of