Case Example of Task-Centered Approach
Mary is the 34-year-old single parent of a 5-year-old boy. She has been living with her mother since her own divorce three years ago. This is a negative situation because her mother is verbally abusive of Mary and her son, abuses alcohol, and smokes inside the home. In addition, their living space is small, and Mary and her son share a bedroom. Mary’s original goal was to live with her mother for only six months, but whenever she considers moving out she becomes overwhelmed with the prospect of not only finding an appropriate apartment, but finding child care as well, because despite her mother’s abusive behavior, Mary has been relying on her mother for before- and after-school child care while she works. Mary feels trapped but completely powerless to do anything about her situation. During Mary’s intake interview she described her prior counseling experiences, sharing that she quit counseling because whenever she was faced with the prospect of finding an apartment, her fears would snowball into so many fears that she simply couldn’t even bring herself to make the first phone call in search of housing. She ended up feeling embarrassed, as if she were letting the counselor down, and just decided she could not deal with any more failures, so she stopped going to counseling. Mary explained that through- out the past several years her mother has consistently reminded her that she would never make it on her own, that she would surely fail, and that she would end up destroying her life and the life of her son. Her mother also told Mary that if she moved out, and ran out of money, she would not bail Mary out again and would instead force Mary and her son to go to a shelter. Opening the newspaper to look for a rental advertisement resulted in a flood of worries and concerns—some specific and some she could not even put into words. She worried about everything from whether she would know what to say when calling on an apartment, to whether she would be able to support herself and her son. What if she was laid off from her job and could no longer afford her apartment and had to live in a shelter? What if she couldn’t find a babysitter she could afford? What if she found an apartment and got a babysitter, but the babysitter ended up abusing her son worse than her mother did? She read about such things all the time in the newspaper, she reasoned. Or what if she found an apartment, but she had a financial emergency such as her car breaking down, and she started falling behind in her rent and was evicted? She couldn’t fathom the thought of moving out and then having to move back in with her mother again, or worse what if her mother made good on her threat and refused to allow them to move back in with her? Once confronted with this slippery slope of catastrophizing, she would resist even taking the first step toward independence and could not bring herself to even look at rental ads. Mary’s mood became increasingly melancholy over the years, and after years of verbal abuse from her mother, her ex-husband, and now her mother again, she had no confidence in her ability to financially support her own son or even to manage her own life without her mother’s assistance. Mary’s caseworker reassured her that there was absolutely no rush in finding an apartment. In fact, she reminded Mary that she was in charge of her own life and could make the choices she thought were best for her and her son. During the first two sessions, Mary and her caseworker developed realistic goals for her, including securing an apartment when Mary had the funds to ensure financial security. Mary and her caseworker developed a detailed budget and determined that she would need three
months’ salary put away in a savings account to ensure against any realistic financial emer- gencies. By identifying possible obstacles to Mary achieving independence, decisions were made based on facts and realistic risks, not on undefined and generalized fear. Once goals were developed and obstacles identified, Mary and her caseworker agreed on tasks to be accomplished by the following week. Mary’s task for the first week was to look through the newspaper and circle rental advertisements within her price range. She was not to call any of them though, even if she found one that seemed ideal. Mary came in the second week with the newspaper filled with circled apartment ads. Mary and her caseworker spent the first portion of the session discussing how Mary felt while circling these ads. Mary ex- plained that her initial excitement was quickly followed by intense anxiety, but that when she realized she could not call the apartments even if she had wanted to, she calmed down almost immediately. The next portion of the session was spent on determining tasks for the following week. The first task included circling all appropriate ads and calling on two apartments for informational purposes only. Because Mary had a significant amount of anxiety about calling and talking to a stranger, Mary and her caseworker wrote a script and rehearsed it by doing a role-play with her caseworker playing the part of the potential landlord. Mary’s additional task for the week was to talk to her boss seeking reassurance that her employment was secure. Mary returned the following week excited. She called on two apartments and followed the script on the first one, but the second call went so well she did not even need the script. Her discussion with her boss also went well, and he reas- sured her that her job was secure. Mary shared excitedly that her boss was pleased that Mary showed assertiveness in approaching him and offered her an opportunity to attend some training courses so that she could be promoted. For the next three months Mary’s counseling proceeded in a similar fashion with weekly tasks that inched her along slowly enough that she did not become overwhelmed by unreasonable fears, but quickly enough that she gained confidence and courage with each successive step. Mary rented an apart- ment during her fourth month of counseling with three months’ income safely tucked away in a savings account, a promotion with a raise, and reputable and affordable day care.
