Case Study Assignment

Case Study Assignment

Page 1

PSY105 CASE STUDY

Type Your Name Here

Introduction to Psychology
April 3, 2019

Given what you have learned in Chapter 3 about brain development and social development, explain why Gloria’s son is making poor decisions. (Use page 3.4 for brain development and page 3.6 for social development).

What specific strategies can Gloria use to help her son make better decisions? (Hint: pages 3.7 and 3.17 have resources to help)

From what you have learned about human development and self-regulation, why do you think these strategies will be effective?

(Hint – based on what you offered as a suggestion in question 2, why would that strategy help Gloria’s son)

How does Reggie’s mindset affect the way that he prepares for the compliance test? (Hint: page 7.6 will help you learn about mindset)

 

Use brain plasticity (neuroplasticity) to explain how Reggie can start to develop a growth mindset. What can Reggie do to actually change his brain so that he can adopt a growth mindset approach? (Hint: page 7.6 will be a great resource for this question)

Suggest at least three study strategies that Reggie can use to study for the compliance test. Based on what you have learned about memory in Chapter 4, explain why these would be effective study techniques. (Hint: page 4.15 has suggestions to improve your memory)

What are the big five personality traits? When thinking about the big five personality traits, on which ones do Gloria and Lakeisha differ the most? (Hint: page 3.12 helps you learn about the big five traits)

Give some advice to Gloria. How can she use emotional regulation to work more effectively with Lakeisha? Give at least two things that Gloria can do and provide a rationale for why these will be effective. (Hint: Pages 6.4 and 6.11 have resources to help with this question)

References

Myers, D. (2017). Psychology (4th ed.). Asheville, NC: Soomo Learning. Available from hMp://www.webtexts.com

Case Study Assignment Template Note: Please use this template to complete the Case Study Assignment (due in Week 7). All you need to do is write a paragraph within each box contained in the template to receive credit for this assignment.

 

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Case Study Assignment Overview

Case Study Section 1 Review

Case Study Section 2 Review

Case Study Section 3 Review

 

_________________

 

Gloria has recently graduated college and started a new job. Her coworkers seem very nice, and Gloria has gotten to know Lakeisha and Reggie the best.

Reggie is a friendly older man who often talks about his plans for retirement in five years. He likes to make people laugh but often jokes about his struggles to learn new programs and technology.

Gloria and Lakeisha have been assigned to work on a project together. Lakeisha is very organized and has prepared a list of to-do items along with due dates. She even color-coded the list to indicate which partner will do each item. Gloria, who is more laid-back, feels a bit uncomfortable with this micromanaging from Lakeisha, who has only been at the job a few months longer than she has. Gloria wonders if Lakeisha thinks she is either lazy or stupid, and she does not look forward to working on this project. In the past, Gloria attempted to communicate her feelings with a co-worker; however, her coworker told Gloria that she needed to put her feelings aside and just do the work assigned to her. As Gloria ponders having a conversation with Lakeisha, she starts to feel overwhelmed and thinks she might have to ask to be removed from this project.

Still, she and Lakeisha have connected because they are both single mothers of teenagers. Gloria confides in Lakeisha about her 16-year-old son who has started making poor choices and is currently grounded for sneaking out of the house and getting drunk at a party the night before a big exam.

The company recently informed the team that there will be a compliance test on new safety policies, which employees will need to pass in order to keep their jobs. The company has provided materials to study as well as optional practice exams. Gloria and Lakeisha have signed up to take the first practice test. Reggie, however, jokes that he will probably wait until the night before the test to read the material. As the date of the test approaches, Reggie becomes increasingly nervous. He makes frequent comments about how hard it is for him to learn a different way of doing the jobs that he has been doing for years, joking that “you can’t teach an old man new tricks.”

1. Gloria’s son is making poor decisions. Given what you have learned about a) brain development and b) social development in Chapter 3:
Explain why Gloria’s son is making those poor decisions.
Discuss specific strategies Gloria can implement to help her son make better choices.
Use specific concepts related to development and self-regulation to explain why these strategies would be effective.
2. Reggie is demonstrating a fixed mindset. How is Reggie’s mindset affecting the way he prepares for the new compliance test?
Use brain plasticity (neuroplasticity) to explain how Reggie can start to develop a growth mindset.
Suggest study strategies for Reggie so that he will be prepared for the compliance test. Use specific concepts from Chapter 4 to explain why these strategies will be effective.
3. Consider Gloria and Lakeisha’s different approaches to the project. On which of the Big 5 personality traits do they most differ?
Give advice to Gloria on how she can use emotional regulation and cognitive reappraisal to work with Lakeisha.

 
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Psychology homework help

Psychology homework help

I need only 4 simple pages without any out resources USE JUST THE FILE ATTACHED AND THE LINK AT THE BOTTOM. **With the verb (I). I will attach  Pamela Hays’ Addressing Model and the first part that I did about myself.

The name of this class is Culture and Gender in Counseling and Psychotherapy

The paper has to be divided into two parts. The first part I did in the first half of the semester, and the second part is due now.

It is a self-assessment. The first part was about my self-identity. The second part is:

The second section is due in Week 11 and should be 4-6 pages in APA style. This section is to include a self-assessment using Pamela Hays’ Addressing Model discussed in class, along with reflections on changes or new awareness that have emerged as a result of the course. In other words, reflect on Part 1. You are to turn in the graded copy of Part 1 along with Part 2.

……………………………………………………………………………………………………..

Here, the professor said:

C) Self-Assessment.  This paper has two parts. The first section will be a follow-up to in-class activities presented in Weeks 1 and 2.  For this assignment, you will reflect on your cultural identity.  Honesty is expected and will not be penalized; however, a respectful tone is required.  The first section should be 2-3 pages in APA style and be an honest assessment of your cultural identity and how you see yourself at the start of this class. We will do a few in-class exercises during the first two weeks to support this process. The second section is due in Week 11 and should be 4-6 pages in APA style. This section is to include a self-assessment using Pamela Hays’ Addressing Model discussed in class, along with reflections on changes or new awareness that have emerged as a result of the course. In other words, reflect on Part 1.

The following are questions to consider in the completion of this assignment:

a) Which one of these identities (from the ADDRESSING model) do you find to be most salient? Why? Which is least salient? Why?

b) What does it mean to you (and to American society as a whole) to be part of this group?

c) What are some of your recollections about interactions and experiences that have significantly impacted your cultural identity development as part of this group?  Have your feelings changed or stayed the same about being part of this group?

d) Have you contributed to discrimination or oppression as part of this group?  Have you been a victim of discrimination or oppression as part of this group?

e) What messages have you received (directly or indirectly) about people who share your identity and people who do not share your identity?

f) What are some skills you have learned in this class that you can use when working with individuals from diverse groups?

g) Have your views changed since taking this class?  If so, how?  What are some areas you still need to work on?

The link for Pamela Hay’s

https://ltc.highline.edu/cce/Addressing%20Complexities%20in%20Counseling%20(ADRESSING%20model)-%20Hays.pdf

 

 

Running head: SELF-ASSESSMENT 1

SELF-ASSESSMENT 2

 

Self-Assessment Part1

 

Self-Assessment Part1

Everyone has different cultural identity. Each of them has their owns’ cultures, behavior, ethics, religions, languages, education, social..etc. People are different in the whole world. They cannot be similar, but they can respect each other. In this essay, I will reflect my cultural identity.

I am from Saudi Arabia, and we have our behavior that connect with our religion and habits. For example, all of my family members live together at the same house. The daughter or the son cannot live in separate home until they get married. That means, they can move to another house when they want to get married. That because of my religion, which prevents intimacy between any couple without marriage.

Furthermore, in my culture, women cannot drive a car. This related to our habits cultures. Men think that is dangers for woman to drive by herself. They believe that is a part from their responsibility. I do not agree with them, however, I respect their opinions. Thus, women having hard time moving inside the city especially we do not have good transportation.

As a Muslims woman, I grow up in a conservative family. For example, I and other females in my family wear hijab, which is a scarf on our head with long and wide dress. In addition, we do not shake hand with other gender. Sometimes this put me in embarrassing situation with people who are from different cultures. We like our religion and respect other religions and beliefs.

I grow up in a big lovely family, which I have seven siblings. They are five sweet sisters, and two great brothers. I really appreciate my parents’ fatigue. They support all of us and they did their best to make us good people. Therefore, we have strong communication between each other and all of us complete our education until Bachelor’s degree or higher.

My parents give me the power to have a family too. I marry in early age, which I was only 18 years old. In my culture, this is normal age to get married for girls, but it is very young and up normal for other cultures. Men in my culture can get married as soon as they have a job. I got my decision to be marry for my husband when I was in high school. Now, I am so happy and proud to be a mother for two beautiful children, and a wife for an awesome husband.

Schools and universities in Saudi Arabia are very different form the United States. For example, form first grade to university students study in separate schools for each grander. That means males and females study in divided building, and that do not happened in the United States, which student with different gender study together. This difference come by cultures behaviors.

My language is Arabic, and it is a basic language in the Middle East. Recently, I learned English language as a second language after I decided to study my master degree in the United States. I got intensified English classes for one year and half. That because the fact that my county gives me the opportunity to study here after I took a high grade in my under gradate.

Therefore, I am a graduate student in Chestnut Hill College. I am proud that I achieve part of my dreams, which was to study Psychology in under graduate, and Clinical and Counseling in my graduate; however, many people around me tried to change my mind in choosing this major. Unfortunately, they think is a major that take for madness. I did not hear for them because of my desire to help people getting better life.

In spite the fact that I am shy in making friendship, I am a social person and I like to have many friends. I am always interesting for having friends, but it is difficult for me to have a friend from different gender. In my culture, it is fine for females to work with males, but it should not be friendship.

 
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Psychology homework help

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MILT 375

 

APA Format Paper Instructions

 

This assignment will prepare you for developing well-written and formatted papers for this course, and others in which you use APA formatting. The paper is to be 4 pages that demonstrate your ability and understanding of APA format and writing style.

 

The paper will consist of:

 

1. A Title/Cover Page: This page of the assignment will have your running head and page number, your title of the assignment, your name, and specific information necessary for any APA research paper. Make sure this page and every page is formatted with correct spacing, content positioning, type font, size of font, etc.

 

2. Abstract Page: Write this abstract as the one you would write for your Needs Assessment paper. It is very important that you read the APA manual to understand what an abstract is supposed to be. Make sure it is in the correct tense and correct format. You will not be able to give your reader your final findings as indicated in number 3 in the instructions for the Needs Assessment paper, yet you can write the rest of the abstract with a fair amount of accuracy. Remember, this paper is an “exercise” to get a head start, demonstrate your ability to develop a good APA formatted paper, and receive feedback on this before you submit the other 2 writing assignments for the course.

 

3. Paper Body Page: This page will consist of 2 basic components. The first will be a brief introduction paragraph. Introduce the Needs Assessment Paper. Even though you have not done a lot of reading or research yet, this should be fairly easy to do. The second component is a correctly formatted demonstration of all 5 APA level headings. You will need to use each heading with a single sentence telling your instructor which level it is. See the example of the first heading below.

 

Level 1 heading

 

A level 1 heading is bold face font, centered and uses upper and lower case font.

 

4. Reference Page: Use your page 4 to demonstrate your ability to cite references correctly. You will need to format the page while citing a website/internet article, a research article, book, the Bible, and an eBook. Use care to make sure all spacing, capitals, abbreviations, etc. are done according to APA.

 

Submit this assignment by 11:59 p.m. (ET) on Monday of Module/Week 3.

 
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Psychology Theoretical Analysis homework help

Psychology Theoretical Analysis homework help

Ethical and Professional Issues in Group Practice

Those who seek to be professional group leaders must be willing to examine both their ethical standards and their level of competence. Among the ethical issues treated in this chapter are the rights of group members, including informed consent and confidentiality; the psychological risks of groups; personal relationships with clients; socializing among members; the impact of the group leader’s values; addressing spiritual and religious values of group members; working effectively and ethically with diverse clients; and the uses and misuses of group techniques. In my opinion, a central ethical issue in group work pertains to the group leader’s competence. Special attention is given to ways of determining competence, professional training standards, and adjuncts to academic preparation of group counselors. Also highlighted are ethical issues involved in training group workers. The final section outlines issues of legal liability and malpractice.

As a responsible group practitioner, you are challenged to clarify your thinking about the ethical and professional issues discussed in this chapter. Although you are obligated to be familiar with, and bound by, the ethics codes of your professional organization, many of these codes offer only general guidelines. You will need to learn how to make ethical decisions in practical situations. The ethics codes provide a general framework from which to operate, but you must apply these principles to concrete cases. The Association for Specialists in Group Work’s (2008) “Best Practice Guidelines” is reproduced in the Student Manual that accompanies this textbook. You may want to refer to these guidelines often, especially as you study Chapters 1 through 5.

The Rights of Group Participants

My experience has taught me that those who enter groups are frequently unaware both of their basic rights as participants and of their responsibilities. As a group leader, you are responsible for helping prospective members understand what their rights and responsibilities are. This section offers a detailed discussion of these issues.

A Basic Right: Informed Consent

If basic information about the group is discussed at the initial session, the participants are likely to be far more cooperative and active. A leader who does this as a matter of policy demonstrates honesty and respect for group members and fosters the trust necessary for members to be open and active. Such a leader has obtained the informed consent of the participants.

Informed consent is a process that begins with presenting basic information about group treatment to potential group members to enable them to make better decisions about whether or not to enter and how to participate in a group (Fallon, 2006). Members have a right to receive basic information before joining a group, and they have a right to expect certain other information during the course of the group. Discussing informed consent is not a one-time event, and clients should understand at the outset that informed consent is an ongoing process.

It is a good policy to provide a professional disclosure statement to group members that includes written information on a variety of topics pertaining to the nature of the group, including therapists’ qualifications, techniques often used in the group, the rights and obligations of group members, and the risks and benefits of participating in the group. Other information that potential members should have includes alternatives to group treatment; policies regarding appointments, fees, and insurance; and the nature and limitations of confidentiality in a group. Group leaders should not overwhelm members with too much information at one time because an overly lengthy informed consent process may replace a collaborative working relationship with a legalistic framework, which is not in the best interests of group members (Fallon, 2006).

Pregroup Disclosures Here is a list of what group participants have a right to expect before they make the decision to join a group:

• A clear statement regarding the purpose of the group

• A description of the group format, procedures, and ground rules

• An initial interview to determine whether this particular group with this particular leader is at this time appropriate to their needs

• An opportunity to seek information about the group, to pose questions, and to explore concerns

• A discussion of ways the group process may or may not be congruent with the cultural beliefs and values of group members

• A statement describing the education, training, and qualifications of the group leader

• Information concerning fees and expenses including fees for a follow-up session, should there be one; also, information about length of the group, frequency and duration of meetings, group goals, and techniques being employed

• Information about the psychological risks involved in participating in a group

• Knowledge of the circumstances in which confidentiality must be broken because of legal, ethical, or professional reasons

• Clarification of what services can and cannot be provided within the group

• Help from the group leader in developing personal goals

• A clear understanding of the division of responsibility between leader and participants

• A discussion of the rights and responsibilities of group members

Clients’ Rights During the Group Here is a list of what members have a right to expect during the course of the group:

• Guidance concerning what is expected of them

• Notice of any research involving the group and of any audio- or videotaping of group sessions

• Assistance from the group leader in translating group learning into action in everyday life

• Opportunities to discuss what one has learned in the group and to bring some closure to the group experience so participants are not left with unnecessary unfinished business

• A consultation with the group leader should a crisis arise as a direct result of participation in the group, or a referral to other sources of help if further help is not available from the group leader

• The exercise of reasonable safeguards on the leader’s part to minimize the potential risks of the group; respect for member privacy with regard to what the person will reveal as well as to the degree of disclosure

• Observance of confidentiality on the part of the leader and other group members

• Freedom from having values imposed by the leader or other members

• The right to be treated as an individual and accorded dignity and respect

It is critical that group leaders stress that participation in groups carries certain responsibilities as well as rights. These responsibilities include attending regularly, being prompt, taking risks, being willing to talk about oneself, giving others feedback, maintaining confidentiality, and defining one’s personal goals for group participation. Some of these group norms may pose problems for certain members because of their cultural background. It is essential that the expectations for group members be clear from the outset and that members be in agreement with such expectations. Of course, part of the group process involves the participation of members in developing norms that will influence their behavior in a group situation.

Issues in Involuntary Groups

When participation is mandatory, informed consent is as important as it is when working with voluntary groups. Much effort needs to be directed toward fully informing involuntary members of the nature and goals of the group, the procedures to be used, their rights and responsibilities, the limits of confidentiality, and what effect their level of participation in the group will have on critical decisions about them outside of the group. When groups are involuntary, every attempt should be made to enlist the cooperation of the members and encourage them to continue attending voluntarily. One way of doing this is to spend some time with involuntary clients helping them reframe the notion “I have to come to this group.” They do have some choice whether they will attend group or deal with the consequences of not being in the group. If “involuntary” members choose not to participate in the group, they will need to be prepared to deal with consequences such as being expelled from school, doing jail time, or being in juvenile detention.

Another alternative would be for the group leader to accept involuntary group members only for an initial limited period. There is something to be said for giving reluctant members a chance to see for themselves what a group is about and then eventually (say, after three sessions) letting them decide whether they will return. Group leaders can inform members that it is their choice of how they will use the time in the group. The members can be encouraged to explore their fears and reluctance to fully participate in the group, as well as the consequences of not participating in the group. Ethical practice would seem to require that group leaders fully explore these issues with clients who are sent to them.

The Freedom to Leave a Group

Leaders should be clear about their policies pertaining to attendance, commitment to remaining in a group for a predetermined number of sessions, and leaving a particular session if they do not like what is going on in the group. If members simply drop out of the group, it is extremely difficult to develop a working level of trust or to establish group cohesion. The topic of leaving the group should be discussed during the initial session, and the leader’s attitudes and policies need to be clear from the outset.

In my view, group members have a responsibility to the leaders and other members to explain why they want to leave. There are a number of reasons for such a policy. For one thing, it can be deleterious to members to leave without having been able to discuss what they considered threatening or negative in the experience. If they leave without discussing their intended departure, they are likely to be left with unfinished business, and so are the remaining members. A member’s dropping out may damage the cohesion and trust in a group; the remaining members may think that they in some way “caused” the departure. It is a good practice to tell members that if they are even thinking of withdrawing they should bring the matter up for exploration in a session. It is critical that members be encouraged to discuss their departure, at least with the group leader.

If a group is counterproductive for an individual, that person has a right to leave the group. Ideally, both the group leader and the members will work cooperatively to determine the degree to which a group experience is productive or counterproductive. If, at a mutually agreed-upon time, members still choose not to participate in a group, I believe they should be allowed to drop out without being subjected to pressure by the leader and other members to remain.

Freedom From Coercion and Undue Pressure

Members can reasonably expect to be respected by the group and not to be subjected to coercion and undue group pressure. However, some degree of group pressure is inevitable, and it is even therapeutic in many instances. People in a group are challenged to examine their self-defeating beliefs and behaviors and are encouraged to recognize what they are doing and determine whether they want to remain the way they are. Further, in a counseling group, there is pressure in sessions to speak up, to make personal disclosures, to take certain risks, to share one’s reactions to the here-and-now events within the group, and to be honest with the group. All of these expectations should be explained to potential group members during the screening and orientation session. Some individuals may not want to join a group if they will be expected to participate in personal ways. It is essential for group leaders to differentiate between destructive pressure and therapeutic pressure. People often need a certain degree of pressure to challenge them to take the risks involved in becoming fully invested in the group.

The Right to Confidentiality

Confidentiality is a central ethical issue in group counseling, and it is an essential condition for effective group work. The legal concept of privileged communication is not recognized in a group setting unless there is a statutory exception. However, protecting the confidentiality of group members is an ethical mandate, and it is the responsibility of the counselor to address this at the outset of a group (Wheeler & Bertram, 2012). The American Counseling Association’s (ACA, 2014) Code of Ethics makes this statement concerning confidentiality in groups: “In group work, counselors clearly explain the importance and parameters of confidentiality for the specific group” (Standard B.4.a.). The ASGW (2008) addresses the added complexity entailed in coming to a mutual understanding of confidentiality in diverse groups: “Group Workers maintain awareness and sensitivity regarding the cultural meaning of confidentiality and privacy. Group Workers respect differing views toward disclosure of information” (A.6.). As a leader, you are required to keep the confidences of group members, but you have the added responsibility of impressing on the members the necessity of maintaining the confidential nature of whatever is revealed in the group. This matter bears reinforcement along the way, from the initial screening interview to the final group session.

Although group leaders are themselves ethically and legally bound to maintain confidentiality, a group member who violates another member’s confidences faces no legal consequences (Lasky & Riva, 2006). If the rationale for confidentiality is clearly presented to each individual during the preliminary interview and again to the group as a whole at the initial session, there is less chance that members will treat this matter lightly. Confidentiality is often on the minds of people when they join a group, so it is timely to fully explore this issue. A good practice is to remind participants from time to time of the danger of inadvertently revealing confidences. My experience continues to teach me that members rarely gossip maliciously about others in their group. However, people do tend to talk more than they should outside the group and can unwittingly offer information about fellow members that should not be revealed. If the maintenance of confidentiality is a matter of concern, the subject should be discussed fully in a group session.

In groups in institutions, agencies, and schools, where members know and have frequent contact with one another outside of the group, confidentiality becomes especially important and is more difficult to maintain. Clearly, there is no way to ensure that group members will respect the confidences of others. As a group leader, you cannot guarantee confidentiality in a group setting because you cannot control absolutely what the members do or do not keep private. Members have a right to know that absolute confidentiality in groups is difficult and at times even unrealistic (Lasky & Riva, 2006). However, you can discuss the matter, express your convictions about the importance of maintaining confidentiality, and have members sign contracts agreeing to it. Your own modeling and the importance that you place on maintaining confidentiality will be crucial in setting norms for members to follow. Ultimately, it is up to the members to respect the need for confidentiality and to maintain it.

Members have the right to know of any audio- or videotape recordings that might be made of group sessions, and the purpose for which they will be used. Written permission should be secured before recording any session. If the tapes will be used for research purposes or will be critiqued by a supervisor or other students in a group supervision session, the members have the right to deny permission.

