Define resilience from a contemporary developmental systems perspective
Resilience: The capacity of a system to adapt successfully to challenges that threaten system function, survival, or development.
Current times are challenging
Threat from disasters (war, natural disasters, etc.)
Lifelong effects of early adversity
We know more about biological causes, effects of trauma
World War II: study of resilience rooted here
Norman Garmezy, Emmy Werner, Michael Rutter: pioneers of resilience science around 1970
Many of the kids they followed who had shared risk factors were growing up successfully or surprising people w/recovery
Need to understand underlying processes of good outcomes w/adversity
Since WWII, we have developed better ways of measuring stress & advanced our statistics
3 defining questions about resilience
What are the challenges?
Threats: trauma, neglect, poverty, war, natural disaster, ACEs
What fosters adaptive success? How do we explain how well a person is doing in a maladaptive environment?
Promoters/Protections: neurobiological, individual, family & relational, community, cultural, societal
How is the person doing?
Adaptive success: Developmental tasks, mental health, physical health, happiness, school or job achievement, caregiving
Varies based on culture
The current definition
"The capacity of a system to adapt successfully to challenges that threaten system function, survival, or development" (same as given above)
Developmental science definition
Can talk about resilience of child, family, economy, community, climate (planet as a whole) using this definition
Development is dynamic, influenced constantly by experiences, lots of interactions that shape development (from genetic to molecular to environment)
Resilience of the family is important to resilience of child; resilience of family depends on environmental supports, etc.
So many different systems that interact, within and without (embedded, interacting, interdependent)
Resilience always changing, depends on interaction of many other systems
Resilience globally will depend on that of children, families, communities; growing in importance as rise of natural disasters, threats
Identify salient evidence-based protective processes for children and families
Developmental cascades: impact in one system spreads to other systems
Both negative and positive examples
High licking behavior in rats alter genes in anxious rats
Family resilience: regulatory purpose
Parenting resilience: capacity of parents to deliver competent parenting despite adversity
Good family functioning mitigates risk of adolescent health problems, psychological well-being
Executive function skills
Schools can be a huge protective factor
Efficacy, skill building, accomplishment
Basic needs: food
Positive adult role models
Communities matter
Support they provide for families
Education, recreation, healthcare
Some have virtually no resources for children and families and others have lots
Other protective systems
Within the individual: immune, arousal regulation, stress regulation
Religion and cultural systems
Provide meaning-making systems of belief, rituals and rules, ceremonies, practices to help cope
Meditation processes (mindfulness, etc.)
Improve outcomes for kids
Reduce risk exposure: prevent premature birth, homelessness, put positive resources into the lives of kids and families (asset resources), quality early childcare
Practitioners play many roles in development and nurturing of resilience
Promoting school success in children from high-risk homeless and highly mobile families
Interventions more successful if stakeholders help with design process
Describe new directions of research on resilience in children, families, and communities
Masten et al. 2016 figure demonstrates possible resilience patterns following trauma (post-traumatic growth)
Some people galvanized by trauma
Delayed breakdown (depletion model)
Annette LaGreca 1992 post hurricane Andrew
3 patterns in kids: doing well, improving (recovering), chronically affected
We don’t know how they were doing before hurricane (problem in disaster research)- can’t see clinically significant change
Luo et al. 2012, earthquake in 2008, started PTSD study afterward in young Chinese girls; could see levels of cortisol before and after earthquake
Some people starting to use baby teeth too
Chronic adversity shows different pathways than trauma
Child soldiers, orphanages, maltreatment
Don’t expect resilience, look for it when conditions improve (b/c most kids are overwhelmed)
Gradual deterioration
Rescued child soldiers: some stayed stable, some deteriorated over time (Betancourt et al 2018)
Osofsky et al 2015: Katrina and BP oil spill trajectory analyses looking at PTSD symptoms over time
Intriguing questions
Are there hidden skills? When kids adjust to stress, they may exhibit poorly in school but adaptive in neighborhood
Is there a price for resilience? It can take a toll biologically. Lots of work to be done still
More attention to leveraging power of integrated systems (family, school, peers; pulling resources across levels and sectors)
Resources by Ann Masten
Book on resilience
Masten, A. S. (2014). Ordinary magic: Resilience in development. New York: Guilford Press. Paperback (2015) Available through Amazon and Guilford for about $25. Opening chapter free at Guilford Press.
