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Crisis Intervention: Assessment & Practical Strategies
Crisis Intervention: Assessment & Practical Strategies - 10 CEUs

Section 8
Track #8 - Effectively Handling 4 Sociocultural Factors

CEU Question 8 | CEU Answer Booklet | Table of Contents | Crisis
Social Worker CEUs, Psychologist CEs, Counselor CEUs, MFT CEUs

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On the last track, we discussed three factors influencing client equilibrium during crisis resolution.  These three factors are perception of the event, situational supports, and coping mechanisms.

On this track, we will discuss four sociocultural factors that affect therapeutic intervention during a crisis.  These four factors are differing cultural values, class stratification systems, lower socioeconomic groups, and barriers to therapy.

Jim and Pam, both 26, had three small children.  Jim had gone to school until 8th grade, and worked as an unskilled mechanic at the airport.  Pam had completed 9 years of school, and had worked at a garment factory until the birth of their first child.  Jim usually worked 6 or 7 days per week, leaving care of the couple’s children almost entirely to Pam and his mother Phyllis.  When Jim was home, he expected complete deference and obedience from his wife.  If Pam served a meal that Jim did not like, he would angrily throw his food to the floor.  Recently, the couple’s oldest son Michael, age 7, had begun modeling Jim’s displays of dominance. 

Initially, the couple had sought help from their pastor, who referred Jim and Pam to my practice.  Jim was angry and suspicious of me, but after several minutes, reluctantly stated, "I think Pam is going crazy.  Yesterday afternoon, I guess Pam caught our oldest boy, Michael, playing with matches and setting caterpillars on fire behind the house.  She dragged him inside and threatened to burn his arm on the stove.  Apparently Ma walked in then while Michael was screaming.  She grabbed Pam and pushed her arm onto the stove so she could ‘see how it felt’."  In regards to reporting an incident of child abuse, I immediately assessed Pam’s risk of violence.  It was clear from her responses that her threats to harm Michael would not be carried out. 

As you are well aware, sociocultural differences between client and therapist can pose challenges during crisis resolution, especially in regards to how the client perceives the therapist.  As I indicated, Jim’s perception of me as an outsider contributed to his initially hostile and reticent interactional style. 

Therapeutic Intervention During a Crisis - 4 Sociocultural Factors

#1 Differing Cultural Values
A first sociocultural factor that affects therapeutic interventions during a crisis can be differing cultural values.  In the case of Jim and Pam, Jim expected to reign unchallenged in his role as patriarch and breadwinner in the family.  Jim stated, "Pam’s job is to obey me.  She’s my wife.  All she had to do is take care of the kids, the kitchen, and help out at church.  I don’t see what her problem is."

Share on Facebook #2 Class Stratification Systems
A second sociocultural factor that affects therapeutic interventions during a crisis is class stratification systems.   Hollingshead and Redlich conducted extensive research into how members of different social ‘classes’ interact with a traditional therapy structure.  The stratification system they developed grouped potential clients into five categories

Class One in Hollingshead’s terms consists of a community’s business and professional leaders, who have a highly educated background and high income.  Class 5, again using the terms of the study, consisted of the individuals with the lowest educational background, often between 6 and 8 years of education.  Individuals in this category tend to work in unskilled, un-unionized labor for low pay, and live in tenement areas. Individuals in this category tend to be unable to invest time or money in extensive psychotherapy. 

Other barriers may arise from educational backgrounds.  Jim, for example, was limited in his ability to understand psychotherapeutic goals and terminology.  He was highly concrete and direct in his thinking, and not particularly introspective.  Jim stated, "I need help with Pam’s behavior now.  I can’t screw around for six months waiting for this to work."  Clearly, coming to therapy for Jim was a last resort. 

#3 Lower Socioeconomic Groups
In addition to differing cultural values and class stratification systems, a third sociocultural factor that affects therapeutic interventions during a crisis is working with  lower socioeconomic groups.  While class stratification systems may provide a useful model for initially understanding a patient’s situation, I have found it can be dangerous to assume a client falls into all of the class features.  For example, while Jim and Pam were very low income, they had made health care and education for their children a priority.  Both Jim and Pam were very well-versed in the care options available for children of low-income families.

#4 Barriers to Therapy
A fourth sociocultural factor that affects therapeutic interventions during a crisis can be barriers to therapy.  One major barrier to establishing a therapeutic rapport with Jim during his crisis was an essential distrust of authority figures.  Another was fear and anxiety about Pam’s "mental disturbance."  Jim expressed a poor understanding about the normal course and treatment of mental illness or crisis, and feared that his wife was going permanently "crazy."  He feared that this would result in a stigmatization of his entire family that would isolate them from the community.

Share on Facebook Technique: "Immediate Results"
As an immediate crisis intervention for Jim and Pam, I used the "immediate results" technique.  After Jim described the precipitating event that brought them to crisis counseling, I asked to see the burn on Pam’s arm.  I stated to Pam that I would like her to see the doctor so that he could give her an antibiotic prescription, and perhaps a medication to control her anger.  I arranged an immediate medical consultation.  While Pam met with the doctor, I met with Tony. 

This immediate results technique provided the couple with evidence that I was able to provide immediate help.  By presenting a nonjudgemental attitude and acceptance of their behavior in the session, I also established a basis for rapport.  When Pam left the session to see the doctor, Jim was able to drop his initially defensive attitude and show his true concern for Pam and her irrational behavior.

Think of a couple you are currently treating who are in a similar sociocultural situation to Jim and Pam.  What barriers to effective crisis resolution does their situation create?  Would an immediate results technique be useful in establishing  rapport?

On this track, we have discussed four sociocultural factors that affect therapeutic intervention during a crisis.  These four factors are differing cultural values, class stratification systems, lower socioeconomic groups, and barriers to therapy.

On the next track, we will discuss four important concepts in the treatment of a cases of crisis precipitated by a sudden status change.  These four concepts are understanding social roles, assessment, intervention techniques, and anticipatory planning.

Online Continuing Education QUESTION 8
What are four sociocultural factors that affect therapeutic intervention during a crisis? To select and enter your answer go to CEU Answer Booklet.

 
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