Exceptions to Confidentiality Group leaders have the ethical responsibility of informing members of the limits of confidentiality within the group setting. For instance, leaders can explain to members when they are legally required to break confidentiality. Leaders can add that they can assure confidentiality on their own part but not on the part of other members. It is important to encourage members to bring up matters pertaining to confidentiality whenever they are concerned about them. The ACA Code of Ethics (ACA, 2014) identifies exceptions to confidentiality that members should understand:

The general requirement that counselors keep information confidential does not apply when disclosure is required to protect clients or identified others from serious and foreseeable harm or when legal requirements demand that confidential information must be revealed. Counselors consult with other professionals when in doubt as to the validity of an exception. Additional considerations apply when addressing end-of-life issues. (Standard B.2.a.)

It is a good policy for group workers to give a written statement to each member setting forth the limitations of confidentiality and spelling out specific situations that would require breaching confidences. Such straightforwardness with members from the outset does a great deal to create trust because members then know where they stand.

Of course, it is imperative that those who lead groups become familiar with the state laws that have an impact on their practice. Group leaders do well to let members know that legal privilege does not apply to group treatment, unless provided by state statute (ASGW, 2008). The American Group Psychotherapy Association (AGPA, 2002) states: “The group therapist is knowledgeable about the limits of privileged communication as they apply to group therapy and informs group members of those limits” (2.2). Counselors are legally required to report clients’ threats to harm themselves or others. This requirement also covers cases of child abuse or neglect, incest, child molestation, elder abuse, and dependent-adult abuse. Taking an extreme case, if one of your group members convincingly threatens to seriously injure another person, you may have to consult your supervisor or other colleagues, warn the intended victim, and even notify the appropriate authorities. The threat need not involve others; clients may exhibit bizarre behavior that requires you to take steps to have them evaluated and possibly hospitalized.

If you lead a group at a correctional institution or a psychiatric hospital, you may be required to act as more than a counselor; for instance, you will probably have to record in a member’s file certain behaviors that he or she exhibits in the group. At the same time, your responsibility to your clients requires you to inform them that you are recording and passing on certain information. Generally speaking, you will find that you have a better chance of gaining the cooperation of group members if you are candid about a situation rather than hiding your disclosures and thereby putting yourself in the position of violating their confidences.

Confidentiality With Minors In a group for children in a school setting, care needs to be exerted to ensure that what goes on within the group is not a subject for discussion in class or on the playground. If children begin to talk about other members outside of the group, this will certainly block progress and damage the cohesion of the group. As is the case for adults and adolescents, children require the safety of knowing they will be treated respectfully. On this matter, the American School Counselor Association’s (ASCA, 2010) Ethical Standards for School Counselors provides an important guideline:

Professional school counselors establish clear expectations in the group setting, and clearly state that confidentiality in group counseling cannot be guaranteed. Given the developmental and chronological ages of minors in schools, recognize the tenuous nature of confidentiality for minors renders some topics inappropriate for group work in a school setting. (A.6.c.)

Group leaders must also be careful in how they talk about the children to teachers and administrators. Those who do groups with children need to explain what will be kept confidential and what may need to be shared with school personnel. This also applies to talking with parents. Do parents have a right to information that is disclosed by their children in a group? The answer to that question depends on whether you are looking at it from a legal, ethical, or professional viewpoint. It is a good practice to require written permission from parents before allowing a minor to enter a group. It is useful to have this permission include a brief statement concerning the purpose of the group, along with comments regarding the importance of confidentiality as a prerequisite to accomplishing such purposes, and your intention not to violate any confidences. It may sometimes be useful to provide parents with information about their child if this can be done without violating confidences. One useful practice to protect the privacy of what goes on in the group is to provide feedback to parents in a session with the child and one or both parents. In this way the child will have less cause to doubt the group leader’s integrity in keeping his or her disclosures private.

Group leaders have a responsibility in groups that involve children and adolescents to take measures to increase the chances that confidentiality will be kept. It is important to work cooperatively with parents and guardians as well as to enlist the trust of the young people. It is also useful to teach minors, in terms that they are capable of understanding, about the nature, purposes, and limitations of confidentiality. In summary, group leaders would do well to continue to remind members to bring up their concerns about confidentiality for discussion whenever the issue is on their minds.

Social Media in Group Work: Confidentiality and Privacy Considerations Confidentiality and privacy issues take on special considerations when group members and their therapists communicate with each other online and when group members communicate with other members via the Internet. There is an increased risk of breach of confidentiality when members of a counseling group engage in social media (Wheeler & Bertram, 2012). Group counselors must address the parameters of online behavior through informed consent and should establish ground rules regarding members’ commitment to avoid posting pictures, comments, or any type of confidential information about other members online. Developing these rules needs to be part of the discussion about norms governing the group.

Breaches of confidentiality or privacy may occur when members share their own information online, especially if they struggle with poor boundaries. Others may lack the technological skills and knowledge to protect information that is intended to remain private. Educate members to share their experience with others outside the group by talking about their own experience, reactions, and insights rather than telling stories about other members or mentioning others in the group by name.

The Issue of Psychological Risks in Groups

Groups can be powerful catalysts for personal change, and they can also pose definite risks for group members. Ethical practice demands that group practitioners inform prospective participants of the potential risks involved in the group experience. The nature of these risks—which include life changes that cause disruption, hostile and destructive confrontations, scapegoating, and harmful socializing among members—and what the leader can do about them are the subject of this section. It is unrealistic to expect that a group will not involve risk, for all meaningful learning in life involves taking some kind of risk. It is the ethical responsibility of the group leader to ensure that prospective group members are aware of the potential negative outcomes that are associated with various risks and to take every precaution against them.

The ACA Code of Ethics (ACA, 2014) specifies that “[i]n a group setting, counselors take reasonable precautions to protect clients from physical, emotional, or psychological trauma” (Standard A.9.b.). This includes discussing the impact of potential life changes and helping group members explore their readiness to deal with such changes. A minimal expectation is that group leaders discuss with members the advantages and disadvantages of a given group, that they prepare the members to deal with any problems that might grow out of the group experience, and that they be alert to the fears and reservations that members might have.

It is also incumbent on group leaders to have a broad and deep understanding of the forces that operate in groups and how to mobilize those forces for ethical ends. Unless leaders exert caution, members not only may miss the benefits of a group but also could be harmed by it psychologically. Group leaders must take precautionary measures to reduce unnecessary psychological risks by knowing members’ limits, respecting their requests, developing an invitational style as opposed to an aggressive or dictatorial style, avoiding abrasive confrontations, describing behavior rather than making judgments, and presenting hunches in a tentative way.

Here are a few of the problems group leaders can warn members about and work toward minimizing:

1. Members should be made aware of the possibility that participating in a group (or any other therapeutic endeavor) may disrupt their lives. As members become increasingly self-aware, they may make changes in their lives that, although constructive in the long run, can create turmoil along the way. For example, changes that a woman makes as a result of what she gains in a group may evoke resistance, even hostility, in her partner, with a resulting strain on their relationship. Furthermore, others with whom she is close may not appreciate her changes and may prefer the person she was before getting involved in counseling.

2. Occasionally an individual member may be singled out as the scapegoat of the group. Other group members may “gang up” on this person, blaming him or her for problems of the group. Clearly, the group leader must take firm steps to deal with such occurrences.

3. Confrontation, a valuable and powerful tool in any group, can be misused, especially when it is employed to destructively attack another. Intrusive interventions, overly confrontive leader tactics, and pushing members beyond their limits often produce negative outcomes. Here, again, leaders (and members as well) must be on guard against behavior that can pose a serious psychological risk for group participants. To lessen the risks of destructive confrontation, leaders can model the type of confrontation that focuses on specific behaviors and can avoid making judgments about members. They can teach members how to talk about themselves and the reactions they are having to a certain behavior pattern of a given member.

4. If safety is lacking in a group, members who have been subjected to social injustices may be revictimized when they explore their experiences in the group.

One way to minimize psychological risks in groups is to use a contract in which the leader specifies his or her responsibilities and the members specify their commitment by stating what they are willing to explore and do in the group. Such a contract reduces the chances that members will be exploited or will leave the group feeling that they have had a negative experience.

Another safeguard against unnecessary risk is the ability of leaders to recognize the boundaries of their competence and to restrict themselves to working only with those groups for which their training and experience have properly prepared them. Ultimately, the group leader is responsible for minimizing the inevitable psychological risks associated with group activity. To best assume this responsibility, the leader will undergo the supervised practice and course work described later in this chapter.

The Ethics of Group Leaders’ Actions

Being a group practitioner demands sensitivity to the needs of the members of your group and to the impact your values and techniques can have on them. It also demands an awareness of community standards of practice, the policies of the agency where you work, and the state laws that govern group counseling. In the mental health professions in general, there is a trend toward accountability and responsible practice. Graduate programs in counseling and social work are increasingly requiring course work in ethics and the law.

Almost all of the professional organizations have gone on record as affirming that their members should be aware of prevailing community standards and of the impact that conformity to or deviation from these standards will have on their practice. These organizations state explicitly that professionals will avoid exploitation of the therapeutic relationship, will not damage the trust that is necessary for a relationship to be therapeutic, and will avoid dual relationships if they interfere with the primary therapeutic aims. Typically, the ethics codes caution against attempting to blend social or personal relationships with professional ones and stress the importance of maintaining appropriate boundaries.

Group counselors need to be mindful about misusing their role and power to meet their personal needs at the expense of clients. To do so is to commit an ethical violation. The role of leaders is to help members meet their goals, not to become friends with their clients. Of course, leaders who develop sexual relationships with current group members are acting unethically. They not only jeopardize their license and their professional career, but they also degrade the profession at large. For a more complete discussion of these topics, see Herlihy and Corey (2015a, 2015b).

Socializing Among Group Members

An issue to consider is whether socializing among group members hinders or facilitates the group process. This concern can become an ethical issue if members are forming cliques and gossiping about others in the group or if they are banding together and talking about matters that are best explored in the group sessions. If hidden agendas develop through various subgroups within the group, it is likely that the progress of the group will come to an abrupt halt. Unless the hidden agenda is brought to the surface and dealt with, it seems very likely that many members will not be able to use the group therapeutically or meet their personal goals.

Yalom (2005) states that a therapy group teaches people how to form intimate relationships but is not designed to provide these relationships. He also points out that members meeting outside of the group have a responsibility to bring information about their meeting into the group. Any type of outof- group socialization that interferes with the functioning of the group is counterproductive and should be discouraged. This is especially true when some participants discuss issues relevant to the group but avoid bringing up the same issues in the group itself. As Yalom (2005) explains, “It is not the subgrouping per se that is destructive to the group, but the conspiracy of silence that generally surrounds it” (p. 352).

In some cases, out-of-group contact and socialization can be beneficial. From the perspective of feminist group therapy, out-of-group socialization is not viewed as harmful. This is especially true if members are selected carefully and are able to manage out-of-group contact so that it works to their own best interests and to the good of the group as a whole. During out-of-group contact, members often have the opportunity to expand on their goals outside of the group.

One of the best ways for the group leader to prevent inappropriate and counterproductive socialization among group members is to bring this issue up for discussion. It is especially timely to explore the negative impact of forming cliques when the group seems to be stuck and is getting nowhere or when it appears that members are not talking about their reactions to one another. The members can be taught that what they do not say in the group itself might very well prevent their group from attaining any level of cohesion or achieving its goals.

The Impact of the Leader’s Values on the Group

In all controversial issues related to the group process, the leader’s values play a central role. Your awareness of how your values influence your leadership style is in itself a central ethical issue. Value-laden issues are often brought to a group—religion, spirituality, abortion, divorce, gender roles in relationships, and family struggles, to name just a few. The purpose of the group is to help members clarify their beliefs and examine options that are most congruent with their own value system. Group counseling is not a forum in which leaders impose their worldview on the members; it is a way to assist members in exploring their own cultural values and beliefs. To practice effectively and to empower members of a group, group leaders must be able to keep their personal values separate from their work with group members. Kocet and Herlihy (2014) describe this process as ethical bracketing, the “intentional setting aside of the counselor’s personal values in order to provide ethical and appropriate counseling to all clients, especially those whose worldviews, values, belief systems, and decisions differ significantly from those of the counselor” (p. 182).

If you become aware of a value conflict that interferes with your ability to respect a particular value of a member, you may need to seek consultation or supervision. It is critical that group counselors increase their awareness of how their personal reactions to members may inhibit the group process. They must monitor their countertransference and recognize the danger of stereotyping individuals on the basis of race, ethnicity, gender, age, religious or spiritual background, or sexual identity.

Members are best served if they learn to evaluate their own behavior to determine how it is working for them. If they come to the realization that what they are doing is not serving them well, it is appropriate for them to consider alternative ways of behaving that will enable them to reach their goals. A group is an ideal place for members to assess the degree to which their behavior is consistent with their own values. They can get feedback from others, yet it will be their responsibility to make their own decisions.

Religious and Spiritual Values in Group Counseling

Some counselors support the inclusion of religious and spiritual interventions in group work (Christmas & Van Horn, 2012; Cornish & Wade, 2010). Even when such interventions are viewed as appropriate by group counselors, Cornish, Wade, and Post (2012) found that religious and spiritual interventions were infrequently used in group counseling. Almost all survey participants found it appropriate to discuss both spiritual and religious topics when group members brought up these concerns, but they did not introduce these topics or ask group members about their spiritual or religious background and beliefs. In addition, counselors were twice as likely to comment on the therapeutic value of spiritual discussions over religious discussions.

Explicitly religious or spiritual interventions may be inappropriate in some groups due to the heterogeneous nature of clients’ beliefs and practices. It is important to pay attention to how this topic is introduced in a group. Interventions tied to a particular faith could present problems in a group composed of members from diverse backgrounds. Some highly religious or spiritual therapists may find that some group members are uncomfortable with these interventions, especially if their own beliefs do not match the interventions integrated into the group process (Cornish, Wade, & Knight, 2013).

To better understand how religion and spirituality are addressed in groups, Post, Cornish, Wade, and Tucker (2013) conducted a study in the university counseling setting. Counselors in this setting generally held the following views:

• Religious and spiritual concerns are appropriate topics of discussion for the groups they facilitate.

• Spiritual interventions are more appropriate than religious interventions, and spiritual interventions are used more frequently.

• When a client brings up a religious or spiritual concern, basic interventions rather than specific spiritual or religious interventions are most often used.

Addressing spiritual and religious values in group counseling encompasses particularly sensitive, controversial, and complex concerns. It is critical to be aware of and to understand your own spiritual or religious attitudes, beliefs, values, and experiences if you hope to facilitate an exploration of these issues with members of your group. Religious and spiritual values are a basic aspect of the lives of some group members, and clients may feel that their needs are not being met if their religious or spiritual concerns are ignored. In this area, the group members should set the agenda.

Ethical Issues in Multicultural Group Counseling

Becoming Aware of Your Cultural Values

If group leaders ignore some basic differences in people, they can hardly be doing what is in the best interests of these clients, which is an ethical matter. Regardless of your ethnic, cultural, and racial background, if you hope to build bridges of understanding between yourself and group members who are different from you, it is essential that you guard against stereotyped generalizations about social and cultural groups.

Johnson, Santos Torres, Coleman, and Smith (1995) write about issues that group counselors are likely to encounter as they attempt to facilitate culturally diverse counseling groups. They point out that group members typically bring with them their values, beliefs, and prejudices, which quickly become evident in a group situation. For Johnson and her colleagues, one goal of multicultural group counseling is to provide new levels of communication among members. This can be instrumental in assisting members in challenging their stereotypes by providing accurate information about individuals. Another goal of a diverse group is to promote understanding, acceptance, and trust among members of various cultural groups. For group leaders to facilitate this understanding and acceptance in a diverse group, it is essential that they be aware of their biases and that they have challenged their stereotypes.

Social justice issues often surface when working with people from culturally diverse backgrounds (MacNair-Semands, 2007). Individuals can be invited to talk about their pain from the social injustices they have encountered. In these instances, group leaders have an opportunity and a responsibility to transform the group experience and work toward healing rather than perpetuating harmful interactions marked by sexism, racism, and heterosexism. Leaders can do this by assisting members in evaluating their attitudes about a range of diversity issues. The ASGW (2008) “Best Practice Guidelines” offers this guidance on recognizing the role of diversity in the practice of group work:

Group workers practice with broad sensitivity to client differences including but not limited to ethnic, gender, religious, sexual, psychological maturity, economic class, family history, physical characteristics or limitations, and geographic location. Group workers continuously seek information regarding the cultural issues of the diverse population with whom they are working both by interaction with participants and from using outside resources. (B.8.)

An essential aspect of training for group leaders is promoting sensitivity and competence in addressing diversity in all forms of group work. Ethical practice requires that multicultural issues be incorporated in the training of group counselors (Debiak, 2007). There is increased recognition that all group work is multicultural; thus effective training of group counselors must address multicultural dimensions. Addressing diversity is an ethical mandate, but this practice is also a route to more effective group work.

Transcending Cultural Encapsulation

Cultural encapsulation is a potential trap that all group counselors are vulnerable to falling into. If you accept the idea that certain cultural values are supreme, you limit yourself by refusing to consider alternatives. If you possess cultural tunnel vision, you are likely to misinterpret patterns of behavior displayed by group members who are culturally different from you. Unless you understand the values of other cultures, you are likely to misunderstand these clients. If you are able to appreciate cultural differences and do not associate such differences with superiority or inferiority, you can increase your psychological resourcefulness.

Cultural encapsulation, or provincialism, can afflict both group members and the group leader. As group counselors, we have to confront our own distortions as well as those of the members. Culture-specific knowledge about a client’s background should not lead counselors to stereotype the client. Culturally competent group leaders recognize both differences among groups and differences within groups. It is essential that you avoid perceiving individuals as simply belonging to a group. Indeed, the differences between individuals within a group are often greater than the differences among the various groups (Pedersen, 2000). Not all Native Americans have the same experiences, nor do all African Americans, Asians, women, older people, or people with disabilities. It is important to explore individual differences among members of the same cultural group and not to make general assumptions based on an individual’s group. Regardless of your cultural background, you must be prepared to deal with the complex differences among individuals in areas such as race, culture, ethnicity, sexual orientation, disability status, religion, socioeconomic status, gender, and age (Lee & Park, 2013).

Certain practitioners may encounter resistance from some people of color because they are using traditional White, middle-class values to interpret these clients’ experiences. Such culturally encapsulated practitioners are not able to view the world through the eyes of all of their clients. Wrenn (1985) defines the culturally encapsulated counselor as one who has substituted stereotypes for the real world, who disregards cultural variations among clients, and who dogmatizes technique-oriented definitions of counseling and therapy. Such individuals, who operate within a monocultural framework, maintain a cocoon by evading reality and depending entirely on their own internalized value assumptions about what is good for society and the individual. These encapsulated people tend to be trapped in one way of thinking, believing their way is the universal way. They cling to an inflexible structure that resists adaptation to alternative ways of thinking.

Western models need to be adapted to serve the members of certain ethnic groups, especially those clients who live by a different value system. Many clients from non-Western cultures, members of ethnic minorities, and women from nearly all cultural groups tend to value interdependence more than independence, social consciousness more than individual freedom, and the welfare of the group more than their own welfare. Western psychological thought emphasizes self-sufficiency, individualism, directness of communication, assertiveness, independence from family, and self-growth. However, many Asian Americans come from collectivistic cultures that value interconnectedness with family and community (Chung, 2004; Chung & Bemak, 2014). In Asian cultures, moreover, family roles tend to be highly structured, and “filial piety” exerts a powerful influence; that is, obligations to parents are respected throughout one’s life, especially among the male children. The roles of family members are highly interdependent, and family structure is arranged so that conflicts are minimized while harmony is maximized. Traditional Asian values emphasize reserve and formality in most social situations, restraint and inhibition of intense feelings, obedience to authority, and high academic and occupational achievement. The family structure is traditionally patriarchal in that communication and authority flow vertically from top to bottom. The inculcation of guilt and shame are the main techniques used to control the behavior of individuals within a family (D. Sue & Sue, 1993).

These traditional values are shared by other cultural groups. For instance, Latinos/as emphasize familismo, which stresses interdependence over independence, affiliation over confrontation, and cooperation over competition. Parents are afforded a great deal of respect, and this respect governs all interpersonal relationships. The role of fate is often a pervasive force governing behavior. Latinos/as typically place a high value on spiritual matters and religion (Comas-Diaz, 1990). Torres-Rivera, Torres Fernandez, and Hendricks (2014) suggest that the common topics of discussion among Latino/a group members often include relationships, friendship, intimacy and love, sexuality, time, money, parenting, commitment and responsibility, decision making, power, rules, and morality.

The central point is that if the group experience is largely the product of values that are alien to certain group members, it is easy to see that such members will not embrace the group. Group counselors who practice exclusively with a Western perspective are likely to meet with a considerable amount of resistance from clients with a non-Western worldview. Culturally sensitive group practice can occur only when leaders are willing to reveal the underlying values of the group process and determine whether these values are congruent with the cultural values of the members. Group members can also be encouraged to express their values and needs. The major challenge for group leaders is to determine what techniques are culturally appropriate for which individuals.

Being aware of how cultural values influence their own thinking and behavior will help group leaders work ethically and effectively with members who are culturally different from themselves. It is clear that ethical practice demands that group counselors possess the self-awareness, knowledge, and skills that are basic components of diversity-competent practitioners.

Uses and Misuses of Group Techniques

In leading groups, it is essential that you have a clear rationale for each technique you use. This is an area in which theory is a useful guide for practice. As you will see, the 11 theories at the core of this book give rise to many therapeutic strategies and techniques. Such techniques are a means to increase awareness, to accomplish change, or to promote exploration and interaction. They can certainly be used ethically and therapeutically, yet they also can be misused.

Some of the ways in which leaders can practice unprofessionally are using techniques with which they are unfamiliar, using techniques in a mechanical way, using techniques to serve their own hidden agenda or to enhance their power, or using specific techniques to pressure members. Many techniques that are used in a group do facilitate an intense expression of emotion. For example, guided fantasies into times of loneliness as a child can lead to deep psychological memories. Such techniques should be congruent with the overall purpose of the group. If leaders use such techniques, they must be ready to deal with any emotional release.

Leaders should avoid pushing members to “get into their emotions.” Some group leaders measure the efficacy of their group by the level of catharsis, and group leaders who need to see members experience intense emotions can exploit the group members. This expression of emotion can sometimes reveal the leader’s needs rather than the needs of the members.

