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In the last section, we discussed three factors influencing client equilibrium during crisis resolution. These three factors are perception of the event, situational supports, and coping mechanisms.
In this section, 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.
#1 Differing Cultural Values
♦ #2 Class Stratification Systems
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
#4 Barriers to Therapy
♦ Technique: "Immediate Results"
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?
In this section, 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.
In the next section, 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.