Masten, A. S., & Barnes, A. J. (2018). Resilience in children: Developmental perspectives. Children, 5, 98. doi:10.3390/children5070098
Masten, A. S. (2014). Global perspectives on resilience in children and youth. Child Development, 85, 6-20. doi:10.1111/cdev.12205
Southwick, S. M., Bonanno, G. A., Masten, A. S., ...(2014). Resilience definitions theory, and challenges: Interdisciplinary perspectives. European Journal of Psychotraumatology, 5, 25338 (1-14). doi:10.3402/ejpt.v5.25338
Encyclopedia on Early Childhood Development ~ section on resilience
Risk and resilience in homeless families – overviews of 25 years of research
Masten, A. S. et al., (2015). Educating homeless and highly mobile students: Implications of research on risk and resilience. School Psychology Review, 2015, 44, 315-330.
1.Participants will be able to name characteristics of mass violent events that impact the long-term recovery and healing of communities.
Needs to be a connection, interplay between those who do the research and those who do the community work
Are we touching all systems? Pediatric, schools, military, child welfare, DOD, disaster care
20 school shootings in past year vs. 105; not fake news, it’s because there’s not a universal definition of what we mean by mass violence
Casualties can mean injured or dead
Operationalization is important!
Information to gather prior to responding to an event:
Learn about the community (e.g., previous adverse events; in one community experiencing a mass shooting, many residents had moved there b/c of Hurricane Harvey)
All of this influences how we intervene, what support we provide (even things like is graduation or prom coming up?)
Think about magnitude; how has it influenced community? Certain populations targeted? How many people were affected?
Sandy Hook: had to bring in previous principal who had retired b/c principal who had been killed, had to support hierarchy
Temporary building, felt displaced while they built new building
San Bernardino: Dept. of Public Health; peer of workers, not an outsider; led to a lot of mistrust; had to change everything the perpetrator had signed (permits throughout the community), emails he sent, etc.
What is going to influence/change how the community reacts?
Vegas Shooting: 62% of ticket holders were from California; just as much a CA disaster as a NV disaster
Does recovery happen where it occurred or do we have a larger scope? (e.g., Boston bombing, thinking about all the different areas and making sure support was provided)
How do we adapt based on circumstances?
Different elements to take into account
Dose of exposure
Who was in life threat or had most exposure and how to help them (those in classroom in Sandy Hook; several kids who ran out when he was reloading had a lot of exposure; sounds projected over intercom, so others could hear too)
Traditional first responders but also others; taxi drivers, etc. Need to make sure EVERYONE who is witness has to get support
Secondary adversities
People call and put in threats on anniversaries, etc.
2. Participants will be able to describe the 5 key empirically-supported trauma intervention principles.
Intervention Strategies
“Once I was very very scared”- a book using animals to explain coping strategies, etc. Good for working with kids who have experienced trauma
Identify people who need to expand network for different types of supports
Tap them into community resources
Attending to the Injured
Make sure people are getting proper supports, rehab
Use evidence-based treatments
Psychological first-aid is an acute intervention in immediate aftermath
Different translations: schools, faith-based, victim advocates
8 core actions; not fixed, flexible depending on where person is at. May need to help with basic needs, may only need to help with coping and resource support
Mobile app (PFA mobile)- goes into 8 core actions. Talks about provider care
Attendees will learn about the three main types of cultural empirical research
Individualistic model
Focus is on the patient and treatment goals relate to improving the individual
e.g., increasing self-esteem, self-efficacy, etc.