Techniques have a better chance of being used appropriately when there is a rationale underlying their use. Techniques are aimed at fostering the client’s self-exploration and self-understanding. At their best, they are invented in each unique client situation, and they are a collaborative effort between the leader and members. Techniques assist the group member in experimenting with some form of new behavior. It is critical that techniques be introduced in a timely and sensitive manner, with respect for the client, and that they be abandoned if they are not working.

Effective group counselors incorporate a wide range of techniques in their therapeutic style. Much depends on the purpose of the group, the setting, the personality and style of the group facilitator, the qualities of particular group members, and the problems selected for intervention. Effective leaders continuously assess their group and decide what relationship style to adopt; what techniques, procedures, or intervention methods to use; when to use them; and with which clients.

In working with culturally diverse client populations, leaders may need to modify some of their interventions to suit the client’s cultural and ethnic background. For example, if a client has been taught not to express his feelings in public, it may be inappropriate to quickly introduce techniques aimed at bringing out his feelings. It would be useful first to find out if this member is interested in exploring what he has learned from his culture about expressing his feelings. In another situation, perhaps a woman has been socialized to obey her parents without question. It could be inappropriate to introduce a role-playing technique that would have her confronting her parents directly. Leaders can respect the cultural values of members and at the same time encourage them to think about how these values and their upbringing have a continuing effect on their behavior. In some cases members will decide to modify certain behaviors because the personal price of retaining a value is too high. In other cases they will decide that they are not interested in changing certain cultural values or behaviors. The techniques used by leaders can help such members examine the pros and cons of making these changes. For a more detailed discussion of ethical considerations in using group techniques, see Corey, Corey, Callanan, and Russell (2015).

Group Leader Competence

Determining One’s Own Level of Competence

How can leaders determine whether they have the competence to use a certain technique? Some leaders who have received training in the use of a technique may hesitate to use it (out of fear of making a mistake), whereas other overly confident leaders without training may not have any reservations about trying out new methods. Leaders should have a clear theoretical and therapeutic rationale for any technique they use. Further, it is useful if leaders have experienced these techniques as members of a group. The issue of whether one is competent to lead a specific group or type of group is an ongoing question that faces all professional group leaders. You will need to remain open to struggling with questions such as these:

• Am I qualified through education and training to lead this specific group?

• What criteria can I use to determine my degree of competence?

• How can I recognize the boundaries of my competence?

• If I am not as competent as I’d like to be as a group worker, what specifically can I do?

• How can I continue to upgrade my leadership knowledge and skills?

• What techniques can I effectively employ?

• With what kinds of clients do I work best?

• With whom do I work least well, and why?

• When and how should I refer clients?

• When do I need to consult with other professionals?

There are no simple answers to these questions. Different groups require different leader qualities. For example, you may be fully competent to lead a group of relatively well-adjusted adults or of adults in crisis situations yet not be competent to lead a group of seriously disturbed people. You may be well trained for, and work well with, adolescent groups, yet you may not have the skills or training to do group work with younger children. You may be successful leading groups dealing with domestic violence yet find yourself ill-prepared to work successfully with children’s groups. In short, you need supervised experience to understand the challenges you are likely to face in working with different types of groups.

Most practitioners have had their formal training in one of the branches of the mental health field, which include counseling psychology, clinical psychology, clinical social work, community counseling, educational psychology, school counseling, couples and family counseling, nursing, pastoral psychology, rehabilitation counseling, mental health counseling, and psychiatry. Generally, however, those who seek to become group practitioners find that formal education, even at the master’s or doctoral level, does not give them the practical grounding they require to effectively lead groups. Practitioners often find it necessary to take a variety of specialized group therapy training workshops to gain experience.

The American Group Psychotherapy Association (AGPA) and the Association for Specialists in Group Work (ASGW) both address competence in group work. For example, “The group psychotherapist must be aware of his/ her own individual competencies, and when the needs of the patient/client are beyond the competencies of the psychotherapist, consultation must be sought from other qualified professionals or other appropriate sources” (AGPA, 2002, 3.1). Professional competence is not arrived at once and for all; it is an ongoing developmental process for the duration of your career.

The “Best Practice Guidelines” (ASGW, 2008, section A), which are reproduced in the Student Manual for Theory and Practice of Group Counseling, provide some general suggestions for enhancing your level of competence as a group worker:

• Remain current and increase your knowledge and skill competencies through activities such as continuing education, professional supervision, and participation in personal and professional development activities.

• Utilize consultation and/or supervision to ensure effective practice regarding ethical concerns that interfere with effective functioning as a group leader.

• Be open to getting professional assistance for personal problems or conflicts of your own that may impair your professional judgment or work performance.

Part of being a competent group counselor involves being able to explain to group members the theory behind your practice, telling members in clear language the goals of the group and how you conceptualize the group process, and relating what you do in a group to this model. As you acquire competence, you will be able to continually refine your techniques in light of your model. Competent group counselors possess the knowledge and skills that are described in the following section.

Professional Training Standards for Group Counselors

Effective group leadership programs are not developed by legislative mandates and professional codes alone. For proficient leaders to emerge, a training program must make group work a priority. Unfortunately, most master’s programs in counseling require only one group course, and it is typical for this single course to cover both the didactic and experiential aspects of group process. This course often deals with both theories of group counseling and group process as well as providing students with opportunities to experience a group as a member. It is a major challenge to train group counselors adequately in a single course!

The ASGW (2000) “Professional Standards for the Training of Group Workers” specify two levels of competencies and related training. First is a set of core knowledge and skill competencies that provides the foundation on which specialized training is built. At a minimum, one group course should be included in a training program, and it should be structured to help students acquire the basic knowledge and skills needed to facilitate a group.

The ASGW (2000) training standards state that group leadership skills (see Chapter 2) are best mastered through supervised practice that involves observation and participation in a group experience. Although a minimum of 10 hours of supervised practice is required, 20 hours is recommended as part of the core training. Furthermore, these training standards require that all counselor trainees complete core training in group work during their entry-level education.

Once counselor trainees have mastered the core knowledge and skill domains, they have the platform to develop a group work specialization in one or more of four areas (see Chapter 1): (1) task groups, (2) psychoeducational groups, (3) group counseling, or (4) group psychotherapy. The standards outline specific knowledge and skill competencies for these specialties and specify the recommended number of hours of supervised training for each.

The current trend in training group workers focuses on learning group process by becoming involved in supervised experiences. Certainly, the mere completion of one graduate course in group theory and practice does not equip a counselor to effectively lead groups. Both direct participation in planned and supervised small groups and clinical experience in leading various groups under careful supervision are needed to provide leaders with the skills to meet the challenges of group work.

Ieva, Ohrt, Swank, and Young (2009) investigated the impact on master’s students who participated in experiential personal growth groups. The students’ perceptions of their experience supported the following assumptions:

• Group process is a beneficial aspect of training.

• Experience in a personal growth group increases knowledge about groups and leadership skills.

• Experience in a personal growth group enhances students’ ability to give and receive feedback.

All study participants reported some personal or professional progress as a result of their experience in a group. Areas of benefit included interpersonal learning, knowledge about group process, self-awareness, empathy for future clients, and opportunities to learn by observing group process in action. The participants’ confidence in facilitating a group increased after having experience as a group member, and they believed their participation assisted them in developing their own personal leadership style. Not only did the counselors-in-training report benefiting both personally and professionally from participating in personal growth groups, but they thought this should be a requirement for all students in a master’s level counseling program. Ieva and colleagues (2009) conclude that this study provides counselor educators with valuable information that can help them design and facilitate training experiences that are positive, beneficial, and ethically responsible.

Three Important Adjuncts to the Training of Group Counselors

If you expect to lead groups, you will want to be prepared for this work, both personally and academically. If your program has not provided this preparation, it will be necessary for you to seek in-service workshops in group processes. It is not likely that you will learn how to lead groups merely through reading about them and listening to lectures.

I recommend at least three experiences as adjuncts to a training program for students learning about group work: (1) participation in personal counseling, (2) participation in group counseling or a personal growth group, and (3) participation in a training and supervision group. Following is a discussion of these three adjuncts to the professional preparation of group counselors.

Personal Counseling for Group Leaders I believe that extensive selfexploration is necessary for trainees to identify countertransference feelings, to recognize blind spots and biases, and to use their personal attributes effectively in their group work. Group trainees can benefit greatly from the experience of being a client at some time. To me it makes sense that group leaders need to demonstrate the courage and willingness to do for themselves what they expect members in their groups to do—expand their awareness of self and the effect of that self on others.

What does research reveal on this subject? More than 90% of mental health professionals report positive outcomes from their own counseling experiences (Geller, Norcross, & Orlinsky, 2005). In his synthesis of 25 years of research on the personal therapy of mental health professionals, Norcross (2005b) states: “The cumulative results indicate that personal therapy is an emotionally vital, interpersonally dense, and professionally formative experience that should be central to the development of health care psychologists” (p. 840). Norcross points out that most mental health care practitioners strongly value experiential over didactic learning.

Increasing self-awareness is a major reason to seek out personal counseling. In leading a group, you will encounter many instances of transferences, both among members and toward you. Transference refers to the unconscious process whereby members project onto you, the group leader, past feelings or attitudes that they had toward significant people in their lives. Of course, you can easily become entangled in your own feelings of countertransference, which often involves both conscious and unconscious emotional responses to group members. You may have unresolved personal problems, which you can project onto the members of your group. Through personal counseling, you can become increasingly aware of personal triggers and can also work through some of your unfinished business that could easily interfere with your effectiveness in facilitating groups. If you are not actively involved in the pursuit of healing your own psychological wounds, you will probably have considerable difficulty entering the world of a client. Through being a client yourself, you can gain an experiential frame of reference to view yourself as you are. This experience will increase your compassion for your clients and help you learn ways of intervening that you can use in the groups you facilitate. For further reading on this topic, I recommend The Psychotherapist’s Own Psychotherapy (Geller, Norcross, & Orlinsky, 2005).

Self-Exploration Groups for Group Leaders Being a member of a variety of groups can prove to be an indispensable part of your training as a group leader. By experiencing your own cautiousness, resistances, fears, and uncomfortable moments in a group, by being confronted, and by struggling with your problems in a group context, you can experience what is needed to build a trusting and cohesive group.

In addition to helping you recognize and explore personal conflicts and increase self-understanding, a personal growth group can be a powerful teaching tool. One of the best ways to learn how to assist group members in their struggles is to participate yourself as a member of a group. A survey of 82 master’s-level counseling programs suggests that experiential group training is alive, evolving, and an accepted method for training group leaders (Shumaker, Ortiz, & Brenninkmeyer, 2011).

Yalom (2005) states that a substantial number of training programs require both personal therapy and a group experience for trainees. Some of the benefits of participating in a therapeutic group that he suggests are experiencing the power of a group, learning what self-disclosure is about, coming to appreciate the difficulties involved in self-sharing, learning on an emotional level what one knows intellectually, and becoming aware of one’s dependency on the leader’s power and knowledge.

If a self-exploration group or an experiential group is a program requirement, students must be made aware of this requirement at an orientation meeting during the admissions process or prior to their enrollment in a program. Shumaker, Ortiz, and Brenninkmeyer’s (2011) survey of experiential group training in counseling master’s programs resulted in them recommending systematic instructor self-reflection, informed consent of students, and selfdisclosure training as “the most promising and critical safeguard elements dedicated to promoting a positive experiential group experience” (p. 127).

Participation in Experiential Training Workshops I have found training workshops most useful in helping group counselors develop the skills necessary for effective intervention. The trainees can also learn a great deal about their response to feedback, their competitiveness, their need for approval, their concerns over being competent, and their power struggles. In working with both university students learning about group approaches and with professionals who want to upgrade their group skills, I have found an intensive weekend or weeklong workshop to be an effective format. In these workshops the participants all have ample opportunity to lead their small group for a designated period with the benefit of direct supervision. After a segment in which a participant leads the group, my colleagues and I who are supervising their group offer feedback to those who led the group, provide a commentary on the process, and facilitate discussion of what happened in the group by the entire group.

My Journey Toward Becoming a Group Work Specialist

I want to share some highlights of what I found helpful in becoming a teacher and practitioner of group counseling. In my doctoral studies in the mid-1960s, I had no formal course work in group counseling. It was my experiences as a participant in many different kinds of groups after getting my doctorate that perked my interest in becoming a group practitioner, in teaching group courses, in training and supervising group workers, and in writing textbooks on group counseling.

During my 30s and 40s I availed myself to a wide range of different groups, a few of which included overnight marathon groups, traditional weekly therapy groups, and various residential workshops done in a group format. I participated in many personal growth workshops and encounter groups, which lasted in length from a weekend to 10 days. My early experiences as a group member provided insights and were instrumental in leading me to make significant changes in my personal life. This encouraged me to continue seeking out various groups aimed at personal and professional development. Although my main motivation for participating in these group workshops was not to learn techniques or to acquire skills in conducting groups, I received indirect benefits that I was able to apply to my professional work. This led to finding ways to incorporate group work into my teaching and professional practice. I learned significant lessons about organizing and facilitating groups from my experience as a group member even though I had concerns about the way some of the groups I attended were set up or conducted. These experiences were important in my learning how to design different kinds of therapeutic groups, and they helped me to think about ethics in group practice. Many of the specific dimensions of group facilitation that I address in this book came about as a result of the experiential learning and training I acquired beyond my doctoral program.

My own journey into group work has convinced me of how crucial it is for those who want to facilitate groups to open themselves to the experience of being in groups as a member. Certainly course work in group counseling is crucial, as is supervision when we are beginning to lead groups; in addition, what we can learn about ourselves personally by being a member of a group can pay dividends in our professional work. For a more detailed description of my journey into group work, both from a personal and professional perspective, see Creating Your Professional Path: Lessons From My Journey (Corey, 2010).

Ethical Issues in Training Group Counselors

Training programs differ on whether participating in a group is optional or required. My own bias is clear on the importance of doing personal work in a group as a prerequisite to becoming a group counselor. To be sure, requiring participation in a therapeutic group as part of a training program can present some practical and ethical problems of its own. A controversial ethical issue in the preparation of group workers involves combining experiential and didactic training methods.

I consider an experiential component to be essential when teaching group counseling courses. Admittedly, there are inherent problems in teaching students how groups function by involving them on an experiential level. Such an arrangement entails their willingness to engage in self-disclosure, to become active participants in an interpersonal laboratory, and to engage themselves on an emotional level as well as a cognitive one. Time and again, however, my colleagues and I hear both students and professionals who participate in our group training workshops comment on the value of supervised experience in which they have both leadership and membership roles. Through this format, group process concepts come alive. Trainees experience firsthand what it takes to create trust and what resistance feels like. They often say that they have gained a new appreciation of the group experience from a member’s perspective.

In talking with many other counselor educators throughout the country who teach group courses, I find that it is common practice to combine the experiential and didactic domains. Sometimes students colead a small group with a peer and are supervised by the instructor. Of course, this arrangement is not without problems, especially if the instructor also functions in the roles of facilitator and supervisor. Many of my colleagues believe the potential risks of experiential methods are offset by the benefits to students who become personally involved in experiential group work. These educators believe the experiential component helps students acquire the skills necessary to function as effective group leaders. Clearly, instructors need to be aware of the potential drawbacks inherent in multiple roles and relationships in teaching group courses, and they need to develop safeguards to minimize risk.

Students may fear that their grade will be influenced by their participation (or lack of it) in the experiential part of the class. In grading and evaluating students in group courses, the professionalism of the instructor is crucial. Ethical practice requires instructors to spell out their grading criteria clearly. The criteria may include the results of written reports, oral presentations, essay tests, and objective examinations. Most group counselor educators agree that students’ performance in the experiential group should not be graded, but they can be expected to attend regularly and to participate. Clear guidelines need to be established so that students know what their rights and responsibilities are at the beginning of the group course.

There is potential for abuse when using experiential approaches in training group leaders, but this does not warrant the conclusion that all such experiences are inappropriate or unethical. I view it as a mistake to conclude that group work educators should be restricted to the singular role of providing didactic information. The challenge of educators is to provide the best training available. I am convinced that teaching group process by involving students in personal ways is the best way for them to learn how to eventually set up and facilitate groups. I am in agreement with Stockton, Morran, and Chang (2014) who indicate that there is a fine line between offering experiential activities and safeguarding against gaining information that could be used in evaluating students. Faculty who use experiential approaches are often involved in balancing multiple roles, which requires consistent monitoring of boundaries. Stockton and colleagues emphasize that group work educators need to exert caution so that they offer training that is both ethical and efficacious.

Liability and Malpractice

Although the topics of professional liability and malpractice are not strictly a part of ethical practice, these are legal dimensions with implications for group practitioners. Group leaders are expected to practice within the code of ethics of their particular profession and also to abide by legal standards. Practitioners are subject to civil penalties if they fail to do right or if they actively do wrong to another. If group members can prove that personal injury or psychological harm was caused by a leader’s failure to render proper service, either through negligence or ignorance, the leader is open to a malpractice suit. Negligence consists of departing from the standard and commonly accepted practices of others in the profession. Practitioners involved in a malpractice action may need to justify the techniques they use. If their therapeutic interventions are consistent with those of other members of their profession in their community, they are on much firmer ground than if they employ uncommon techniques.

Group leaders need to keep up to date with the laws of their state as they affect their professional practice. Ignorance is not a sufficient excuse. Those leaders who work with groups of children and adolescents, especially, must know the law as it pertains to matters of confidentiality, parental consent, the right to treatment or to refuse treatment, informed consent, and other legal rights of clients. Such awareness not only protects the group members but also protects group leaders from malpractice suits arising from negligence or ignorance.

The best way to protect yourself from a malpractice suit is to take preventive measures, which means not practicing outside the boundaries of your competence. Following the spirit of the ethics codes of your professional organization is also important. The key to avoiding a malpractice suit is maintaining reasonable, ordinary, and prudent practices. Here are some prudent guidelines for ethical and professional standards of practice:

• Be willing to devote the time it takes to adequately screen, select, and prepare the members of your group.

• Develop written informed consent procedures at the outset of a group. Give the potential members of your groups enough information to make informed choices about group participation. Do not mystify the group process.

• Provide an atmosphere of respect for diversity within the group.

• Become aware of local and state laws that limit your practice, as well as the policies of the agency for which you work. Inform members about these policies and about legal limitations (such as exemptions to confidentiality, mandatory reporting, and the like).

• Emphasize the importance of maintaining confidentiality before the group begins and at various times during the life of a group.

• If social media is part of group work, establish with members the importance of maintaining boundaries, confidentiality, and privacy of others in the group.

• Restrict your practice to client populations for which you are prepared by virtue of your education, training, and experience.

• Be alert for symptoms of psychological debilitation in group members, which may indicate that their participation should be discontinued. Be able to put such clients in contact with appropriate referral resources.

• Do not promise the members of your group anything that you cannot deliver. Help them realize that their degree of effort and commitment will be key factors in determining the outcomes of the group experience.

• In working with minors, secure the written permission of their parents, even if this is not required by state law.

• Consult with colleagues or supervisors whenever there is an ethical or legal concern. Document the nature of these consultations.

• Make it a practice to assess the general progress of a group, and teach members how to evaluate their progress toward their personal goals; keep adequate clinical records on this progress.

• Learn how to assess and intervene in cases in which clients pose a threat to themselves or others.

• Avoid blending professional relationships with social ones. Avoid engaging in sexual relationships with either current or former group members.

• Remain alert to ways in which your personal reactions might inhibit the group process, and monitor your countertransference. Avoid using the group you are leading as a place where you work on personal problems.

• Continue to read the research, and use group interventions and techniques that are supported by research as well as by community practice.

• Have a theoretical orientation that serves as a guide to your practice. Be able to describe the purpose of the techniques you use in your groups.

As you read about the stages of group development in Chapters 4 and 5, reflect on the issues raised in this chapter as they apply to the tasks and challenges you will face as a group leader during various group phases. Realize that there are few simple answers to the ethical aspects of group work. Learn how to think through the ethical considerations that you will face as a group practitioner. Being willing to raise questions and think about an ethical course to follow is the beginning of becoming an ethical group counselor. The Student Manual for Theory and Practice of Group Counseling (9th edition) contains a number of resources that will help you develop your awareness of ethical group practice. I urge you to consult these resources frequently as you begin to formulate your own ideas about ethical practice in group work. For a more comprehensive discussion of ethical issues in group work, see Corey, Corey, Corey, and Callanan (2015, chap. 12).

 
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Nursing Paper Examples on Behcet’s Disease: Understanding a Complex Disorder

Nursing Paper Examples on Behcet’s Disease: Understanding a Complex Disorder

Behcet’s Disease, also known as Behcet’s Syndrome, is a rare autoimmune disorder characterized by recurrent oral and genital ulcers, skin lesions, and inflammation of the eyes. First identified by the Turkish dermatologist Hulusi Behcet in 1937, this condition primarily affects individuals in the Mediterranean, Middle Eastern, and Asian regions. Despite decades of research, the exact cause of Behcet’s Disease remains elusive, with genetic predisposition and environmental triggers believed to play key roles. The disease’s pathophysiology involves systemic inflammation and vasculitis, leading to various manifestations across multiple organs and tissues. Diagnosis is based on clinical criteria, and treatment aims to manage symptoms, reduce inflammation, and prevent complications. Patient education is crucial for empowering individuals with Behcet’s Disease to understand their condition and effectively manage their health. This paper aims to explore the causes, signs and symptoms, etiology, pathophysiology, DSM-5 diagnosis, treatment regimens, and patient education strategies related to Behcet’s Disease. (Nursing Paper Examples on Behcet’s Disease: Understanding a Complex Disorder)

Nursing Paper Examples on Behcet's Disease: Understanding a Complex Disorder

Causes of Behcet’s Disease

Behcet’s Disease is a multifactorial condition with complex underlying causes. While the precise etiology remains uncertain, several factors are believed to contribute to the development and progression of the disease.

Genetic Predisposition: Genetic susceptibility plays a significant role in Behcet’s Disease, with certain genetic markers associated with increased susceptibility to the condition. Notably, the HLA-B51 gene has been identified as a potential genetic risk factor, particularly in populations with a higher prevalence of the disease. However, it is essential to recognize that genetic predisposition alone is not sufficient to cause Behcet’s Disease, indicating the involvement of additional factors in disease pathogenesis.