Perceptual Reframing, Emotional Regulation, Networking, and Advocacy
Another general counseling method includes the reframing of a client’s perception of a situation, emphasizing the importance of viewing various events, relationships, and occurrences from a variety of possible perspectives. For some reason it seems easier for human beings to assume the negative in many situations. Whether considering the intentions of a boyfriend or the prospects of getting a better job, most of us seem to gravitate toward negative assumptions. Many people in the midst of a physical or emotional crisis of any proportion will often resort to taking a somewhat polarized negative stance on an issue and would benefit from assistance in seeing situations and relationships from a different perspective. A client’s perception that life is unfair and nothing good ever happens to her can be encouraged to see life struggles as normal and even good because they promote positive personal growth. Clients who feel shame because they were recently fired from a job they despised can be encouraged to see this
incident as a disguised blessing opening the door to find a career for which they are far better suited.
Additional intervention goals include assisting clients with emotional regulation, teaching them how to sit with their emotions rather than immediately acting on them; developing a better social support network so that they can become emotionally in- dependent and self-reliant; and advocating for clients who are being oppressed, either within their family systems or in society in general.
Cultural Competence and Diversity
Because human service professionals work with such a wide range of people, across vari- ous cultures, socioeconomic levels, coming from varying backgrounds, it is vital that hu- man service education and training be presented in a context of cultural competence and cultural sensitivity. Cultural competence is reflective of a counselor’s ability to work effectively with people of color and minority populations by being sensitive to their needs and recognizing their unique experiences and is a required component of working in the human services field. For instance, the NOHS ethical standards specify the requirements and compe- tencies human service professionals are required to maintain. Spe- cifically, standards 17 through 21 deal with issues related to cultural competence, focusing in particular on anti-discrimination, cultural awareness, self-awareness relating to personal cultural bias, and re- quirements for ongoing training in the field of cultural competence: STATEMENT 17 Human service professionals provide services without discrimi- nation or preference based on age, ethnicity, culture, race, disability, gender, reli- gion, sexual orientation or socioeconomic status.
STATEMENT 18 Human service professionals are knowledgeable about the cultures and communities within which they practice. They are aware of multicul- turalism in society and its impact on the community as well as individuals within the community. They respect individuals and groups, their cultures and beliefs.
STATEMENT 19 Human service professionals are aware of their own cultural backgrounds, beliefs, and values, recognizing the potential for impact on their re- lationships with others.
STATEMENT 20 Human service professionals are aware of sociopolitical is- sues that differentially affect clients from diverse backgrounds.
STATEMENT 21 Human service professionals seek the training, experience, education and supervision necessary to ensure their effectiveness in working with culturally diverse client. (NOHS, 1996)
The human services field is not the only discipline to require cultural training. Rather, most professional organizations require that their mental health professionals obtain cul- tural competency training based upon a foundation of respect for and sensitivity to cul- tural differences and diversity (Conner & Grote, 2008). Yet, cultural competency extends beyond that of ethnic differences. For instance, counselors who undergo cultural com- petency training will learn the importance of remaining sensitive to populations from different income levels, religions, physical and mental capacities, genders, and sexual
Cultural competence is reflective of a counselor’s ability to work effectively with people of color and minority populations by being sensitive to their needs and recognizing their unique experiences.
orientations, as well as races, and as such, will learn the importance of avoiding what is commonly referred to as ethnocentrism—the tendency to perceive one’s own back- ground and associated values as being superior, or more “normal” than others. In recent years, the issue of cultural or multicultural competence has become so important that training protocols have been developed with recommendations that all those who work in the helping fields engage in some form of cultural competency training.
Cultural competence is somewhat of a general term though and is often used syn-
onymously with other terms such as cultural sensitivity. Despite the relatively universal belief among human service and mental health experts that cultural
competence is a vital aspect of practice, very little consensus exists as to what constitutes cultural competency on a practice level (Fortier & Shaw-Taylor, 2000). Although broad themes of respect and sen- sitivity tend to be universally accepted as foundational to cultural competent practice, the concept of cultural competency has tended to remain as an idea or general philosophy that has not yet been op- erationalized in a concrete way. For instance, Cunningham, Foster, and Henggeler (2002) surveyed counselors who considered them- selves culturally competent and found that there was a vast differ- ence in terms of which counseling methods they believed were most effective with culturally diverse clients. This last of consensus among experts on which specific counseling approaches and counselor re- sponses constituted “cultural competence” makes it difficult, if not impossible, to determine what methods will have the greatest likeli- hood of having a positive outcome in counseling a particular ethni- cally diverse client group. Although recent research has attempted
to develop what is called evidence-based practice with regard to cultural competence, to date there remains very little research on what constitutes cultural competent practice.