Treatment does not focus on the cultural context
These therapies are based on a great deal of evidence that shows their efficacy, and these types of therapies have indeed helped many people
While the extant evidence base was built mostly on homogeneous samples, the empirically-supported treatment movement includes race and ethnicity as an important area of focus
Evidence shows that these factors make a difference
e.g., Sue (1997) looked at outcome data in California to assess how many ethnic minorities would return to a second therapy appointment and found that only 50% would (in contrast, white clients with white clinicians returned at a rate of 80%)
The cultural competence model grew out of this type of work
This work also highlighted the dearth of mental health providers compared to the extant need in communities
Relational Psychotherapies
Relational psychotherapy recognizes that therapy is a process between the patent and the therapist
The relationship plays a role in the therapy outcomes
e.g., in making decisions
This has been shown with some research
Quantitative methods are often used in this work to identify the ways that the therapeutic relationship predicts outcomes
Within this framework, culture is defined more broadly (not just race and ethnicity)
It is considered part of how you make sense of the world
This point is an important innovation over the individualistic model, as it allows us to refine the research on cultural competence
It raises important issues for assessing how people make sense of their race/culture
This is helpful for, among other things, combating stereotypes
It emphasizes the importance of asking people how they make sense of their own culture
One of the most important meanings that a person makes is self-orientation
This is part of how we make sense of the world
One of most studied cultural variables has two dimensions:
Individualism vs. egocentrism
Collectivism vs. allocentrism
These facets are not mutually exclusive, and they tend to break down along racial lines
e.g., Asians and Latinxs have more allocentric tendencies, whereas white and African American people tend to be more egocentric
One study found differences in the effectiveness of a relaxation training exercise based on allocentric/egocentric framing
The level of allocentrism in participants predicted the effectiveness of the relational intervention
Takeaway message: making the intervention more culturally specific makes a difference in terms of symptoms and service utilization
Critically, this is not just about skin color but more importantly it concerns the way people see the world
When we give people what they want (something that accords with their self-view) they come to treatment and get better
Contextual Psychotherapies
Guiding principle: the meanings we make only make sense in context
We cannot understand the meanings of our behaviors without understanding the contexts in which they are embedded
There have been a few big-data studies to support this idea
e.g., people are often motivated to make choices (voting, buying, etc.) not because of their beliefs, but because of the people with whom they interact
I.e., context has an influence on what we do
Community is an important factor for understanding behaviors
New studies are including measures of SES, but another thing to consider is implicit processes
Implicit Processes: things we do that we're not aware of
Many of our experiences in society are implicit
E.g., knowing how we should behave, how to interact with others
We are often on auto-pilot when engaging with the world
Some of the scripts for auto-pilot are based on relevant cultural assumptions
This can lead to problems or miscommunication
E.g., a therapist may assume that a client leaning in closer to them indicates borderline personality disorder, whereas it could equally be a cultural trait
Measures like the Implicit Association Task are designed to measure the implicit processes that guide our assumptions about the world
See also: micro-aggressions (Sue et al., 2019); stereotype threat (Steele and Aronson, 1995)
Ethnic minorities report more trauma, partly because of continued assaults on their worldview
Implications
Clinicians should include implicit assessments in studies of psychotherapy
Attendees will learn about Cultural Psychotherapy’s basic assumptions and characteristics
Fundamental tenet: we all have a culture
Culture is not solely the domain of minority groups
Culture has an effect on all interactions, including psychotherapy
It is important to examine the impact that culture has on our lives
People who recognize their own culture may be more open to others'
Culture is central
It is part of our internal identities and how we relate to one another
Global cultural psychotherapy is an approach that benefits from many different therapeutic approaches and evidence bases
We should understand the cultural context underlying differential responses on our measures
This would capture people more holistically so that they feel heard and continue to engage in therapy
This approach complements existing evidence-based therapies