Environmental Triggers: Environmental factors are thought to trigger and exacerbate Behcet’s Disease in genetically susceptible individuals. Infections, particularly viral and bacterial pathogens, have been proposed as potential triggers due to their ability to stimulate the immune system and initiate inflammatory responses. Additionally, environmental factors such as exposure to certain chemicals, dietary components, and climatic conditions may influence disease susceptibility and severity.

Immune System Dysregulation: Behcet’s Disease is characterized by dysregulation of the immune system, leading to abnormal immune responses and inflammation. Dysfunction in immune pathways, including aberrant activation of T cells and cytokine imbalances, contributes to the chronic inflammatory process observed in the disease. Dysregulation of innate and adaptive immune responses further perpetuates the inflammatory cascade, resulting in tissue damage and organ involvement.

Abnormal Responses to Microorganisms: Some evidence suggests that Behcet’s Disease may result from abnormal immune responses to specific microorganisms. Molecular mimicry, where microbial antigens resemble self-antigens, may trigger autoimmune reactions, leading to tissue damage and inflammation. Furthermore, alterations in the microbiome composition and dysbiosis in the gut microbiota have been implicated in Behcet’s Disease pathogenesis, highlighting the potential role of microbial factors in disease development.

Overall, Behcet’s Disease is a complex disorder influenced by a combination of genetic predisposition, environmental triggers, immune system dysregulation, and abnormal responses to microorganisms. Further research is needed to elucidate the precise mechanisms underlying disease pathogenesis and identify targeted therapeutic approaches. (Nursing Paper Examples on Behcet’s Disease: Understanding a Complex Disorder)

Nursing Paper Examples on Behcet's Disease: Understanding a Complex Disorder

Signs and Symptoms

Behcet’s Disease is characterized by a wide range of signs and symptoms affecting various organs and tissues throughout the body. The severity and frequency of symptoms can vary among affected individuals and may fluctuate over time.

Recurrent Oral and Genital Ulcers: One of the hallmark features of Behcet’s Disease is the presence of recurrent oral ulcers, which are often painful and can affect the lips, tongue, and oral mucosa. Genital ulcers, occurring on the vulva or scrotum, are also common and may recur frequently, leading to discomfort and impaired quality of life.

Skin Lesions: Behcet’s Disease can cause a variety of skin lesions, including erythema nodosum-like lesions, papulopustular lesions resembling acne, and pathergy, which is an exaggerated skin reaction to minor trauma. These skin manifestations can vary in appearance and distribution but are typically inflammatory and may leave scars upon healing.

Eye Inflammation (Uveitis): Inflammation of the eyes, specifically uveitis, is a significant complication of Behcet’s Disease and can lead to vision impairment or blindness if left untreated. Uveitis may present with symptoms such as eye pain, redness, blurred vision, sensitivity to light (photophobia), and floaters.

Arthritis: Joint involvement is common in Behcet’s Disease and can manifest as arthritis, causing joint pain, swelling, and stiffness. The arthritis associated with Behcet’s Disease often affects large joints such as the knees, ankles, and wrists, but can also involve smaller joints.

Gastrointestinal Involvement: Behcet’s Disease can affect the gastrointestinal tract, leading to symptoms such as abdominal pain, diarrhea, and gastrointestinal bleeding. Inflammation of the intestines, known as intestinal Behcet’s Disease, can mimic inflammatory bowel diseases like Crohn’s disease or ulcerative colitis.

Neurological Symptoms: In rare cases, Behcet’s Disease can involve the nervous system, leading to neurological symptoms such as headaches, cognitive dysfunction, seizures, and movement disorders. Neurological involvement typically occurs as a result of inflammation of the brain or spinal cord.

Vascular Complications: Behcet’s Disease can affect blood vessels, leading to various vascular complications such as deep vein thrombosis (DVT), arterial thrombosis, and arterial aneurysms. These vascular manifestations can pose significant risks and may require urgent medical intervention to prevent complications such as stroke or pulmonary embolism.

Overall, Behcet’s Disease is characterized by a diverse array of signs and symptoms affecting multiple organ systems, highlighting the systemic nature of the condition. Early recognition and appropriate management of these manifestations are essential for improving patient outcomes and preventing long-term complications. (Nursing Paper Examples on Behcet’s Disease: Understanding a Complex Disorder)

Nursing Paper Examples on Behcet's Disease: Understanding a Complex Disorder

Etiology

Behcet’s Disease is a complex disorder with an intricate etiology involving a combination of genetic, environmental, and immunological factors. While the precise cause of Behcet’s Disease remains unclear, several hypotheses have been proposed to elucidate its underlying etiology.

Genetic Predisposition: Genetic factors play a significant role in Behcet’s Disease, with evidence suggesting a genetic predisposition to the condition. Certain genetic markers, particularly variations in the HLA-B51 gene, have been associated with increased susceptibility to Behcet’s Disease, particularly in populations with a higher prevalence of the disorder. However, the inheritance pattern of Behcet’s Disease is complex and likely involves multiple genetic factors interacting with environmental triggers.

Environmental Triggers: Environmental factors are thought to contribute to the development and progression of Behcet’s Disease by triggering immune dysregulation and inflammatory responses in genetically susceptible individuals. Infections, particularly viral and bacterial pathogens, have been proposed as potential environmental triggers due to their ability to stimulate the immune system and initiate inflammatory cascades. Additionally, environmental factors such as dietary components, smoking, and climatic conditions may influence disease susceptibility and severity.

Immune Dysregulation: Behcet’s Disease is characterized by dysregulation of the immune system, leading to abnormal immune responses and chronic inflammation. Dysfunction in immune pathways, including aberrant activation of T cells, dysregulated cytokine production, and impaired regulation of inflammatory responses, contributes to the pathogenesis of the disease. These immunological abnormalities result in systemic inflammation and tissue damage, leading to the characteristic manifestations of Behcet’s Disease across multiple organ systems.

Microbial Factors: Some evidence suggests that Behcet’s Disease may result from abnormal immune responses to specific microbial antigens. Molecular mimicry, where microbial antigens resemble self-antigens, may trigger autoimmune reactions, leading to chronic inflammation and tissue damage. Furthermore, alterations in the composition of the microbiome and dysbiosis in the gut microbiota have been implicated in Behcet’s Disease pathogenesis, suggesting a potential role for microbial factors in disease development.

Behcet’s Disease is a complex disorder with a multifactorial etiology involving genetic predisposition, environmental triggers, immune dysregulation, and abnormal responses to microbial factors. Further research is needed to unravel the intricate interplay between these factors and identify targeted therapeutic approaches for Behcet’s Disease. (Nursing Paper Examples on Behcet’s Disease: Understanding a Complex Disorder)

Pathophysiology

Behcet’s Disease is characterized by systemic inflammation and vasculitis, leading to various manifestations across multiple organs and tissues. The pathophysiology of Behcet’s Disease involves a complex interplay of immune dysregulation, endothelial dysfunction, and inflammatory mediators.

Immune Dysregulation: Dysregulation of the immune system plays a central role in the pathogenesis of Behcet’s Disease. Abnormal activation of T cells, particularly CD4+ T cells, and dysregulated cytokine production contribute to the chronic inflammatory response observed in the disease. Elevated levels of pro-inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α), interleukin-1 (IL-1), and interleukin-6 (IL-6), further perpetuate the inflammatory cascade, leading to tissue damage and organ involvement.

Endothelial Dysfunction: Endothelial dysfunction, characterized by impaired endothelial cell function and integrity, is a key feature of Behcet’s Disease. Endothelial cells play a crucial role in maintaining vascular homeostasis and regulating inflammatory responses. In Behcet’s Disease, endothelial dysfunction leads to aberrant expression of adhesion molecules, increased vascular permeability, and enhanced leukocyte adhesion and migration into tissues. These alterations contribute to the development of vasculitis and tissue inflammation observed in Behcet’s Disease.

Vasculitis: Vasculitis, inflammation of blood vessels, is a hallmark feature of Behcet’s Disease and underlies many of its clinical manifestations. Vasculitis in Behcet’s Disease can affect blood vessels of all sizes, including arteries, veins, and capillaries, leading to a wide range of vascular complications such as thrombosis, aneurysms, and vessel occlusion. The inflammatory infiltrates in vessel walls, consisting of T cells, macrophages, and neutrophils, contribute to vascular damage and tissue injury, further perpetuating the inflammatory process.

Overall, Behcet’s Disease is characterized by immune dysregulation, endothelial dysfunction, and vasculitis, leading to systemic inflammation and tissue damage across multiple organ systems. Understanding the underlying pathophysiological mechanisms of Behcet’s Disease is crucial for developing targeted therapeutic strategies aimed at modulating the immune response and reducing inflammation to improve patient outcomes. (Nursing Paper Examples on Behcet’s Disease: Understanding a Complex Disorder)

DSM-5 Diagnosis

Behcet’s Disease is primarily diagnosed based on clinical criteria established by the International Study Group for Behcet’s Disease. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the diagnosis of Behcet’s Disease requires the presence of recurrent oral ulcers plus any two of the following:

  1. Recurrent Genital Ulcers: The presence of recurrent genital ulcers, typically observed on the vulva or scrotum, is a common manifestation of Behcet’s Disease and is considered a diagnostic criterion.
  2. Eye Inflammation (Uveitis): Uveitis, characterized by inflammation of the uvea (middle layer of the eye), is a significant complication of Behcet’s Disease. Eye involvement, presenting as symptoms such as eye pain, redness, blurred vision, photophobia, or floaters, fulfills the diagnostic criteria.
  3. Skin Lesions: Various skin lesions, including erythema nodosum-like lesions, papulopustular lesions resembling acne, and pathergy (an exaggerated skin reaction to minor trauma), are characteristic of Behcet’s Disease and contribute to the diagnostic criteria.
  4. Positive Pathergy Test: The pathergy test is a diagnostic procedure in which a small needle prick is made on the skin, typically on the forearm, and the reaction is observed. A positive pathergy test, defined as the development of a papule or pustule at the site of the needle prick within 24 to 48 hours, is considered indicative of Behcet’s Disease.

In addition to these clinical criteria, other diagnostic tests such as laboratory investigations (e.g., inflammatory markers, HLA-B51 genetic testing) and imaging studies (e.g., ocular examinations, MRI) may be performed to rule out other conditions and assess for complications associated with Behcet’s Disease. (Nursing Paper Examples on Behcet’s Disease: Understanding a Complex Disorder)

Treatment Regimens

Treatment for Behcet’s Disease aims to alleviate symptoms, reduce inflammation, prevent complications, and improve the quality of life for affected individuals. The choice of treatment depends on the severity and specific manifestations of the disease in each individual.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs such as ibuprofen or naproxen may be used to manage pain, reduce inflammation, and relieve symptoms associated with Behcet’s Disease, particularly during mild flares.

Corticosteroids: Corticosteroids, such as prednisone or methylprednisolone, are often prescribed to suppress immune-mediated inflammation during acute flares of Behcet’s Disease. These medications can help alleviate symptoms and reduce the severity of inflammatory manifestations, but long-term use may be associated with significant side effects.

Immunomodulatory Agents: Immunomodulatory agents such as colchicine, azathioprine, methotrexate, cyclosporine, and mycophenolate mofetil may be used to control disease activity, prevent relapses, and reduce the need for long-term corticosteroid therapy. Biologic therapies targeting specific immune pathways, such as tumor necrosis factor-alpha (TNF-α) inhibitors or interleukin-1 (IL-1) inhibitors, may also be considered for refractory cases or severe manifestations of Behcet’s Disease.

Topical Treatments: Topical treatments such as corticosteroid creams or ointments may be used to manage oral and genital ulcers and skin lesions associated with Behcet’s Disease. These topical therapies can help reduce pain, promote healing, and improve local symptoms. (Nursing Paper Examples on Behcet’s Disease: Understanding a Complex Disorder)

Patient Education and Self-Management

Patient education is essential for empowering individuals with Behcet’s Disease to understand their condition, manage symptoms, and make informed decisions about their health. Key components of patient education and self-management include:

  1. Understanding the Disease: Educating patients about the nature of Behcet’s Disease, its chronicity, and the potential impact on various organ systems helps individuals develop realistic expectations and cope with the challenges associated with the condition.
  2. Medication Adherence: Emphasizing the importance of adhering to prescribed medications as directed by healthcare providers helps optimize treatment outcomes and reduce the risk of disease flares and complications.
  3. Lifestyle Modifications: Encouraging patients to adopt healthy lifestyle habits such as regular exercise, balanced nutrition, adequate sleep, stress management, and smoking cessation can help improve overall well-being and potentially reduce disease activity.
  4. Monitoring and Self-Assessment: Teaching patients how to monitor disease symptoms, recognize signs of flares or complications, and seek prompt medical attention when necessary empowers individuals to actively participate in their care and collaborate with healthcare providers to optimize treatment outcomes.
  5. Disease-Specific Education: Providing tailored education about specific manifestations of Behcet’s Disease, such as oral and genital ulcer management, eye care, skin lesion care, and joint protection strategies, helps individuals manage symptoms and minimize the impact of the disease on their daily lives.

By providing comprehensive education and support, healthcare providers can empower individuals with Behcet’s Disease to effectively manage their condition, improve their quality of life, and achieve better long-term outcomes. (Nursing Paper Examples on Behcet’s Disease: Understanding a Complex Disorder)

Conclusion

Behcet’s Disease is a complex autoimmune disorder characterized by recurrent oral and genital ulcers, skin lesions, and inflammation of the eyes. While the exact cause remains unknown, a multifactorial etiology involving genetic predisposition, environmental triggers, immune dysregulation, and abnormal responses to microorganisms is implicated. The pathophysiology of Behcet’s Disease is characterized by systemic inflammation, vasculitis, and endothelial dysfunction. Diagnosis is based on clinical criteria, and treatment aims to alleviate symptoms, reduce inflammation, and prevent complications through a combination of NSAIDs, corticosteroids, immunomodulatory agents, and biological therapies. Patient education is crucial for empowering individuals to understand their condition, adhere to treatment regimens, and adopt self-management strategies to improve their quality of life. By providing comprehensive education and support, healthcare providers can help individuals with Behcet’s Disease effectively manage their condition and achieve better long-term outcomes. (Nursing Paper Examples on Behcet’s Disease: Understanding a Complex Disorder)

References

https://www.ncbi.nlm.nih.gov/books/NBK470257/

 
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Nursing Paper Example on Understanding Barth Syndrome

Nursing Paper Example on Understanding Barth Syndrome

Barth Syndrome, a rare genetic disorder, presents complex challenges to affected individuals and their families. This condition, characterized by mutations in the TAZ gene, disrupts mitochondrial function, leading to a range of debilitating symptoms. Despite its rarity, Barth Syndrome profoundly impacts various bodily systems, particularly the heart, muscles, and immune system. Understanding the causes, signs, and symptoms of Barth Syndrome is essential for accurate diagnosis and effective management. This paper aims to explore the intricacies of Barth Syndrome, including its causes, signs, and symptoms, etiology, pathophysiology, DSM-5 diagnosis criteria, treatment regimens, patient education, and potential avenues for future research. By shedding light on this condition, we can enhance awareness, improve diagnostic accuracy, and provide better support for individuals living with Barth Syndrome. (Nursing Paper Example on Understanding Barth Syndrome)

Nursing Paper Example on Understanding Barth Syndrome

Causes

Barth Syndrome arises from mutations in the TAZ gene located on the X chromosome. These mutations disrupt the normal functioning of mitochondria, the cell’s powerhouse responsible for generating energy. The TAZ gene encodes a protein called tafazzin, essential for maintaining the structure and function of mitochondria. When mutations occur in the TAZ gene, tafazzin production is impaired, leading to mitochondrial dysfunction.

The exact mechanism by which TAZ gene mutations affect mitochondrial function is not fully understood. However, it is believed that tafazzin plays a crucial role in remodeling cardiolipin, a phospholipid found in the inner mitochondrial membrane. Cardiolipin is essential for various mitochondrial processes, including oxidative phosphorylation, the process by which cells generate energy.

Mutations in the TAZ gene disrupt cardiolipin remodeling, affecting mitochondrial function and energy production. As a result, cells, particularly those in tissues with high energy demands such as the heart, muscles, and immune system, are unable to function properly. This disruption in cellular energy metabolism contributes to the characteristic symptoms of Barth Syndrome, including cardiomyopathy, muscle weakness, growth delays, and neutropenia.

Since Barth Syndrome is an X-linked genetic disorder, it primarily affects males. Females who carry a single copy of the mutated TAZ gene are typically asymptomatic or may exhibit mild symptoms due to random X-chromosome inactivation.

Barth Syndrome is caused by mutations in the TAZ gene, leading to mitochondrial dysfunction and disruption of cellular energy metabolism. These mutations impair tafazzin production and cardiolipin remodeling, affecting various bodily systems and resulting in the characteristic symptoms of the disorder. (Nursing Paper Example on Understanding Barth Syndrome)

Nursing Paper Example on Understanding Barth Syndrome

Signs and Symptoms

Barth Syndrome presents a spectrum of symptoms that can vary in severity and may change over time. The hallmark features of Barth Syndrome include cardiomyopathy, muscle weakness, growth delays, and neutropenia.

Cardiomyopathy, a condition characterized by weakened heart muscles, is a common manifestation of Barth Syndrome. It can lead to symptoms such as fatigue, shortness of breath, chest pain, and an irregular heartbeat. In severe cases, cardiomyopathy can result in heart failure, a life-threatening condition requiring immediate medical attention.

Muscle weakness is another prominent symptom of Barth Syndrome. Individuals may experience generalized muscle weakness, particularly affecting skeletal muscles used for movement. This can lead to difficulties with mobility, including walking and climbing stairs, as well as challenges with activities of daily living.

Growth delays are frequently observed in individuals with Barth Syndrome, manifesting as below-average height and weight for their age. These growth deficits may become apparent in infancy or early childhood and can persist into adulthood.

Neutropenia, a condition characterized by low levels of neutrophils, a type of white blood cell, is a common hematological feature of Barth Syndrome. Neutrophils play a crucial role in the immune system’s defense against infections. Therefore, individuals with neutropenia are at an increased risk of recurrent bacterial infections, particularly of the skin, respiratory tract, and mucous membranes.

In addition to these hallmark symptoms, individuals with Barth Syndrome may experience other health issues, including feeding difficulties, developmental delays, gastrointestinal problems, and exercise intolerance. The severity and combination of symptoms can vary among affected individuals, making the clinical presentation of Barth Syndrome highly variable. Early recognition and diagnosis of these signs and symptoms are crucial for initiating appropriate medical management and supportive care. (Nursing Paper Example on Understanding Barth Syndrome)

Etiology

The etiology of Barth Syndrome lies in genetic mutations affecting the TAZ gene located on the X chromosome. This gene encodes a protein called tafazzin, which plays a vital role in maintaining the integrity of mitochondrial membranes, particularly through the remodeling of cardiolipin, a phospholipid crucial for mitochondrial function.

The mutations in the TAZ gene result in dysfunctional tafazzin, leading to abnormalities in cardiolipin composition and structure within the inner mitochondrial membrane. This disruption impairs the efficiency of oxidative phosphorylation, the process by which cells generate energy in the form of adenosine triphosphate (ATP). Consequently, affected cells experience energy deficits, leading to the characteristic symptoms of Barth Syndrome.

The inheritance pattern of Barth Syndrome follows an X-linked recessive pattern. Since the TAZ gene is located on the X chromosome, the condition predominantly affects males. Females have two X chromosomes and therefore, if they inherit a mutated TAZ gene on one chromosome, the normal gene on the other chromosome may compensate, resulting in milder or asymptomatic presentation. However, some carrier females may exhibit mild symptoms due to random X-chromosome inactivation.

While most cases of Barth Syndrome are caused by mutations in the TAZ gene, there is significant genetic heterogeneity observed among affected individuals. Variations in the specific mutations and their locations within the TAZ gene can influence the severity and presentation of the disorder. Additionally, other genetic and environmental factors may modulate the clinical features of Barth Syndrome, contributing to its variable expressivity and phenotypic spectrum.

Overall, the etiology of Barth Syndrome is rooted in genetic mutations affecting mitochondrial function, particularly involving the TAZ gene and its role in cardiolipin remodeling. Understanding these underlying genetic mechanisms is essential for accurate diagnosis, genetic counseling, and potential therapeutic interventions for individuals affected by Barth Syndrome. (Nursing Paper Example on Understanding Barth Syndrome)

Nursing Paper Example on Understanding Barth Syndrome

Pathophysiology

Barth Syndrome’s pathophysiology primarily revolves around mitochondrial dysfunction resulting from mutations in the TAZ gene. Tafazzin, the protein encoded by the TAZ gene, plays a crucial role in cardiolipin remodeling within the inner mitochondrial membrane. Cardiolipin is essential for maintaining mitochondrial structure and function, particularly in oxidative phosphorylation, the process by which cells generate ATP, the energy currency of the cell.

In individuals with Barth Syndrome, mutations in the TAZ gene lead to dysfunctional tafazzin, disrupting cardiolipin remodeling. This disruption affects the stability and fluidity of the mitochondrial membrane, impairing its ability to carry out oxidative phosphorylation efficiently. As a result, affected cells experience energy deficits, leading to various clinical manifestations observed in Barth Syndrome.

Mitochondrial dysfunction in Barth Syndrome primarily affects tissues with high energy demands, such as the heart, skeletal muscles, and immune system. Cardiomyocytes, the cells responsible for heart contraction, are particularly susceptible to mitochondrial dysfunction due to their continuous need for energy to maintain cardiac function. Consequently, individuals with Barth Syndrome often develop cardiomyopathy, characterized by weakened heart muscles and impaired cardiac function.

Skeletal muscles, which rely on oxidative phosphorylation for energy during physical activity, also exhibit dysfunction in Barth Syndrome. This leads to muscle weakness and fatigue, impacting mobility and physical functioning in affected individuals.

Additionally, mitochondrial dysfunction in Barth Syndrome affects the immune system, leading to neutropenia, a condition characterized by low levels of neutrophils, a type of white blood cell crucial for fighting infections. This renders individuals more susceptible to recurrent bacterial infections, further contributing to the clinical manifestations of the disorder.

Overall, the pathophysiology of Barth Syndrome involves mitochondrial dysfunction resulting from mutations in the TAZ gene, leading to energy deficits and cellular dysfunction, particularly in tissues with high energy demands. Understanding these underlying mechanisms is crucial for developing targeted interventions to manage and potentially mitigate the impact of Barth Syndrome on affected individuals.

DMS-5 Diagnosis

Diagnosing Barth Syndrome involves a comprehensive evaluation following the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The diagnostic process typically begins with a thorough medical history and physical examination to assess the presence of characteristic signs and symptoms associated with the disorder.

Genetic testing plays a crucial role in confirming the diagnosis of Barth Syndrome. Analysis of the TAZ gene for mutations is essential to identify specific genetic abnormalities associated with the condition. Identification of mutations in the TAZ gene confirms the diagnosis of Barth Syndrome, particularly in individuals presenting with characteristic clinical features.

In addition to genetic testing, clinical evaluation of symptoms is essential for diagnosing Barth Syndrome. Common manifestations such as cardiomyopathy, muscle weakness, growth delays, and neutropenia are carefully assessed to support the diagnosis. Laboratory tests may also be performed to evaluate cardiac function, muscle strength, growth parameters, and blood counts.

Diagnostic criteria outlined in the DSM-5 help clinicians establish a clear diagnosis of Barth Syndrome based on the presence of characteristic signs and symptoms, supported by genetic testing and clinical evaluation. The multidisciplinary approach involving medical history, physical examination, genetic testing, and laboratory investigations ensures accurate diagnosis and appropriate management of individuals with Barth Syndrome.

Overall, the DSM-5 criteria provide a standardized framework for diagnosing Barth Syndrome, enabling clinicians to identify affected individuals based on specific clinical features and genetic abnormalities. Early recognition and diagnosis are crucial for initiating timely interventions and providing appropriate medical care to improve outcomes for individuals with Barth Syndrome. (Nursing Paper Example on Understanding Barth Syndrome)

Treatment Regimens and Patient Education

The management of Barth Syndrome involves a multidisciplinary approach aimed at addressing the various symptoms and complications associated with the disorder. Treatment regimens focus on symptom management, supportive care, and promoting overall well-being in affected individuals. Patient education plays a crucial role in empowering patients and their families to understand the condition and actively participate in their care.

Medications: Pharmacological interventions are tailored to address specific symptoms and complications of Barth Syndrome. For individuals with cardiomyopathy, medications such as angiotensin-converting enzyme (ACE) inhibitors and beta-blockers may be prescribed to improve cardiac function and manage heart failure symptoms. Other medications may be used to address muscle weakness, growth delays, and neutropenia as needed.

Nutritional Support: Nutritional interventions are essential for individuals with Barth Syndrome to support growth and development, optimize energy levels, and maintain overall health. A balanced diet rich in nutrients, including proteins, carbohydrates, fats, vitamins, and minerals, is recommended. In some cases, dietary supplements or specialized formulas may be prescribed to address specific nutritional deficiencies or challenges.

Physical Therapy: Physical therapy plays a vital role in managing muscle weakness and promoting mobility and functional independence in individuals with Barth Syndrome. Tailored exercise programs, stretching exercises, and muscle-strengthening activities help improve muscle tone, flexibility, and overall physical function. Physical therapists also guide adaptive equipment and assistive devices to enhance mobility and facilitate activities of daily living.

Patient Education: Patient education is essential for individuals with Barth Syndrome and their families to understand the nature of the disorder, its potential complications, and the importance of adherence to treatment regimens. Education sessions provide information on symptom management, medication administration, dietary recommendations, and strategies to optimize overall health and well-being. Patients and families are encouraged to actively participate in treatment decisions, communicate openly with healthcare providers, and seek support from patient advocacy groups and support networks.

Regular Monitoring: Regular follow-up visits with healthcare providers are crucial for monitoring disease progression, assessing treatment efficacy, and addressing any emerging issues or complications. Monitoring may include cardiac evaluations, growth assessments, nutritional status evaluations, blood count monitoring, and other relevant tests as needed.

Overall, a comprehensive treatment approach, coupled with patient education and support, is essential for optimizing outcomes and enhancing the quality of life for individuals living with Barth Syndrome. By addressing symptoms, promoting healthy lifestyle habits, and fostering patient empowerment, healthcare providers can help individuals with Barth Syndrome thrive despite the challenges posed by this complex disorder. (Nursing Paper Example on Understanding Barth Syndrome)

Conclusion

Barth Syndrome is a rare genetic disorder characterized by mutations in the TAZ gene, leading to mitochondrial dysfunction and a range of debilitating symptoms. The causes, signs, and symptoms of Barth Syndrome, along with its etiology and pathophysiology, highlight the complexity of this condition. Accurate diagnosis according to DSM-5 criteria is crucial for appropriate management. Treatment regimens focus on symptom management, supportive care, and patient education. Patient education plays a pivotal role in empowering individuals and their families to understand the condition and actively participate in their care. By addressing symptoms, promoting healthy lifestyle habits, and fostering patient empowerment, healthcare providers can enhance the quality of life for individuals living with Barth Syndrome. Ongoing research offers hope for improved understanding and management of this complex disorder, paving the way for better outcomes in the future. (Nursing Paper Example on Understanding Barth Syndrome)

References

https://www.ncbi.nlm.nih.gov/books/NBK247162/

 
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Nursing Paper Example on Alpers Disease: Understanding a Rare Neurological Disorder

Nursing Paper Example on Alpers Disease: Understanding a Rare Neurological Disorder

Alpers Disease, also recognized as Alpers-Huttenlocher syndrome, is an uncommon neurological disorder that profoundly impacts infants and young children, often presenting within the initial years of life. This condition, characterized by a trio of symptoms encompassing seizures, liver dysfunction, and progressive neurological degeneration, was first delineated by Bernard Jacob Alpers in 1931. Despite its rarity, Alpers Disease poses significant challenges to affected individuals and their families due to its severe and debilitating nature. Understanding the underlying causes, clinical manifestations, and management strategies for Alpers Disease is crucial for healthcare professionals and caregivers alike. In this paper, we will delve into the causes, signs and symptoms, etiology, pathophysiology, DMS-5 diagnosis criteria, treatment regimens and patient education, and conclude by highlighting the importance of comprehensive care for individuals grappling with this challenging condition. (Nursing Paper Example on Alpers Disease: Understanding a Rare Neurological Disorder)

Nursing Paper Example on Alpers Disease: Understanding a Rare Neurological Disorder

Causes

The exact cause of Alpers Disease remains enigmatic, yet it is predominantly attributed to genetic mutations affecting mitochondrial DNA (mtDNA). Mitochondria, revered as the powerhouse of the cell, play a pivotal role in energy production. The mutations implicated in Alpers Disease primarily target genes responsible for mitochondrial function, particularly those crucial for DNA replication and maintenance within mitochondria.

These genetic mutations engender mitochondrial dysfunction, thereby impeding energy metabolism, particularly in tissues with elevated energy requisites like the brain and liver. Consequently, affected individuals endure a cascade of physiological disturbances, culminating in the characteristic triad of symptoms associated with Alpers Disease.

Mitochondrial DNA mutations are typically inherited in an autosomal recessive pattern, signifying that both parents must carry a mutated gene for their offspring to manifest the disease. Occasionally, Alpers Disease can also result from spontaneous mutations occurring in the mtDNA during embryonic development.

It is essential to recognize that while genetic mutations serve as the primary precipitant for Alpers Disease, environmental factors, and additional genetic modifiers may influence the severity and clinical presentation of the disorder. Furthermore, the variable penetrance and expressivity of mitochondrial DNA mutations contribute to the heterogeneous nature of Alpers Disease, wherein affected individuals may exhibit a spectrum of symptoms ranging from mild to severe.

Given the intricate interplay between genetic predisposition and environmental factors in the pathogenesis of Alpers Disease, further research endeavors are imperative to elucidate the precise mechanisms underlying this debilitating disorder. Such insights hold the potential to inform the development of novel therapeutic interventions aimed at ameliorating the clinical course and enhancing the quality of life for individuals grappling with Alpers Disease. (Nursing Paper Example on Alpers Disease: Understanding a Rare Neurological Disorder)

Signs and Symptoms

Alpers Disease presents a constellation of symptoms that progressively worsen over time, severely impairing affected individuals’ quality of life. The clinical manifestations of this disorder are diverse, encompassing neurological, hepatic, and systemic abnormalities.

Nursing Paper Example on Alpers Disease: Understanding a Rare Neurological Disorder

Neurological Symptoms: Seizures represent a hallmark feature of Alpers Disease and often serve as the initial presenting symptom. These seizures typically commence in infancy or early childhood and tend to be refractory to conventional antiepileptic medications. As the disease progresses, affected individuals may experience various types of seizures, including focal, generalized, or myoclonic seizures.

Developmental Regression: Progressive developmental regression is a prominent feature of Alpers Disease, characterized by a loss of previously acquired developmental milestones. Affected individuals may exhibit a decline in motor skills, speech, and cognitive abilities, ultimately leading to profound intellectual disability.

Neurological Decline: Over time, individuals with Alpers Disease experience a relentless deterioration of neurological function, marked by a decline in motor coordination, muscle weakness, and spasticity. The progressive neurodegeneration may also manifest as movement disorders, including dystonia and ataxia.

Hepatic Dysfunction: Liver involvement is another cardinal feature of Alpers Disease, presenting as hepatomegaly, jaundice, and signs of hepatic failure. Liver dysfunction may manifest early in infancy or later in the disease course and can significantly impact overall prognosis.

Systemic Symptoms: In addition to neurological and hepatic manifestations, individuals with Alpers Disease may exhibit systemic symptoms, including failure to thrive, feeding difficulties, and metabolic disturbances.

Ophthalmological Abnormalities: Ophthalmological abnormalities, such as optic atrophy and retinitis pigmentosa, have also been reported in some individuals with Alpers Disease, further contributing to the multisystemic nature of the disorder.

The progressive nature and multisystemic involvement of Alpers Disease underscore the complex pathophysiology underlying this devastating disorder, necessitating a multidisciplinary approach to management and care. (Nursing Paper Example on Alpers Disease: Understanding a Rare Neurological Disorder)

Etiology

Alpers Disease is primarily rooted in genetic aberrations that disrupt mitochondrial function, leading to the characteristic clinical features observed in affected individuals. The genetic etiology of Alpers Disease predominantly revolves around mutations in genes encoding proteins essential for mitochondrial DNA (mtDNA) replication and maintenance.

Mitochondria play a pivotal role in cellular energy production through oxidative phosphorylation, a process that generates adenosine triphosphate (ATP). Mutations in genes encoding components of the mitochondrial DNA polymerase gamma (POLG) enzyme complex, such as the POLG gene itself, have been identified as major contributors to Alpers Disease. POLG is crucial for mtDNA replication and repair, and mutations in this gene impair mitochondrial DNA synthesis, leading to mitochondrial dysfunction.

Furthermore, mutations in other genes involved in mitochondrial DNA replication and maintenance, including TWNK (Twinkle) and DGUOK (Deoxyguanosine Kinase), have also been implicated in the pathogenesis of Alpers Disease. These genetic mutations disrupt mitochondrial DNA replication and repair processes, culminating in mitochondrial dysfunction and cellular energy depletion.

The inheritance pattern of Alpers Disease is typically autosomal recessive, necessitating the presence of mutations in both alleles of the causative gene for disease manifestation. However, in some cases, Alpers Disease can result from de novo mutations occurring sporadically during embryonic development.

Although the genetic etiology of Alpers Disease predominantly involves mutations in nuclear genes encoding mitochondrial proteins, mitochondrial DNA mutations can also contribute to disease pathogenesis. Mitochondrial DNA mutations can arise spontaneously or be maternally inherited and can further exacerbate mitochondrial dysfunction, amplifying the severity of clinical manifestations in affected individuals.

Understanding the underlying genetic basis of Alpers Disease is critical for accurate diagnosis, genetic counseling, and potential targeted therapeutic interventions aimed at mitigating the devastating consequences of this debilitating disorder. (Nursing Paper Example on Alpers Disease: Understanding a Rare Neurological Disorder)

Pathophysiology

The pathophysiology of Alpers Disease revolves around mitochondrial dysfunction, which disrupts cellular energy metabolism and leads to widespread neuronal and hepatic damage. Mitochondria, organelles responsible for generating cellular energy in the form of adenosine triphosphate (ATP), play a central role in the pathogenesis of this disorder.

Mutations in genes encoding proteins involved in mitochondrial DNA (mtDNA) replication and maintenance, such as POLG, TWNK, and DGUOK, impair mitochondrial DNA synthesis and repair processes. Consequently, mitochondrial dysfunction ensues, characterized by reduced ATP production and increased production of reactive oxygen species (ROS).

The impaired energy metabolism resulting from mitochondrial dysfunction particularly affects tissues with high energy demands, such as the brain and liver. Neurons are highly susceptible to mitochondrial dysfunction due to their reliance on ATP for synaptic transmission and neuronal signaling. The progressive neuronal degeneration observed in Alpers Disease is attributed to energy depletion, oxidative stress, and impaired mitochondrial function, leading to neuronal cell death.

Hepatic dysfunction in Alpers Disease stems from mitochondrial impairment and the resultant disruption of liver metabolism. Mitochondria play a crucial role in hepatic energy metabolism, and their dysfunction leads to hepatocyte injury, hepatomegaly, and liver failure.

The accumulation of reactive oxygen species (ROS) resulting from mitochondrial dysfunction exacerbates cellular damage, leading to oxidative stress and further amplifying tissue injury. Additionally, impaired mitochondrial function disrupts calcium homeostasis and alters cellular signaling pathways, contributing to the pathogenesis of Alpers Disease.

Overall, the pathophysiology of Alpers Disease is characterized by mitochondrial dysfunction, energy depletion, oxidative stress, and widespread cellular damage, particularly affecting the brain and liver. Understanding these underlying pathogenic mechanisms is crucial for developing targeted therapeutic interventions aimed at ameliorating mitochondrial dysfunction and mitigating the devastating consequences of this debilitating disorder. (Nursing Paper Example on Alpers Disease: Understanding a Rare Neurological Disorder)

DMS-5 Diagnosis

Diagnosing Alpers Disease typically involves a comprehensive clinical evaluation, neuroimaging studies, and genetic testing to ascertain the presence of characteristic symptoms and identify underlying genetic mutations. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), does not delineate specific diagnostic criteria for Alpers Disease but provides guidelines for assessing the clinical presentation and determining the appropriate diagnostic approach.

The DSM-5 criteria for epilepsy, a common feature of Alpers Disease, encompass recurrent, unprovoked seizures, which align with the clinical manifestation of seizures observed in affected individuals. Additionally, developmental regression, cognitive decline, and neurological abnormalities evident in Alpers Disease may fulfill the criteria for intellectual disability or other neurodevelopmental disorders outlined in the DSM-5.

Neuroimaging studies, particularly magnetic resonance imaging (MRI), play a crucial role in the diagnostic workup of Alpers Disease. MRI findings may reveal characteristic abnormalities, including cerebral atrophy, white matter changes, and signal abnormalities in the basal ganglia, which are consistent with the neurodegenerative nature of the disorder.

Genetic testing is paramount for confirming the diagnosis of Alpers Disease, as it enables the identification of mutations in genes associated with mitochondrial dysfunction, such as POLG, TWNK, and DGUOK. Targeted sequencing or whole-exome sequencing techniques are utilized to detect pathogenic variants in these genes, providing definitive confirmation of the diagnosis.

The diagnostic evaluation of Alpers Disease necessitates a multidisciplinary approach involving neurologists, geneticists, and other healthcare professionals. By integrating clinical assessment, neuroimaging studies, and genetic testing, healthcare providers can establish an accurate diagnosis and initiate appropriate management strategies tailored to the individual needs of patients with Alpers Disease. (Nursing Paper Example on Alpers Disease: Understanding a Rare Neurological Disorder)

Treatment Regimens and Patient Education

As of now, there is no cure for Alpers Disease, and treatment primarily focuses on managing symptoms and providing supportive care to improve the quality of life for affected individuals. Given the complex nature of this disorder, treatment regimens typically entail a multidisciplinary approach involving neurologists, hepatologists, geneticists, and other healthcare professionals.

Symptom Management: Antiepileptic drugs (AEDs) are commonly prescribed to manage seizures in individuals with Alpers Disease. However, seizures associated with this disorder are often refractory to conventional AEDs, necessitating a tailored approach to medication management. Adjunctive therapies, such as ketogenic diet therapy or other dietary interventions, may be considered in some cases to help control seizures.

Supportive Care: Supportive care plays a pivotal role in managing the diverse array of symptoms associated with Alpers Disease. Physical and occupational therapies are integral components of supportive care, aiming to optimize motor function, enhance mobility, and improve the overall quality of life for affected individuals. Speech therapy may also be beneficial in addressing communication difficulties and speech impairments.

Nutritional Support: Given the hepatic involvement observed in Alpers Disease, ensuring adequate nutritional support is essential to support overall health and well-being. Nutritional interventions may include specialized formulas, dietary modifications, or gastrostomy tube placement to facilitate adequate nutrient intake, particularly in individuals with feeding difficulties or failure to thrive.

Liver Transplantation: In cases of severe liver dysfunction or liver failure secondary to Alpers Disease, liver transplantation may be considered as a therapeutic option. Liver transplantation can provide a life-saving intervention by replacing the diseased liver with a healthy donor organ, thereby improving the overall prognosis and quality of life for affected individuals.

Patient Education: Patient education is integral to the management of Alpers Disease, as it empowers patients and their families to understand the nature of the disorder and actively participate in treatment decisions. Educating patients and caregivers about the signs and symptoms of Alpers Disease, available treatment options, and strategies for symptom management can help alleviate anxiety and improve coping mechanisms.

Additionally, providing information about available support services, such as patient advocacy groups and community resources, can facilitate access to additional support and assistance for affected individuals and their families. By fostering open communication and providing comprehensive education, healthcare providers can empower patients and caregivers to navigate the challenges associated with Alpers Disease effectively.

While there is currently no cure for Alpers Disease, a multidisciplinary approach to treatment focusing on symptom management, supportive care, and patient education can significantly improve the quality of life for affected individuals and their families. By addressing the diverse array of symptoms and providing comprehensive support, healthcare providers can optimize outcomes and enhance the overall well-being of individuals grappling with this rare and debilitating disorder. (Nursing Paper Example on Alpers Disease: Understanding a Rare Neurological Disorder)

Conclusion

Alpers Disease presents a significant challenge due to its rare occurrence and severe clinical manifestations affecting infants and young children. Through an exploration of its causes, signs and symptoms, etiology, pathophysiology, DSM-5 diagnosis, treatment regimens, and patient education, we have gained a deeper understanding of this debilitating disorder. While the exact cause remains elusive, genetic mutations disrupting mitochondrial function play a central role in its pathogenesis. Symptom management, supportive care, and patient education are paramount in addressing the diverse array of symptoms and optimizing outcomes for affected individuals and their families. Despite the absence of a cure, a multidisciplinary approach to treatment, including antiepileptic drugs, supportive therapies, and nutritional support, can significantly enhance the quality of life for those grappling with Alpers Disease. By fostering open communication and providing comprehensive education, healthcare providers can empower patients and caregivers to navigate the challenges associated with this rare and devastating disorder effectively. (Nursing Paper Example on Alpers Disease: Understanding a Rare Neurological Disorder)

References

https://www.ncbi.nlm.nih.gov/books/NBK540966/

 
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Nursing Paper Example on The Absence of the Septum Pellucidum: Understanding a Rare Disorder

Nursing Paper Example on The Absence of the Septum Pellucidum: Understanding a Rare Disorder

The absence of the septum pellucidum is a rare condition where the structure that typically separates the two lateral ventricles of the brain is either partially or entirely missing. This disorder, although infrequent, presents significant challenges due to its association with various neurological and developmental abnormalities. Understanding the intricacies of this condition is essential for healthcare professionals to provide appropriate care and support to affected individuals and their families. Despite its rarity, the absence of the septum pellucidum underscores the complexity of brain development and highlights the need for further research to elucidate its underlying causes and improve diagnostic and therapeutic strategies. This paper explores the causes, signs, and symptoms, etiology, pathophysiology, DSM-5 diagnosis, treatment regimens, and patient education, and concludes with insights into the management and impact of this unique neurological disorder. (Nursing Paper Example on The Absence of the Septum Pellucidum: Understanding a Rare Disorder)

Nursing Paper Example on The Absence of the Septum Pellucidum: Understanding a Rare Disorder

Causes

The causes of the absence of the septum pellucidum are not yet fully understood, but researchers have identified several potential factors contributing to its development. One significant factor is believed to be abnormalities during fetal brain development. During the early stages of pregnancy, intricate processes guide the formation and organization of brain structures, including the septum pellucidum. Any disruption or deviation from these processes can lead to structural anomalies in the developing brain.

Genetic factors also play a role in predisposing individuals to this condition. Studies have suggested that certain genetic mutations or variations may increase the likelihood of developing the absence of the septum pellucidum. However, the specific genes involved and their precise contributions to the disorder remain areas of ongoing investigation.

Furthermore, environmental influences during pregnancy may contribute to the development of this condition. Factors such as maternal infections, exposure to toxins, or maternal health conditions can impact fetal brain development and increase the risk of structural abnormalities like the absence of the septum pellucidum.

Additionally, disruptions in the signaling pathways or molecular mechanisms involved in brain development may also contribute to the pathogenesis of this disorder. Research in this area aims to elucidate the intricate cellular and molecular processes underlying normal and abnormal brain development, providing valuable insights into the causes of conditions like the absence of the septum pellucidum.

Overall, the causes of the absence of the septum pellucidum are likely multifactorial, involving complex interactions between genetic predisposition and environmental influences during critical periods of fetal brain development. Further research is needed to unravel the precise mechanisms contributing to this condition and to develop targeted interventions for affected individuals. (Nursing Paper Example on The Absence of the Septum Pellucidum: Understanding a Rare Disorder)

Signs and Symptoms

The absence of the septum pellucidum presents a range of signs and symptoms that can vary in severity and presentation among affected individuals. Common manifestations of this disorder often become apparent during infancy, childhood, or adolescence.

Nursing Paper Example on The Absence of the Septum Pellucidum: Understanding a Rare Disorder

One of the primary symptoms associated with the absence of the septum pellucidum is cognitive deficits. Individuals affected by this condition may experience difficulties with learning, memory, attention, and problem-solving skills. These cognitive impairments can significantly impact academic performance and daily functioning.