It means paying attention to both individual features and features of a person's culture
It involves being mindful of the evidence base and also cultural factors
Culturally-adapative interventions have been shown to be effective
Recent meta-analyses show that including relevant cultural measures (like assessing level of discrimination) can improve outcomes of interventions
The more variables we have, the better we can match people to interventions
It is important to recognize that many of our samples are from the US
We should start to include information from other parts of the world
Differences can be enriching: understanding cultural biases helps clinicians work with broad populations
Not just those with which a person has particular experience
Being sensitive to cultural backgrounds means measuring individual characteristics and adapting treatment accordingly
Attendees will learn the three-phase therapeutic model of cultural psychotherapy
'Overview
The three phase model integrates interventions to the client's context
Phase 1: Address basic needs and client goals
Focus on symptom reduction and safety
This follows the individualistic paradigm
This phase rests on the evidence-based approaches as much as possible
Phase 2: Understand the client's experiences through the therapeutic relationship
This only happens after you already formed the foundation of the relationship
This phase is highly influenced by the relational paradigm
Phase 3: foster empowerment
This phase utilizes the contextual and ecological paradigm
Rationale: it is sometimes not enough to just address symptoms and improve relationships
It can be important to help children change unjust environments, e.g., by helping reduce levels of violence in their communities
Characteristics of the three phase model
Phase 1 addresses treatment goals and ensure safety
Gets at what the client came in the door looking for
Focus on reducing symptoms as quickly as possible
Also address basic needs through other systems
e.g., food, shelter
This improves retention and also helps the therapist learn how the person solves problems and copes with basic issues
Basic strategies
The most important skill is to listen to the person's chief complaint
Make sure that what they ask for is what is given first of all
Teaching basic skills for managing affect and communicating effectively
Phase 2 address understanding a person's experiences in more detail
This involves listening to the client to understand how they see the world
This cannot happen if a person doesn't have effective affect-regulation strategies
Otherwise, the client might resort to negative communication strategies
Phase 2 involves understanding a person's experiences
e.g., poverty, violence, etc.
This requires having a safe and trusting relationship between the therapist and client
A key to knowing you are in the second phase is that the client is adapting aspects of the therapeutic relationship to other parts of their lives
e.g., with parents, teachers, other members of the community
This trust opens up opportunities to explore topics more effectively, such as race and cultural issues
The client needs to have the skills to disagree with the therapist, otherwise there is a risk of the therapist imposing their worldview
Phase 3: Once the therapeutic relationship is developed, clients can start feeling empowered
Through this, psychotherapy can have an impact on improving communities
To do this, clients and therapists must be interested and able to talk about this in the context of therapy
Often, therapists are not trained to talk about community issues
However, it can be important to understand contextual threats, such as gang violence and other conflicts
These factors impact how children see the world and therefore have an impact on their sticking with therapy
The empowerment phase is like an awakening to making change and engaging with social justice
Many people don't realize that this is an important thing at first, but through therapy they explore these issues and ultimately land on a desire to change them
The timing of these phases is important because each phase builds on the previous one in terms of skills and awareness
Cultural Psychotherapy’s basic assumptions and characteristics and how to translate these characteristics into specific psychotherapeutic interventions
Global and Cultural Psychotherapy (GCP) aims to complement current psychotherapeutic approaches by embedding these into a cultural and global context.
GCP is an integrative approach that benefits from different psychotherapies and evidence.
Not only ethnic minorities have a culture: We all have a culture.
Methodologically, this means that we can not assume psychological characteristics because of race and ethnicity; it is necessary to measure more proximal characteristics (e.g., experiences of discrimination, self-orientation, ethnic identity). Race and ethnicity alone are not sufficient to predict psychological attributes.
GCP emphasizes the importance of culture throughout all the phases of the development of a theory or research project and the psychotherapeutic process.