Developmental delays are also commonly observed in individuals with the absence of the septum pellucidum. Motor skills, language development, and social-emotional milestones may be delayed compared to their peers. This can result in challenges with coordination, speech and language abilities, and social interactions.

Behavioral issues are another hallmark of the absence of the septum pellucidum. Individuals may exhibit behavioral problems such as impulsivity, hyperactivity, aggression, or emotional lability. These behavioral challenges can pose significant challenges for caregivers and may require behavioral interventions or management strategies.

Neurological abnormalities are frequently associated with the absence of the septum pellucidum. Seizures are a common neurological symptom, occurring in a significant portion of affected individuals. Visual impairments, including abnormalities in visual perception or processing, may also be present.

Additionally, some individuals with the absence of the septum pellucidum may experience other neurological symptoms such as headaches, balance problems, or sensory issues. These symptoms can further contribute to the overall impact of the disorder on an individual’s quality of life and daily functioning.

Overall, the signs and symptoms of the absence of the septum pellucidum encompass a wide range of cognitive, developmental, behavioral, and neurological manifestations that require comprehensive evaluation and management by healthcare professionals. Early recognition and intervention are essential for optimizing outcomes and supporting affected individuals in reaching their full potential. (Nursing Paper Example on The Absence of the Septum Pellucidum: Understanding a Rare Disorder)

Etiology

The etiology of the absence of the septum pellucidum is complex and involves multiple factors contributing to its development. While the precise cause remains unclear, researchers have identified several potential etiological factors that may play a role in the pathogenesis of this disorder.

Genetic factors are thought to contribute significantly to the development of the absence of the septum pellucidum. Studies have suggested a genetic predisposition, with certain gene mutations or variations increasing the susceptibility to structural abnormalities in the brain, including the absence of the septum pellucidum. However, the specific genes involved and their exact contributions to the disorder require further investigation.

Environmental influences during critical periods of fetal brain development are also believed to play a role in the etiology of the absence of the septum pellucidum. Factors such as maternal infections, exposure to toxins, nutritional deficiencies, or maternal health conditions can disrupt normal brain development and increase the risk of structural anomalies.

Furthermore, interactions between genetic and environmental factors may contribute to the pathogenesis of this disorder. Studies suggest that gene-environment interactions during prenatal development may influence the susceptibility to structural brain abnormalities like the absence of the septum pellucidum. These interactions may involve complex molecular mechanisms that impact neural development and organization.

Overall, the etiology of the absence of the septum pellucidum is likely multifactorial, involving a combination of genetic predisposition and environmental influences during critical periods of fetal brain development. Further research is needed to elucidate the specific genetic and environmental factors contributing to this disorder and to improve our understanding of its underlying mechanisms. Such insights are essential for the development of targeted interventions and management strategies for affected individuals. (Nursing Paper Example on The Absence of the Septum Pellucidum: Understanding a Rare Disorder)

Pathophysiology

The pathophysiology of the absence of the septum pellucidum involves disruptions in the normal development and organization of the brain, leading to structural abnormalities and functional deficits in affected individuals.

During fetal brain development, the septum pellucidum forms a thin membrane that separates the two lateral ventricles of the brain. In individuals with the absence of the septum pellucidum, this membrane fails to develop properly or is completely absent, resulting in a lack of separation between the ventricles.

This structural anomaly disrupts the normal architecture of the brain and affects the connectivity between different regions, leading to functional impairments. The absence of the septum pellucidum may disrupt neural pathways involved in cognitive processing, sensory perception, motor coordination, and emotional regulation.

Furthermore, the absence of the septum pellucidum can impact the flow of cerebrospinal fluid (CSF) within the brain. Normally, the septum pellucidum helps regulate the flow of CSF between the lateral ventricles. In its absence, CSF circulation may be altered, leading to changes in intracranial pressure and potentially contributing to symptoms such as headaches or neurological deficits.

The absence of the septum pellucidum is often associated with other structural brain abnormalities, such as agenesis of the corpus callosum or abnormalities in the development of the hippocampus. These additional anomalies further exacerbate the neurological and cognitive impairments observed in affected individuals.

Overall, the pathophysiology of the absence of the septum pellucidum involves disruptions in brain development, structural abnormalities, altered neural connectivity, and potential changes in CSF dynamics. These pathophysiological changes contribute to the wide range of symptoms and functional deficits observed in individuals with this disorder. Further research is needed to elucidate the underlying mechanisms and identify potential targets for therapeutic interventions. (Nursing Paper Example on The Absence of the Septum Pellucidum: Understanding a Rare Disorder)

DSM-5 Diagnosis

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the absence of the septum pellucidum is not listed as a specific diagnostic entity. However, this condition may be recognized within the context of related disorders and associated symptoms.

Structural brain abnormalities, including the absence of the septum pellucidum, may be considered in the diagnosis of intellectual disabilities or developmental disorders. These disorders are characterized by significant limitations in intellectual functioning and adaptive behavior, affecting various domains of daily life.

In cases where the absence of the septum pellucidum is associated with neurological symptoms such as seizures, visual impairments, or other neurological deficits, additional diagnostic considerations may be warranted. Depending on the specific clinical presentation, the absence of the septum pellucidum may be identified as a contributing factor in the diagnosis of neurological conditions or disorders.

Furthermore, if the absence of the septum pellucidum is associated with behavioral disturbances or psychiatric symptoms, it may be considered within the diagnostic criteria for psychiatric disorders such as attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), or mood disorders.

Overall, while the absence of the septum pellucidum is not specifically listed as a standalone diagnosis in the DSM-5, it may be recognized and considered within the context of associated symptoms and related disorders. Accurate diagnosis and comprehensive evaluation by healthcare professionals are essential for identifying and addressing the complex clinical presentations associated with this structural brain abnormality. (Nursing Paper Example on The Absence of the Septum Pellucidum: Understanding a Rare Disorder)

Treatment Regimens and Patient Education

Management of the absence of the septum pellucidum focuses on addressing symptoms, providing supportive care, and optimizing the overall well-being of affected individuals. Treatment regimens are tailored to address the specific needs and challenges associated with this rare neurological disorder.

1. Symptom Management:

  • Cognitive deficits: Educational interventions and specialized programs can help address learning difficulties and promote cognitive development. Individualized educational plans (IEPs) and accommodations in academic settings may be implemented.
  • Behavioral issues: Behavioral therapy, counseling, and psychosocial interventions can help manage behavioral challenges such as impulsivity, aggression, and emotional lability. Parent training programs may also be beneficial.
  • Neurological symptoms: Medications may be prescribed to manage seizures or other neurological symptoms. Close monitoring and adjustment of medication regimens are essential for optimal symptom control.

2. Supportive Care:

  • Speech and language therapy: For individuals with speech and language delays or difficulties, speech therapy can improve communication skills and enhance social interactions.
  • Occupational therapy: Occupational therapy focuses on improving motor skills, coordination, and activities of daily living to promote independence and functional abilities.
  • Physical therapy: Physical therapy may be beneficial for individuals with motor impairments, helping to improve mobility, strength, and coordination.

3. Patient Education:

  • Understanding the disorder: Educating patients and their families about the nature of the absence of the septum pellucidum, its potential impact on various aspects of life, and available resources for support is crucial.
  • Treatment options: Providing information about treatment options, including therapies, medications, and supportive services, empowers patients and families to make informed decisions about their care.
  • Monitoring and follow-up: Emphasizing the importance of regular monitoring, follow-up appointments, and collaboration with healthcare providers ensures ongoing management and adjustments to treatment regimens as needed.
  • Community resources: Connecting patients and families with community resources, support groups, and advocacy organizations can provide additional support and opportunities for networking and sharing experiences.

Patient education plays a vital role in promoting self-management, enhancing coping skills, and improving the overall quality of life for individuals with the absence of the septum pellucidum. By providing comprehensive information and support, healthcare professionals empower patients and families to navigate the challenges associated with this rare neurological disorder effectively. (Nursing Paper Example on The Absence of the Septum Pellucidum: Understanding a Rare Disorder)

Conclusion

The absence of the septum pellucidum presents a rare yet significant challenge in neurological and developmental disorders. Through a comprehensive understanding of its causes, signs, and symptoms, along with its complex etiology and pathophysiology, healthcare professionals can better diagnose and manage this condition. While not specifically listed in the DSM-5, recognition within related disorders facilitates tailored treatment approaches focused on symptom management and supportive care. Patient education plays a pivotal role in empowering individuals and families to navigate the challenges associated with the absence of the septum pellucidum, facilitating informed decision-making, and accessing appropriate resources. By implementing treatment regimens addressing cognitive, behavioral, and neurological symptoms, along with providing supportive services and community resources, healthcare professionals can enhance the overall well-being and quality of life of individuals affected by this disorder. Ongoing research and collaboration aim to advance our understanding and management of this unique neurological condition, ensuring optimal outcomes for affected individuals. (Nursing Paper Example on The Absence of the Septum Pellucidum: Understanding a Rare Disorder)

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7069873/

 
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The Cultural Nature of Human Development Assignment help

The Cultural Nature of Human Development Assignment help

The Cultural Nature of Human Development

Barbara Rogoff

OXFORD UNIVERSITY PRESS

 

 

The Cultural Nature

of Human Development

 

 

 Cultural 

 

 

Barbara Rogoff

 Human Development

1 2003

 

 

1 Oxford New York

Auckland Bangkok Buenos Aires Capetown Chennai Dar es Salaam Delhi Hong Kong Istanbul Karachi Kolkata Kuala Lumpur Madrid Melbourne Mexico City Mumbai Nairobi São Paulo Shanghai Taipei Tokyo Toronto

Copyright © 2003 by Barbara Rogoff

Published by Oxford University Press, Inc., 198 Madison Avenue, New York, New York 10016

www.oup.com

Oxford is a registered trademark of Oxford University Press

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of Oxford University Press.

Library of Congress Cataloging-in-Publication Data Rogoff, Barbara. The cultural nature of human development / Barbara Rogoff.

p. cm. Includes bibliographical references and index. ISBN 0-19-513133-9 1. Socialization. 2. Child development. 3. Cognition and culture. 4. Developmental psychology. I. Title. HM686 .R64 2003 305.231 — dc21 2002010393

9 8 7 6 5 4 3 2 1

Printed in the United States of America on acid-free paper

 

 

For Salem, Luisa, Valerie, and David

with appreciation for their companionship

and support all along the way.

 

 

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a c k n o w l e d g m e n t s

I deeply appreciate the wisdom, support, and challenges of Beatrice Whit- ing , Lois and Ben Paul, Mike Cole, Sylvia Scribner, Shep White, Jerry Kagan, Roy Malpass, Marta Navichoc Cotuc, Encarnación Perez, Pablo Cox Bixcul, and the children and parents of San Pedro, who opened my eyes to patterns of culture and how to think about them.

I am grateful to the insightful discussions and questions of Cathy An- gelillo, Krystal Bellinger, Rosy Chang, Pablo Chavajay, Erica Coy, Julie Hollo- way, Afsaneh Kalantari, Ed Lopez, Eugene Matusov, Rebeca Mejía Arauz, Behnosh Najafi, Emily Parodi, Ari Taub, Araceli Valle, and my graduate and undergraduate students who helped me develop these ideas. I especially appreciate the suggestions of Debi Bolter, Maricela Correa-Chávez, Sally Duensing, Shari Ellis, Ray Gibbs, Giyoo Hatano, Carol Lee, Elizabeth Ma- garian, Ruth Paradise, Keiko Takahashi, Catherine Cooper, Marty Chemers, and Wendy Williams and the valuable assistance of Karrie André and Cindy White. The editorial advice of Jonathan Cobb, Elizabeth Knoll, Joan Bossert, and several anonymous reviewers greatly improved the book. I greatly appreciate the donors and UCSC colleagues who created the UCSC Foundation chair in psychology that supports my work.

 

 

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       

 Orienting Concepts and Ways of Understanding the Cultural Nature of Human Development 

Looking for Cultural Regularities  One Set of Patterns: Children’s Age-Grading and Segregation

from Community Endeavors or Participation in Mature Activities 

Other Patterns  Orienting Concepts for Understanding Cultural Processes  Moving Beyond Initial Assumptions 

Beyond Ethnocentrism and Deficit Models  Separating Value Judgments from Explanations 

Diverse Goals of Development  Ideas of Linear Cultural Evolution  Moving Beyond Assumptions of a Single Goal of Human

Development  Learning through Insider/Outsider Communication 

Outsiders’ Position  Insiders’ Position 

Moving between Local and Global Understandings  Revising Understanding in Derived Etic Approaches  The Meaning of the “Same” Situation across Communities 

 

 

 Development as Transformation of Participation in Cultural Activities 

A Logical Puzzle for Researchers  An Example: “We always speak only of what we see”  Researchers Questioning Assumptions 

Concepts Relating Cultural and Individual Development  Whiting and Whiting’s Psycho-Cultural Model  Bronfenbrenner’s Ecological System  Descendents  Issues in Diagramming the Relation of Individual

and Cultural Processes  Sociocultural-Historical Theory  Development as Transformation of Participation

in Sociocultural Activity 

 Individuals, Generations, and Dynamic Cultural Communities 

Humans Are Biologically Cultural  Prepared Learning by Infants and Young Children  Where Do Gender Differences Come From? 

Participation in Dynamic Cultural Communities  Culture as a Categorical Property of Individuals versus

a Process of Participation in Dynamically Related Cultural Communities 

The Case of Middle-Class European American Cultural Communities 

Conceiving of Communities across Generations 

 Child Rearing in Families and Communities 

Family Composition and Governments  Cultural Strategies for Child Survival and Care  Infant-Caregiver Attachment 

Maternal Attachment under Severe Conditions  Infants’ Security of Attachment  Attachment to Whom? 

Family and Community Role Specializations  Extended Families  Differentiation of Caregiving, Companion, and Socializing Roles  Sibling Caregiving and Peer Relations  The Community as Caregiver 

Children’s Participation in or Segregation from Mature Community Activities  Access to Mature Community Activities 

x C O N T E N T S

 

 

“Pitching in” from Early Childhood  Excluding Children and Youth from Labor—

and from Productive Roles  Adults “Preparing” Children or Children Joining Adults 

Engaging in Groups or Dyads  Infant Orientation: Face-to-Face with Caregiver versus Oriented

to the Group  Dyadic versus Group Prototypes for Social Relations  Dyadic versus Multiparty Group Relations in Schooling 

 Developmental Transitions in Individuals’ Roles in Their Communities 

Age as a Cultural Metric for Development  Developmental Transitions Marking Change in Relation to

the Community  Rates of Passing Developmental “Milestones” 

Age Timing of Learning  Mental Testing  Development as a Racetrack 

According Infants a Unique Social Status  Contrasting Treatment of Toddlers and Older Siblings  Continuities and Discontinuities across Early Childhood 

Responsible Roles in Childhood  Onset of Responsibility at Age 5 to 7?  Maturation and Experience 

Adolescence as a Special Stage  Initiation to Manhood and Womanhood  Marriage and Parenthood as Markers of Adulthood  Midlife in Relation to Maturation of the Next Generation  Gender Roles 

The Centrality of Child Rearing and Household Work in Gender Role Specializations 

Sociohistorical Changes over Millennia in Mothers’ and Fathers’ Roles 

Sociohistorical Changes in Recent Centuries in U.S. Mothers’ and Fathers’ Roles 

Occupational Roles and Power of Men and Women  Gender and Social Relations 

 Interdependence and Autonomy 

Sleeping “Independently”  Comfort from Bedtime Routines and Objects  Social Relations in Cosleeping 

C O N T E N T S xi

 

 

Independence versus Interdependence with Autonomy  Individual Freedom of Choice in an Interdependent System  Learning to Cooperate, with Freedom of Choice 

Adult-Child Cooperation and Control  Parental Discipline  Teachers’ Discipline 

Teasing and Shaming as Indirect Forms of Social Control  Conceptions of Moral Relations 

Moral Reasoning  Morality as Individual Rights or Harmonious Social Order  Learning the Local Moral Order  Mandatory and Discretionary Concepts in Moral Codes 

Cooperation and Competition  Cooperative versus Competitive Behavior in Games  Schooling and Competition 

 Thinking with the Tools and Institutions of Culture 

Specific Contexts Rather Than General Ability: Piaget around the World 

Schooling Practices in Cognitive Tests: Classification and Memory  Classification  Memory 

Cultural Values of Intelligence and Maturity  Familiarity with the Interpersonal Relations used in Tests  Varying Definitions of Intelligence and Maturity 

Generalizing Experience from One Situation to Another  Learning to Fit Approaches Flexibly to Circumstances  Cultural Tools for Thinking 

Literacy  Mathematics  Other Conceptual Systems 

Distributed Cognition in the Use of Cultural Tools for Thinking  Cognition beyond the Skull  Collaboration in Thinking across Time and Space  Collaboration Hidden in the Design of Cognitive Tools and

Procedures  An Example: Sociocultural Development in Writing Technologies and

Techniques  Crediting the Cultural Tools and Practices We Think With 

xii C O N T E N T S

 

 

8 Learning through Guided Participation in Cultural Endeavors 

Basic Processes of Guided Participation  Mutual Bridging of Meanings  Mutual Structuring of Participation 

Distinctive Forms of Guided Participation  Academic Lessons in the Family  Talk or Taciturnity, Gesture, and Gaze  Intent Participation in Community Activities 

9 Cultural Change and Relations among Communities 

Living the Traditions of Multiple Communities  Conflict among Cultural Groups  Transformations through Cultural Contact across Human History 

An Individual’s Experience of Uprooting Culture Contact  Community Changes through Recent Cultural Contacts 

Western Schooling as a Locus of Culture Change  Schooling as a Foreign Mission  Schooling as a Colonial Tool  Schooling as a Tool of U.S. Western Expansion 

The Persistence of Traditional Ways in Changing Cultural Systems  Contrasting Ideas of Life Success  Intervention in Cultural Organization of Community Life 

Dynamic Cultural Processes: Building on More Than One Way  Learning New Ways and Keeping Cultural Traditions in Communities

Where Schooling Has Not Been Prevalent  Immigrant Families Borrowing New Practices to Build on Cultural

Traditions  Learning New Ways and Keeping Cultural Traditions in Communities

Where Schooling Has Been Central  Cultural Variety as an Opportunity for Learning—for Individuals and

Communities  The Creative Process of Learning from Cultural Variation 

A Few Regularities  Concluding with a Return to the Orienting Concepts 

References 

Credits 

Index 

C O N T E N T S xiii

 

 

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The Cultural Nature

of Human Development

 

 

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1 Orienting Concepts

and Ways of Understanding

the Cultural Nature of Human Development

Human development is a cultural process. As a biological species, humans are defined in terms of our cultural participation. We are prepared by both our cultural and biological heritage to use language and other cultural tools and to learn from each other. Using such means as language and literacy, we can collectively remember events that we have not personally experienced —becoming involved vicariously in other people’s experience over many generations.

Being human involves constraints and possibilities stemming from long histories of human practices. At the same time, each generation continues to revise and adapt its human cultural and biological heritage in the face of current circumstances.

My aim in this book is to contribute to the understanding of cultural patterns of human development by examining the regularities that make sense of differences and similarities in communities’ practices and tradi- tions. In referring to cultural processes, I want to draw attention to the con- figurations of routine ways of doing things in any community’s approach to living. I focus on people’s participation in their communities’ cultural prac- tices and traditions, rather than equating culture with the nationality or ethnicity of individuals.

For understanding cultural aspects of human development, a primary goal of this book is to develop the stance that people develop as participants in cultural communities. Their development can be understood only in light of

3

 

 

the cultural practices and circumstances of their communities—which also change.

To date, the study of human development has been based largely on re- search and theory coming from middle-class communities in Europe and North America. Such research and theory often have been assumed to gen- eralize to all people. Indeed, many researchers make conclusions from work done in a single group in overly general terms, claiming that “the child does such-and-so” rather than “these children did such-and-so.”

For example, a great deal of research has attempted to determine at what age one should expect “the child” to be capable of certain skills. For the most part, the claims have been generic regarding the age at which chil- dren enter a stage or should be capable of a certain skill.

A cultural approach notes that different cultural communities may ex- pect children to engage in activities at vastly different times in childhood, and may regard “timetables” of development in other communities as surprising or even dangerous. Consider these questions of when children can begin to do certain things, and reports of cultural variations in when they do:

When does children’s intellectual development permit them to be responsible for others? When can they be trusted to take care of an infant?

In middle-class U.S. families, children are often not regarded as capable of caring for themselves or tending another child until perhaps age 10 (or later in some regions). In the U.K., it is an offense to leave a child under age 14 years without adult supervision (Subbotsky, 1995). However, in many other communities around the world, children begin to take on responsibility for tending other children at ages 5–7 (Rogoff et al., 1975; see figure 1.1), and in some places even younger children begin to assume this responsibility. For example, among the Kwara’ae of Oceania,

Three year olds are skilled workers in the gardens and household, excellent caregivers of their younger siblings, and accomplished at social interaction. Although young children also have time to play, many of the functions of play seem to be met by work. For both adults and children, work is accompanied by singing, joking, verbal play and entertaining conversation. Instead of playing with dolls, children care for real babies. In addition to working in the family gar- dens, young children have their own garden plots. The latter may seem like play, but by three or four years of age many children are taking produce they have grown themselves to the market to sell, thereby making a significant and valued contribution to the family income. (Watson-Gegeo, 1990, p. 87)

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Orienting Concepts 5

When do children’s judgment and coordination allow them to handle sharp knives safely?

Although U.S. middle-class adults often do not trust children below about age 5 with knives, among the Efe of the Democratic Republic of Congo, in- fants routinely use machetes safely (Wilkie, personal communication, 1989; see figure 1.2). Likewise, Fore (New Guinea) infants handle knives and fire safely by the time they are able to walk (Sorenson, 1979). Aka parents of Central Africa teach 8- to 10-month-old infants how to throw small spears and use small pointed digging sticks and miniature axes with sharp metal blades:

Training for autonomy begins in infancy. Infants are allowed to crawl or walk to whatever they want in camp and allowed to use knives, machetes, digging sticks, and clay pots around camp. Only if an infant begins to crawl into a fire or hits another child do parents or others interfere with the infant’s activity. It was not unusual, for in- stance, to see an eight month old with a six-inch knife chopping the branch frame of its family’s house. By three or four years of age chil- dren can cook themselves a meal on the fire, and by ten years of age Aka children know enough subsistence skills to live in the forest alone if need be. (Hewlett, 1991, p. 34)

f i g u r e 1 . 1

This 6-year-old Mayan (Guatemalan) girl is a skilled caregiver for her baby cousin.

 

 

So, at what age do children develop responsibility for others or suffi- cient skill and judgment to handle dangerous implements? “Ah! Of course, it depends,” readers may say, after making some guesses based on their own cultural experience.

Indeed. It depends. Variations in expectations for children make sense once we take into

account different circumstances and traditions. They make sense in the context of differences in what is involved in preparing “a meal” or “tending” a baby, what sources of support and danger are common, who else is nearby, what the roles of local adults are and how they live, what institutions peo- ple use to organize their lives, and what goals the community has for devel- opment to mature functioning in those institutions and cultural practices.

Whether the activity is an everyday chore or participation in a test or a laboratory experiment, people’s performance depends in large part on the circumstances that are routine in their community and on the cultural prac- tices they are used to. What they do depends in important ways on the cul- tural meaning given to the events and the social and institutional supports provided in their communities for learning and carrying out specific roles in the activities.

6

f i g u r e 1 . 2

An Efe baby of 11 months skillfully cuts a fruit with a machete, under the watchful eye of a relative (in the Ituri Forest of the Democratic Republic of Congo).

 

 

Cultural research has aided scholars in examining theories based on ob- servations in European and European American communities for their ap- plicability in other circumstances. Some of this work has provided crucial counterexamples demonstrating limitations or challenging basic assump- tions of a theory that was assumed to apply to all people everywhere. Ex- amples are Bronislaw Malinowski’s (1927) research questioning the Oedipal complex in Sigmund Freud’s theory and cross-cultural tests of cognitive de- velopment that led Jean Piaget to drop his claim that adolescents universally reach a “formal operational” stage of being able to systematically test hy- potheses (1972; see Dasen & Heron, 1981).

The importance of understanding cultural processes has become clear in recent years. This has been spurred by demographic changes throughout North America and Europe, which bring everyone more in contact with cultural traditions differing from their own. Scholars now recognize that understanding cultural aspects of human development is important for re- solving pressing practical problems as well as for progress in understanding the nature of human development in worldwide terms. Cultural research is necessary to move beyond overgeneralizations that assume that human development everywhere functions in the same ways as in researchers’ own communities, and to be able to account for both similarities and differences across communities.

Understanding regularities in the cultural nature of human develop- ment is a primary aim of this book. Observations made in Bora Bora or Cincinnati can form interesting cultural portraits and reveal intriguing dif- ferences in custom, but more important, they can help us to discern regu- larities in the diverse patterns of human development in different commu- nities.

Looking for Cultural Regularities

Beyond demonstrating that “culture matters,” my aim in this book is to in- tegrate the available ideas and research to contribute to a greater under- standing of how culture matters in human development. What regularities can help us make sense of the cultural aspects of human development? To understand the processes that characterize the dynamic development of in- dividual people as well as their changing cultural communities, we need to identify regularities that make sense of the variations across communities as well as the impressive commonalities across our human species. Although research on cultural aspects of human development is still relatively sparse, it is time to go beyond saying “It depends” to articulate patterns in the vari- ations and similarities of cultural practices.

Orienting Concepts 7

 

 

The process of looking across cultural traditions can help us become aware of cultural regularities in our own as well as other people’s lives, no matter which communities are most familiar to us. Cultural research can help us understand cultural aspects of our own lives that we take for granted as natural, as well as those that surprise us elsewhere.

For example, the importance given to paying attention to chronologi- cal age and age of developmental achievements is unquestioned by many who study human development. However, questions about age of transi- tions are themselves based on a cultural perspective. They fit with cultural institutions that use elapsed time since birth as a measure of development.

One Set of Patterns: Children’s Age-Grading and Segregation from Community Endeavors or Participation in Mature Activities

It was not until the last half of the 1800s in the United States and some other nations that age became a criterion for ordering lives, and this inten- sified in the early 1900s (Chudacoff, 1989). With the rise of industrializa- tion and efforts to systematize human services such as education and med- ical care, age became a measure of development and a criterion for sorting people. Specialized institutions were designed around age groups. Develop- mental psychology and pediatrics began at this time, along with old-age in- stitutions and age-graded schools.

Before then in the United States (and still, in many places), people rarely knew their age, and students advanced in their education as they learned. Both expert and popular writing in the United States rarely referred to spe- cific ages, although of course infancy, childhood, and adulthood were dis- tinguished. Over the past century and a half, the cultural concept of age and associated practices relying on age-grading have come to play a central, though often unnoticed role in ordering lives in some cultural communities —those of almost all contemporary readers of this book.

Age-grading accompanied the increasing segregation of children from the full range of activities in their community as school became compulsory and industrialization separated workplace from home. Instead of joining with the adult world, young children became more engaged in specialized child-focused institutions and practices, preparing children for later entry into the community.

I argue that child-focused settings and ways in which middle-class par- ents now interact with their children are closely connected with age-grading and segregation of children. Child-focused settings and middle-class child- rearing practices are also prominent in developmental psychology, connect- ing with ideas about stages of life, thinking and learning processes, motiva- tion, relations with peers and parents, disciplinary practices at home and

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school, competition and cooperation. I examine these cultural regularities throughout this book, as they are crucial to understanding development in many communities.

An alternative pattern involves integration of children in the everyday activities of their communities. This pattern involves very different con- cepts and cultural practices in human development (Rogoff, Paradise, Mejía Arauz, Correa-Chávez, & Angelillo, 2003). The opportunities to observe and pitch in allow children to learn through keen attention to ongoing ac- tivities, rather than relying on lessons out of the context of using the knowledge and skills taught. In this pattern, children’s relationships often involve multiparty collaboration in groups rather than interactions with one person at a time. I examine these and related regularities throughout this book.

Other Patterns

Because cultural research is still quite new, the work of figuring out what regularities can make sense of the similarities and variations across com- munities is not yet very far along. However, there are several other areas that appear to involve important regularities in cultural practices.

One set of regularities has to do with a pattern in which human rela- tions are assumed to require hierarchical organization, with someone in charge who controls the others. An alternative pattern is more horizontal in structure, with individuals being responsible together to the group. In this pattern, individuals are not controlled by others—individual autonomy of decision making is respected—but individuals are also expected to coordi- nate with the group direction. As I discuss in later chapters, issues of cul- tural differences in sleeping arrangements, discipline, cooperation, gender roles, moral development, and forms of assistance in learning all connect with this set of patterns.

Other patterns have to do with strategies for managing survival. Infant and adult mortality issues, shortage or abundance of food and other re- sources, and settled living or nomadic life seem to connect with cultural similarities and variations in infant care and attachment, family roles, stages and goals of development, children’s responsibilities, gender roles, cooper- ation and competition, and intellectual priorities.

I develop these suggestions of patterns of regularity and some others throughout the book. Although the search for regularities in cultural sys- tems has barely begun, it has great promise for helping us understand the surprising as well as the taken-for-granted ways of cultural communities worldwide, including one’s own.

To look for cultural patterns, it is important to examine how we can

Orienting Concepts 9

 

 

think about the roles of cultural processes and individual development. In the first three chapters, I focus on how we can conceptualize the interrelated roles of individual and cultural processes. In the next section of this chap- ter, I introduce some important orienting concepts for how we can think about the roles of cultural processes in human development.

Orienting Concepts for Understanding Cultural Processes

The orienting concepts for understanding cultural processes that I develop in this book stem from the sociocultural (or cultural-historical) perspective. This approach has become prominent in recent decades in the study of how cultural practices relate to the development of ways of thinking , remem- bering , reasoning , and solving problems (Rogoff & Chavajay, 1995). Lev Vygotsky, a leader of this approach from early in the twentieth century, pointed out that children in all communities are cultural participants, liv- ing in a particular community at a specific time in history. Vygotsky (1987) argued that rather than trying to “reveal the eternal child,” the goal is to dis- cover “the historical child.”

Understanding development from a sociocultural-historical perspective requires examination of the cultural nature of everyday life. This includes studying people’s use and transformation of cultural tools and technologies and their involvement in cultural traditions in the structures and institu- tions of family life and community practices.

A coherent understanding of the cultural, historical nature of human development is emerging from an interdisciplinary approach involving psy- chology, anthropology, history, sociolinguistics, education, sociology, and other fields. It builds on a variety of traditions of research, including par- ticipant observation of everyday life from an anthropological perspective, psychological research in naturalistic or constrained “laboratory” situations, historical accounts, and fine-grained analyses of videotaped events. To- gether, the research and scholarly traditions across fields are sparking a new conception of human development as a cultural process.

To understand regularities in the variations and similarities of cultural processes of human development across widespread communities it is im- portant to examine how we think about cultural processes and their relation to individual development. What do we mean by cultural processes? How do people come to understand their own as well as others’ cultural practices and traditions? How can we think about the ways that individuals both par- ticipate in and contribute to cultural processes? How do we approach un- derstanding the relation among cultural communities and how cultural communities themselves transform?

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This section outlines what I call orienting concepts for understanding cultural processes. These are concepts to guide thinking about how cultural processes contribute to human development.

The overarching orienting concept for understanding cultural processes is my version of the sociocultural-historical perspective:

Humans develop through their changing participation in the socio- cultural activities of their communities, which also change.

This overarching orienting concept provides the basis for the other orient- ing concepts for understanding cultural processes:

Culture isn’t just what other people do. It is common for people to think of themselves as having no culture (“Who, me? I don’t have an accent”) or to take for granted the circumstances of their his- torical period, unless they have contact with several cultural com- munities. Broad cultural experience gives us the opportunity to see the extent of cultural processes in everyday human activities and development, which relate to the technologies we use and our institutional and community values and traditions. The practices of researchers, students, journalists, and professors are cultural, as are the practices of oral historians, midwives, and shamans.

Understanding one’s own cultural heritage, as well as other cultural com- munities, requires taking the perspective of people of contrasting backgrounds. The most difficult cultural processes to examine are the ones that are based on confident and unquestioned assump- tions stemming from one’s own community’s practices. Cultural processes surround all of us and often involve subtle, tacit, taken-for-granted events and ways of doing things that require open eyes, ears, and minds to notice and understand. (Children are very alert to learning from these taken-for-granted ways of doing things.)

Cultural practices fit together and are connected. Each needs to be un- derstood in relation to other aspects of the cultural approach. Cultural processes involve multifaceted relations among many as- pects of community functioning; they are not just a collection of variables that operate independently. Rather, they vary together in patterned ways. Cultural processes have a coherence beyond “elements” such as economic resources, family size, moderniza- tion, and urbanization. It is impossible to reduce differences be- tween communities to a single variable or two (or even a dozen or two); to do so would destroy the coherence among the con- stellations of features that make it useful to refer to cultural

Orienting Concepts 11

 

 

processes. What is done one way in one community may be done another way in another community, with the same effect, and a practice done the same way in both communities may serve different ends. An understanding of how cultural practices fit together is essential.

Cultural communities continue to change, as do individuals. A commu- nity’s history and relations with other communities are part of cultural processes. In addition, variations among members of communities are to be expected, because individuals connect in various ways with other communities and experiences. Variation across and within communities is a resource for humanity, allow- ing us to be prepared for varied and unknowable futures.

There is not likely to be One Best Way. Understanding different cultural practices does not require determining which one way is “right” (which does not mean that all ways are fine). With an under- standing of what is done in different circumstances, we can be open to possibilities that do not necessarily exclude each other. Learning from other communities does not require giving up one’s own ways. It does require suspending one’s own assump- tions temporarily to consider others and carefully separating ef- forts to understand cultural phenomena from efforts to judge their value. It is essential to make some guesses as to what the patterns are, while continually testing and open-mindedly revis- ing one’s guesses. There is always more to learn.

The rest of this chapter examines how we can move beyond the in- evitable assumptions that we each bring from our own experience, to ex- pand our understanding of human development to encompass other cul- tural approaches. This process involves building on local perspectives to develop more informed ideas about regular patterns, by:

• Moving beyond ethnocentrism to consider different perspectives • Considering diverse goals of development • Recognizing the value of the knowledge of both insiders and out-

siders of specific cultural communities • Systematically and open-mindedly revising our inevitably local un-

derstandings so that they become more encompassing

The next two chapters take up related questions of ways to conceive of the relation between individual and cultural processes, the relation of cul- ture and biology (arguing that humans are biologically cultural), and how to think about participation in changing cultural communities.

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The remaining chapters examine regularities in the cultural nature of such aspects of development as children’s relations with other children and with parents, the development of thinking and remembering and reading skills, gender roles, and ways that communities arrange for children to learn. The research literature that I draw on in these chapters is wide-ranging, in- volving methods from psychology, anthropology, history, sociolinguistics, education, sociology, and related fields. The different research methods en- hance each other, helping us gain broader and deeper views of the cultural nature of human development. In choosing which research to include, I emphasize investigations that appear to be based on some close involvement with everyday life in the communities studied, to facilitate understanding phenomena as they play out.

The book’s concluding chapter focuses on the continually changing na- ture of cultural traditions as well as of people’s involvement in and creation of them. The chapter focuses particularly on changes related to Western schooling—increasingly pervasive in the lives of children and adults world- wide—to examine dynamic cultural processes that build new ways as well as building on cultural traditions.

Moving Beyond Initial Assumptions

It would hardly be fish who discovered the existence of water.

—Kluckhohn, 1949, p. 11

Like the fish that is unaware of water until it has left the water, people often take their own community’s ways of doing things for granted. Engaging with people whose practices differ from those of one’s own community can make one aware of aspects of human functioning that are not noticeable until they are missing or differently arranged (LeVine, 1966). “The most valuable part of comparative work in another culture [is] the chance to be shaken by it, and the experience of struggling to understand it” (Goldberg , 1977, p. 239).

People who have immersed themselves in communities other than their own frequently experience “culture shock.” Their new setting works in ways that conflict with what they have always assumed, and it may be unsettling to reflect on their own cultural ways as an option rather than the “natural” way. An essay on culture shock illustrates this notion by describ- ing discoveries of assumptions by travelers from the Northern Hemi- sphere:

Orienting Concepts 13

 

 

Assumptions are the things you don’t know you’re making, which is why it is so disorienting the first time you take the plug out of a washbasin in Australia and see the water spiraling down the hole the other way around. The very laws of physics are telling you how far you are from home.

In New Zealand even the telephone dials are numbered anti- clockwise. This has nothing to do with the laws of physics—they just do it differently there. The shock is that it had never occurred to you that there was any other way of doing it. In fact, you had never even thought about it at all, and suddenly here it is—different. The ground slips. (Adams & Carwardine, 1990, p. 141)

Even without being immersed in another cultural system, comparisons of cultural ways may create discomfort among people who have never be- fore considered the assumptions of their own cultural practices. Many in- dividuals feel that their own community’s ways are being questioned when they begin to learn about the diverse ways of other groups.

An indigenous American author pointed out that comparisons of cul- tural ways—necessary to achieve understanding of cultural processes— can be experienced as an uncomfortable challenge by people who are used to only one cultural system:

Such contrasts and comparisons tend to polarize people, making them feel either attacked or excluded, because all of us tend to think of comparisons as judgmental. . . . Comparisons are inevitable and so too is the important cultural bias that all of us foster as part of our heritage. (Highwater, 1995, p. 214)

One of my aims in this book is to separate value judgments from un- derstanding of the various ways that cultural processes function in human development. The need to avoid jumping to conclusions about the appro- priateness of other people’s ways has become quite clear in cultural research, and is the topic of the next section.

Suspending judgment is also often needed for understanding one’s own cultural ways. People sometimes assume that respect for other ways implies criticism of or problems with their own familiar ways. Therefore, I want to stress that the aim is to understand the patterns of different cultural com- munities, separating understanding of the patterns from judgments of their value. If judgments of value are necessary, as they often are, they will thereby be much better informed if they are suspended long enough to gain some understanding of the patterns involved in one’s own familiar ways as well as in the sometimes surprising ways of other communities.

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Beyond Ethnocentrism and Deficit Models

People often view the practices of other communities as barbaric. They as- sume that their community’s perspective on reality is the only proper or sensible or civilized one (Berger & Luckmann, 1966; Campbell & LeVine, 1961; Jahoda & Krewer, 1997). For example, the ancient Greeks facilitated their own cultural identity by devaluing people with different languages, customs, and conceptions of human nature (Riegel, 1973). Indeed, the word barbarous derives from the Greek term for “foreign,” “rude,” and “ig- norant” (Skeat, 1974; it is also the derivation of the name Barbara!). The term barbarian was applied to neighboring tribes who spoke languages un- intelligible to the Greeks, who heard only “bar-bar” when they spoke:

Beyond the civilizational core areas lay the lands of the barbarians, clad in skins, rude in manner, gluttonous, unpredictable, and aggres- sive in disposition, unwilling to submit to law, rule, and religious guidance . . . not quite human because they did not live in cities, where the only true and beautiful life could be lived, and because they appeared to lack articulate language. They were barbaraphonoi, bar-bar-speakers [Homer, Iliad 2.867], and in Aristotle’s view this made them natural slaves and outcasts. (Wolf, 1994, p. 2)

To impose a value judgment from one’s own community on the cul- tural practices of another—without understanding how those practices make sense in that community—is ethnocentric. Ethnocentrism involves making judgments that another cultural community’s ways are immoral, unwise, or inappropriate based on one’s own cultural background without taking into account the meaning and circumstances of events in that commu- nity. Another community’s practices and beliefs are evaluated as inferior without considering their origins, meaning , and functions from the per- spective of that community. It is a question of prejudging without appro- priate knowledge.

For example, it is common to regard good parenting in terms deriving from the practices of one’s own cultural community. Carolyn Edwards char- acterized contemporary middle-class North American child-rearing values (of parents and child-rearing experts) in the following terms:

Hierarchy is anathema, bigger children emphatically should not be allowed to dominate smaller ones, verbal reasoning and negotiation should prevail, children should always be presented choices, and physical punishment is seen as the first step to child abuse. All of the ideas woven together represent a meaning system. (1994, p. 6)

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Edwards pointed out that in other communities, not all components of this meaning system are found. If a Kenyan mother says, “Stop doing that or I will beat you,” it does not mean the same thing as if the statement came from a middle-class European American mother. In an environment in which people need a certain physical and mental toughness to thrive (for heavy physical work, preparedness for warfare, long marches with cycles of hunger), the occasional use of physical discipline has a very different mean- ing than in an environment where physical comfort is often taken for granted. In contrast, a Kenyan mother would not consider withholding food from her children as punishment: “To her, what American mothers do (in the best interests of their children), namely, restrict children’s food intake and deprive them of delicious, available, wanted food, would be terrible, un- thinkable, the next thing to child abuse!” (pp. 6–7). Viewed from outside each system of meaning , both sets of practices might be judged as inap- propriate, whereas from within each system they make sense.

From the 1700s, scholars have oscillated between the deficit model— that “savages” are without reason and social order—and a romantic view of the “noble savage” living in a harmonious natural state unspoiled by the constraints of society ( Jahoda & Krewer, 1997). Both of these extremes treat people of cultural communities other than those of the observer as alien, to be reviled (or pitied) on the one hand, or to be wistfully revered on the other.

These models are still with us. An illustration of the deficit model ap- pears in a report based on one week of fieldwork among the Yolngu, an Abo- riginal community in Australia, which concluded:

Humans can continue to exist at very low levels of cognitive de- velopment. All they have to do is reproduce. The Yolngu are, self evi- dently to me, not a terribly advanced group.

But there is not much question that Euro-American culture is vastly superior in its flexibility, tolerance for variety, scientific thought and interest in emergent possibilities from any primitive society extant. (Hippler, quoted and critiqued by Reser, 1982, p. 403)

For many years, researchers have compared U.S. people of color with European American people using a deficit model in which European Amer- ican skills and upbringing have been considered “normal.” Variations in other communities have been considered aberrations or deficits, and inter- vention programs have been designed to compensate for the children’s “cul- tural deprivation.” (See discussions of these issues in Cole & Bruner, 1971; Cole & Means, 1981; Deyhle & Swisher, 1997; García Coll, Lamberty, Jen- kins, McAdoo, Crnic, Wasik, & García, 1996; Hays & Mindel, 1973; Hilliard & Vaughn-Scott, 1982; Howard & Scott, 1981; McLoyd & Ran-

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dolph, 1985; McShane & Berry, 1986; Moreno, 1991; Ogbu, 1982; Valentine, 1971.)

Children and adolescents of color have often been portrayed as “problems” which we dissect and analyze using the purportedly ob- jective and dispassionate tools of our trade. . . . With a white sample serving as the “control,” [the research] proceeds to conducting com- parative analyses. . . . Beginning with the assumption of a problem, we search for differences, which, when found, serve as proof that the problem exists. (Cauce & Gonzales, 1993, p. 8)

Separating Value Judgments from Explanations

To understand development, it is helpful to separate value judgments from observations of events. It is important to examine the meaning and func- tion of events for the local cultural framework and goals, conscientiously avoiding the arbitrary imposition of one’s own values on another group.

Interpreting the activity of people without regard for their meaning system and goals renders observations meaningless. We need to understand the coherence of what people from different communities do, rather than simply determining that some other group of people do not do what “we” do, or do not do it as well or in the way that we do it, or jumping to con- clusions that their practices are barbaric.

Reducing ethnocentrism does not require avoidance of (informed) value judgments or efforts to make changes. It does not require us to give up our own ways to become like people in another community, nor imply a need to protect communities from change. If we can get beyond the idea that one way is necessarily best, we can consider the possibilities of other ways, seeking to understand how they work and respecting them in their time and place. This does not imply that all ways are fine—many commu- nity practices are objectionable. My point is that value judgments should be well informed.

Ordinary people are constantly making decisions that impact others; if they come from different communities it is essential for judgment to be informed by the meaning of people’s actions within their own community’s goals and practices. A tragic example of the consequences of ethnocentric misunderstanding—making uninformed judgments—is provided in an account of the medical ordeal of a Hmong child in California, when the as- sumptions and communication patterns of the U.S. health system were in- compatible with those of the family and their familiar community (Fadi- man, 1997). The unquestioned cultural assumptions of the health workers contributed to the deteriorating care of the child.