GCP underscores distinct conceptual, research and methodological strategies.
Psychotherapy is embedded in global contexts
Global and Cultural Psychotherapy proposes a three–phased model that is a systematic set of conceptualizations and interventions that are beneficial at distinct therapeutic times.
GCP=Individual factors x relational factors x contextual factors
The basic goals, characteristics and requirements of each of the three-phases of Cultural Psychotherapy as illustrated through a clinical example
Phases of Cultural Psychotherapy
Phase 1: Address basic needs/goals and symptom reduction [Individual]
The length of this phase varies greatly depending on the individual
Explicit Systems (increasing coping strategies) are emphasized
Targets affect regulation and flexibility
Individualistic Paradigm and Evidence-Based strategies
Phase 2: Understand patients experience through the therapeutic relationship [Relational Paradigm]
Implicit systems (relational procedural assumptions) are emphasized
Targets relational skills
Phase 3: Foster empowerment [Contextual and Ecological Paradigm]
Targets enhanced empowerment
Emphasizes contextual or ecological change
Characteristics of the Three-Phased Global and Cultural Psychotherapeutic Model
Phases are used because each has specific requirements. A pt needs to have met some requirements to be dealing with certain issues.However, once all requirements are met phases do not occur in linear, stepwise fashion, but are often overlapped and experienced in cycles
The clinical recommendations of each phase are not rigid or exhaustive, they are designed to be heuristic tools
This model is highly influenced by three phased models
Participants need to pass through 3 phases to accomplish some level of empowerment although some participants may be more ready than others to do so
Clinical Strategies for Each Phase
Phase I:
Safety and basic needs are always a priority
Patients’ chief complaints are understood in a culturally sensitive manner [1]
Conduct cultural assessments and diagnosis
Address cultural and demographic differences
Learn and use patients language and patients formulation [2]
Use evidenced based psychotherapies
Use indigenous healing practices to address symptoms
Enhance affect regulation and psychological flexibility
Encourage culturally-sensitive lifestyle changes
Phase II: Prerequisites
No recent psychological crises, optimal levels of affect regulation, a safe and trusting psychotherapeutic relationship.
Phase II:
Start by exploring patients’ lives not only their problems
Examine the complex and changing nature of meanings
Explore and expand meanings
The psychotherapeutic relationship is a reflection of larger macro-social process in which power dynamics are played-out
Address the cultural influences affecting the psychotherapeutic relationship
Ruptures/mistakes are inevitable
Use patients renewed sense of vitality
Phase III:
Prerequisites: Know and be interested in understanding our cultural context
Meanings of symptoms are often culturally dependent
Link contextual influences to patient’s life
Culturally differences are assets
Awaken to social justice
Embrace multiple stories
Restore connections and encourage new ones
Talking is not enough: Action is necessary
Understand that what is local is global
Cope with termination issues
Specific Cultural Psychotherapy skills through a clinical vignette provided by the presenter
Case Study: An Anti-Violence T-Shirt Campaign
A group of adolescents led by one of La Roche’s students who was Japanese American. The group of adolescents consisted of three Latino and three African American boys. Their initial goal was to enhance communication, but as the group progressed they changed goals based on what they wanted to change. The group of adolescent boys decided to be an anti-violence group and created T-shirts to support their anti-violence stats.
Phase I:
Safety was one of the main priorities
Discussion of cultural and demographic differences in the group, so the individuals would feel comfortable mentioning and further addressing these cultural differences.
Psychoeducation in this phase is incredibly important
Phase II:
The phase where it begins to be more “we” than “I”
Rules and regulations needs to be put in place and enforced, so that no one gets hurt
Boundaries and objectivity is important in this phase because we can make more mistakes here
Phase III:
Be aware of what is happening in the community - the patients want to know the cultural context
See cultural differences as aspects, which takes a long time
Group leader/clinician should do it with patient(s), feel it with them
Group started realizing they need to be more open to social justice