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The diversity of cultural ways within a nation and around the world is a resource for the creativity and future of humanity. As with the impor- tance of supporting species diversity for the continued adaptation of life to changing circumstances, the diversity of cultural ways is a resource pro- tecting humanity from rigidity of practices that could jeopardize the species in the future (see Cajete, 1994). We are unable to foresee the issues that humanity must face in the future, so we cannot be certain that any one way of approaching human issues will continue to be effective. Within the practices and worldviews of different communities are ideas and prac- tices that may be important for dealing with the challenges ahead. A uni- form human culture would limit the possibilities for effectively addressing future needs. Just as the cure for some dread disease may lie in a concoc- tion made with leaves in a rain forest, the knowledge and skills of a small community far away (or next door) may provide a solution to other ills of the present or future. Although bureaucracies are challenged by variety and comfortable with uniformity, life and learning rely on the presence of di- verse improvisations.

Diverse Goals of Development

Key to moving beyond one’s own system of assumptions is recognizing that goals of human development—what is regarded as mature or desirable— vary considerably according to the cultural traditions and circumstances of different communities.

Theories and research in human development commonly reveal an as- sumption that development proceeds (and should proceed) toward a unique desirable endpoint of maturity. Almost all of the well-known “grand theo- ries” of development have specified a single developmental trajectory, mov- ing toward a pinnacle that resembles the values of the theorist’s own com- munity or indeed of the theorist’s own life course. For example, theorists who are extremely literate and have spent many years in school often regard literacy and Euro-American school ways of thinking and acting as central to the goals of successful development, and even as defining “higher” cultural evolution of whole societies.

Ideas of Linear Cultural Evolution

The idea that societies develop along a dimension from primitive to “us” has long plagued thinking regarding cultural processes. A clear example ap- pears in a letter to a friend that Thomas Jefferson wrote in the early 1800s:

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Let a philosophic observer commence a journey from the savages of the Rocky Mountains, eastwardly towards our sea-coast. These he would observe in the earliest stage of association living under no law but that of nature, subsisting and covering themselves with the flesh and skins of wild beasts. He would next find those on our frontiers in the pastoral state, raising domestic animals to supply the defects of hunting. Then succeed our own semi-barbarous citizens, the pioneers of the advance of civilization, and so in his progress he would meet the gradual shades of improving man until he would reach his, as yet, most improved state in our seaport towns. This, in fact, is equivalent to a survey, in time, of the progress of man from the infancy of cre- ation to the present day. (Pearce, quoted in Adams, 1996, p. 41)

The assumption that societal evolution progresses toward increasing differentiation of social life—from the “backward” simplicity of “primi- tive” peoples—is the legacy of the intellectual thought of the late 1800s and early 1900s (Cole, 1996; Jahoda, 2000; Shore, 1996). For example, in 1877, cultural evolutionist Lewis Henry Morgan proposed seven stages of human progress: lower savagery, middle savagery, upper savagery, lower bar- barism, middle barbarism, upper barbarism, and civilization. Societies were placed on the scale according to a variety of attributes. Especially important to his idea of the path to civilization were monogamy and the nuclear fam- ily, agriculture, and private property as the basis of economic and social or- ganization (Adams, 1996).

The scholarly elaboration of the idea of linear cultural evolution oc- curred during the same era that the disciplines of psychology, anthropology, sociology, and history arose, subdividing the topics of the broader inquiry. As Michael Cole (1996) noted, it was also the period in which large bu- reaucratic structures were growing to handle education (in schools) and economic activity (in factories and industrial organizations). Also during this time, European influence was at its peak in Africa, Asia, and South Amer- ica; in North America, large influxes of immigrants from Europe inundated the growing cities, fleeing poverty in their homelands and joining rural Americans seeking the promises of U.S. cities.

The European-based system of formal “Western” schooling was seen as a key tool for civilizing those who had not yet “progressed to this stage.” Politicians spoke of school as a way to hasten the evolutionary process (Adams, 1996). In the words of U.S. Commissioner of Education William Torrey Harris in the 1890s:

But shall we say to the tribal people that they shall not come to these higher things unless they pass through all the intermediate stages, or can we teach them directly these higher things, and save them from

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the slow progress of the ages? In the light of Christian civilization we say there is a method of rapid progress. Education has become of great potency in our hands, and we believe that we can now vicari- ously save them very much that the white race has had to go through. Look at feudalism. Look at the village community stage. . . . We have had our tribulation with them. But we say to lower races: we can help you out of these things. We can help you avoid the imperfect stages that follow them on the way to our level. Give us your children and we will educate them in the Kindergarten and in the schools. We will give them letters, and make them acquainted with the printed page. (quoted in Adams, 1996, p. 43)

The assumption that societies develop along one dimension from primitive to advanced survived into the second half of the 1900s (Cole, 1996; see also Latouche, 1996). When, after World War II, the United Na- tions planned economic and political “development” for newly independ- ent colonial empires, the goal was to make them more “developed” (in a unidirectional sense, like earlier attempts to make them more “civilized”). Formal schooling was a key tool. Schooling modeled on European or North American schools spread throughout the former colonial empires to “raise” people out of poverty and ignorance and bring them into “modern” ways.

Moving Beyond Assumptions of a Single Goal of Human Development

Assumptions based on one’s own life about what is desirable for human de- velopment have been very difficult for researchers and theorists to detect be- cause of their similarity of backgrounds (being , until recently, almost ex- clusively highly schooled men from Europe and North America). As Ulric Neisser pointed out, self-centered definitions of intelligence form the basis of intelligence tests:

Academic people are among the stoutest defenders of the notion of intelligence . . . the tests seem so obviously valid to us who are mem- bers of the academic community. . . . There is no doubt that Aca- demic Intelligence is really important for the kind of work that we do. We readily slip into believing that it is important for every kind of significant work. . . . Thus, academic people are in the position of having focused their professional activities around a particular per- sonal quality, as instantiated in a certain set of skills. We have then gone on to define the quality in terms of this skill set, and ended by asserting that persons who lack these special skills are unintelligent al- together. (1976, p. 138)

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f i g u r e 1 . 3

Eastern European Jewish teacher and young students examining a religious text.

Forays of researchers and theorists outside their own cultural commu- nities and growing communication among individuals raised with more than one community’s traditions have helped the field move beyond these ethnocentric assumptions. Research and theory now pay closer attention to the ways that distinct community goals relate to ideals for the development of children (see Super & Harkness, 1997).

For example, cultural research has drawn attention to variations in the relevance of literacy and preliteracy skills in different communities. In a community in which literacy is key to communication and economic suc- cess in adulthood, preschoolers may need to learn to distinguish between the colors and shapes of small ink marks. However, if literacy is not central in a community’s practices, young children’s skill in detecting variations in ink squiggles might have little import.

Similarly, if literacy serves important religious functions, adults may impress its importance on young children (see figure 1.3). For example, in Jewish communities of early twentieth-century Europe, a boy’s first day at school involved a major ceremony that communicated the holiness and at- tractiveness of studying (Wozniak, 1993). The boy’s father would carry him to school covered by a prayer shawl so that he would not see anything un- holy along the way, and at school the rabbi would write the alphabet in honey on a slate while other adults showered the boy with candies, telling him that angels threw them down so that he would want to study.

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School-like ways of speaking are valued in some communities but not others, and children become skilled in using the narrative style valued in their community (Minami & McCabe, 1995; Mistry, 1993a; Scollon & Scol- lon, 1981; Wolf & Heath, 1992). For example, the narrative style used in “sharing time” (show-and-tell) by African American children often involves developing themes in connected episodes, whereas the narrative style used by European American children may employ tightly structured accounts centered on a single topic, which more closely resemble the literate styles that U.S. teachers aim to foster (Michaels & Cazden, 1986). When pre- sented with narratives from which information regarding children’s group membership was removed, European American adults judged the European American children’s style as more skillful and indicating a greater chance of success in reading. In contrast, African American adults found the African American children’s narratives to be better formed and indicating language skill and likelihood of success in reading. The adults’ judgments reflected their appreciation of the children’s use of shared cultural scripts that spec- ify what is interesting to tell and how to structure it (Michaels & Cazden, 1986).

A focus on literacy or on the discourse styles promoted in schools may not hold such importance in some cultural settings, where it may be more important for young children to learn to attend to the nuances of weather patterns or of social cues of people around them, to use words cleverly to joust, or to understand the relation between human and supernatural events. The reply of the Indians of the Five Nations to an invitation in 1744 by the commissioners from Virginia to send boys to William and Mary College il- lustrates the differences in their goals:

You who are wise must know, that different nations have different conceptions of things; and you will therefore not take it amiss, if our ideas of this kind of education happen not to be the same with yours. We have had some experience of it: several of our young people were formerly brought up at the colleges of the northern provinces; they were instructed in all your sciences; but when they came back to us . . . [they were] ignorant of every means of living in the woods . . . neither fit for hunters, warriors, or counsellors; they were totally good for nothing. We are, however, not the less obliged by your kind offer . . . and to show our grateful sense of it, if the gentlemen of Virginia will send us a dozen of their sons, we will take great care of their education, instruct them in all we know, and make men of them. (quoted in Drake, 1834)

A more contemporary example of differences in goals comes from West African mothers who had recently immigrated to Paris. They criti-

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cized the French use of toys to get infants to learn something for the future as tiring out the babies, and preferred to just let babies play without fatigu- ing them (Rabain Jamin, 1994). Part of their criticism also related to a con- cern that such focus on objects may lead to impoverished communication and isolation (in much the same way that a U.S. middle-class parent might express concern about the negative impact of video games). These African mothers seemed to prioritize social intelligence over technological intelli- gence (Rabain Jamin, 1994). They more often responded to their 10- to 15- month-old infants’ social action and were less responsive to the infants’ ini- tiatives regarding objects than were French mothers. The African mothers often structured interaction with their infants around other people, whereas the French mothers often focused interaction on exploration of inanimate objects (see also Seymour, 1999). When interactions did focus on objects, the African mothers stressed the social functions of the objects, such as en- hancement of social relationships through sharing , rather than object use or action schemes.

Prioritization of social relationships also occurs in Appalachian com- munities in the United States, where commitments to other people fre- quently take precedence over completion of schooling. When hard times arise for family members or neighbors, Appalachian youth often leave jun- ior high or high school to help hold things together (Timm & Borman, 1997). Social solidarity is valued above individual accomplishment. The pull of kin and neighbors generally prevails, and has for generations.

In each community, human development is guided by local goals, which prioritize learning to function within the community’s cultural in- stitutions and technologies. Adults prioritize the adult roles and practices of their communities, or of the communities they foresee in the future, and the personal characteristics regarded as befitting mature roles (Ogbu, 1982). (Of course, different groups may benefit from learning from each other, and often people participate in more than one cultural community—topics taken up later in this book.)

Although cultural variation in goals of development needs to be rec- ognized, this does not mean that each community has a unique set of val- ues and goals. There are regularities among the variations. My point is that the idea of a single desirable “outcome” of development needs to be dis- carded as ethnocentric.

Indeed, the idea of an “outcome” of development comes from a par- ticular way of viewing childhood: as preparation for life. It may relate to the separation of children from the important activities of their community, which has occurred since industrialization in some societies (discussed in later chapters). The treatment of childhood as a time of preparation for life differs from ways of communities in which children participate in the local

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mature activities, not segregated from adult life and placed in specialized preparatory settings such as schools.

To learn from and about communities other than our own, we need to go beyond the ethnocentric assumptions from which we each begin. Often, the first and most difficult step is to recognize that our original views are generally a function of our own cultural experience, rather than the only right or possible way. This can be an uncomfortable realization, because people sometimes assume that a respectful understanding of others’ ways implies criticism of their own ways. A learning attitude, with suspended judgment of one’s own as well as others’ ways, is necessary for coming to understand how people both at home and elsewhere function in their local traditions and circumstances and for developing a general understanding of human development, with universal features built on local variations. The prospects of learning in cultural research are enhanced by communication between insiders and outsiders of particular communities, which I address in the next section.

Learning through Insider/Outsider Communication

To move our understanding of human development beyond assumptions and include the perspective of other communities, communication be- tween community “insiders” and “outsiders” is essential. It is not a matter of which perspective is correct—both have an angle on the phenomena that helps to build understanding.

However, social science discussions often question whether the insider’s or the outsider’s perspective should be taken as representing the truth (see Clifford, 1988; LeVine, 1966). Arguments involve whether insiders or out- siders of particular communities have exclusive access to understanding, or whether the views of insiders or of outsiders are more trustworthy (Merton, 1972; Paul, 1953; Wilson, 1974).

Some have even argued that, given the variety of perspectives, there is no such thing as truth, so we should give up the effort to understand social life. But this view seems too pessimistic to me. If we adopted it, we would be paralyzed not only in social science research but in daily life, where such understanding is constantly required.

The argument that only members of a community have access to the real meaning of events in that community, so outsiders’ opinions should be discarded, runs into difficulty when one notes the great variations in opin- ions among members of a community and the difficulties in determining who is qualified to represent the group. In addition, members of a com- munity often have difficulty noticing their own practices because they take their own ways for granted, like the fish not being aware of the water.

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f i g u r e 1 . 4

Leonor, Virginia, and Angelica Lozano (left to right), seated around the family’s first television in their home, about 1953 (Mexican American).

Furthermore, as I discuss more fully in Chapter 3, individuals often par- ticipate simultaneously in several different communities. Increasingly, the boundaries between inside and outside are blurred as people spend time in various communities (see Clifford, 1997; Walker, 2001). For example, people of Mexican descent living in what is now the United States are not entirely outsiders to European American communities; the practices and policies of the two communities interrelate. Similarly, an anthropologist who spends 10 or 50 years working in a community participates in some manner and gains some local understanding. Youngsters who grow up in a family with several cultural heritages, as is increasingly common, have some insider and some outsider understandings of each of their communities. Overlaps across com- munities also come from the media, daily contacts, and shared endeavors— collaborative, complementary, or contested (see figure 1.4).

Hence, it is often a simplification to refer to individuals as being “in” or

Orienting Concepts 25

 

 

“out” of particular communities; many communities do not have strict boundaries or homogeneity that clearly allow determination of what it takes to be “in” or “out” of them. (In Chapter 3, I argue that we need to go beyond thinking solely of membership in a single static group and instead focus on people’s participation in cultural practices of dynamically related communities whose salience to participants may vary.)

To come to a greater understanding of human functioning, people fa- miliar with different communities need to combine their varied observa- tions. What is referred to as “truth” is simply our current agreement on what seems to be a useful way to understand things; it is always under re- vision. These revisions of understanding build on constructive exchanges between people with different perspectives. Progress in understanding, then, is a matter of continually attempting to make sense of the different per- spectives, taking into account the backgrounds and positions of the viewers.

Differences in perspective are necessary for seeing and for understand- ing. Visual perception requires imperceptible movements of the eyes rela- tive to the image. If the image moves in coordination with the eye move- ments, the resulting uniformity of position makes it so the image cannot be seen. Likewise, if we close one eye and thus lose the second viewpoint sup- plied by binocular vision, our depth perception is dramatically reduced. In the same way, both people with intense identification within a community (insiders) and those with little contact in a community (outsiders) run into difficulties in making and interpreting observations. However, working to- gether, insiders and outsiders can contribute to a more edifying account than either perspective would allow by itself.

Outsiders’ Position

In seeking to understand a community’s practices, outsiders encounter dif- ficulties due to people’s reactions to their presence (fear, interest, politeness) as well as their own unfamiliarity with the local web of meaning of events. Outsiders are newcomers to the meaning system, with limited understand- ing of how practices fit together and how they have developed from prior events. At the same time, they are faced with the assumptions of commu- nity members who invariably attempt to figure out what the outsider’s role is in the community, using their everyday categories of how to treat the newcomer.

The outsider’s identity is not neutral; it allows access to only some sit- uations and elicits specific reactions when the outsider is present. For ex- ample, among the Zinacantecos, a Mayan group in Mexico, Berry Brazel- ton (1977) noted fear of observers among both adults and infants in his study of infant development: “We were automatically endowed with ‘the

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evil eye’ . . . the effects of stranger anxiety in the baby were powerfully re- inforced by his parents’ constant anxiety about our presence. We were un- able to relate to babies after nine months of age because the effect was so powerful” (p. 174).

On the other hand, an observer may elicit interest and hospitality, which may be more comfortable but also becomes a part of the events ob- served. Ruth Munroe and Lee Munroe (1971) reported that in Logoli house- holds in Africa, as soon as an observer arrived to study everyday caregiving practices with infants, the infant was readied for display. The Logoli moth- ers were very cooperative, picking up their infants and bringing them to the observer for inspection. Under such circumstances, observations would have to be interpreted as an aspect of a public greeting. Similarly, Mary Ainsworth (1977) reported that she was categorized as a visitor among the Ganda of Uganda; the mothers insisted that she observe during the after- noon, a time generally allocated to leisure and entertaining visitors.

In a study in four different communities, parents varied in their per- ception of the purpose of a home visit interview and observation of mother- toddler interactions (Rogoff, Mistry, Göncü, & Mosier, 1993). In some communities, parents saw it as a friendly visit of an acquaintance interested in child development and skills; in others, it was a pleasant social obligation to help the local schoolteacher or the researcher by answering questions or an opportunity to show off their children’s skills and newest clothes. With humor in her voice, one Turkish woman asked the researcher, who had grown up locally but studied abroad, “This is an international contest . . . Isn’t it?”

Issues of how to interpret observations are connected with restrictions in outsiders’ access. For example:

Among Hausa mothers, the custom is not to show affection for their infants in public. Now those psychologists who are concerned with nurturance and dependency will go astray on their frequency counts if they do not realize this. A casual [observer] is likely to witness only public interaction; only when much further inquiry is made is the ab- sence of the event put into its proper perspective. (Price-Williams, 1975, p. 17)

There are only a few situations in which the presence of outside ob- servers does not transform ongoing events into public ones: if the event is already public, if their presence is undetected, or if they are so familiar that their presence goes without note. Of course, their presence as a familiar member of a household would require interpretation in that light, just as the presence of other familiar people would be necessary to consider in in- terpreting the scene.

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Insiders’ Position

The issues faced by both insiders and outsiders have to do with the fact that people are always functioning in a sociocultural context. One’s interpreta- tion of the situation is necessarily that of a person from a particular time and constellation of background experiences. And if one’s presence is de- tected in a situation, one is a participant. There is no escape from interpre- tation and social presentation.

Differences in how people act when they think they are being observed or not illustrate how the simple presence of an observer (or a video camera) influences behavior. For example, U.S. middle-class mothers varied their in- teractions with their toddlers when they thought they were being observed in a research study (video equipment was conspicuously running) versus when they thought they were simply waiting in an observation room (re- pairs were “being made” on the video equipment, but observers watched from behind a one-way mirror). The mothers’ behavior when they thought they were being observed reflected middle-class U.S. concepts of “good mothering” (Graves & Glick, 1978). The amount of speech to their chil- dren doubled, and they used more indirect requests, engaged in more nam- ing and action routines, and asked more questions than when they thought they were not being observed.

Insiders also may have limited access to situations on the basis of their social identity. For example, their family’s standing in the community and their personal reputation are not matters that are easily suspended. When entering others’ homes, insiders carry with them the roles that they and their family customarily play. It may be difficult for people of one gender to enter situations that are customary for the other gender without arousing suspicions. A person’s marital status often makes a difference in the situa- tions and manner in which he or she engages with other people. For exam- ple, it could be complicated for a local young man to interview a family if he used to be a suitor of one of the daughters in the family, or if the grand- father in the family long ago was accused of cheating the young man’s grandfather out of some property. An insider, like an outsider, has far from a neutral position in the community.

In addition, an insider in a relatively homogeneous community is un- likely to have reflected on or even noticed phenomena that would be of in- terest to an outsider. As was mentioned in the section on ethnocentrism, people with experience in only one community often assume that the way things are done in their own community is the only reasonable way. This is such a deep assumption that we are often unaware of our own practices un- less we have the opportunity to see that others do things differently. Even if contrasting practices have raised insiders’ awareness of their own prac-

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tices, they still may interpret them in ways that fit with unquestioned assumptions:

We rarely recognize the extent in which our conscious estimates of what is worthwhile and what is not, are due to standards of which we are not conscious at all. But in general it may be said that the things which we take for granted without inquiry or reflection are just the things which determine our conscious thinking and decide our con- clusions. And these habitudes which lie below the level of reflection are just those which have been formed in the constant give and take of relationship with others. (Dewey, 1916, p. 22)

The next section examines how varying interpretations can be used and then modified in the effort to reach more satisfactory accounts of human development in different cultural communities. Understanding across cul- tural groups requires adopting

a mode of encounter that I call learning for self-transformation: that is, to place oneself and the other in a privileged space of learning, where the desire [is] not just to acquire “information” or to “repre- sent,” but to recognize and welcome transformation in the inner self through the encounter. While Geertz claims that it’s not necessary (or even possible) to adopt the other’s world view in order to understand it . . . I also think that authentic understanding must be grounded in the sense of genuine humility that being a learner requires: the sense that what’s going on with the other has, perhaps, some lessons for me. (Hoffman, 1997, p. 17)

Moving between Local and Global Understandings

Researchers working as outsiders to the community they are studying have grappled with how they can make inferences based on what they observe. (The concepts cultural researchers have developed are important for any re- search in which an investigator is attempting to make sense of people dif- ferent from themselves, including work with people of an age or gender different from the researcher’s.) The dilemma is that for research to be valu- able, it needs both to reflect the phenomena from a perspective that makes sense locally and to go beyond simply presenting the details of a particular locale. The issue is one of effectively combining depth of understanding of the people and settings studied and going beyond the particularities to make a more general statement about the phenomena. Two approaches to move from local to more global understandings are discussed next. The first

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distinguishes rounds of interpretation that seek open-minded improvement of understanding. The second considers the role of meaning in attempts to compare “similar” situations across communities.

Revising Understanding in Derived Etic Approaches

The process of carefully testing assumptions and open-mindedly revising one’s understanding in the light of new information is essential for learning about cultural ways. The distinctions offered by John Berry (1969; 1999) among emic, imposed etic, and derived etic approaches to cultural research are useful for thinking about this process of revision.

In an emic approach, an investigator attempts to represent cultural in- siders’ perspective on a particular community, usually by means of extensive observation and participation in the activities of the community. Emic re- search produces in-depth analyses of one community and can often be use- ful as such.

The imposed and derived etic approaches attempt to generalize or compare beyond one group and differ in their sensitivity to emic informa- tion. The imposed etic approach can be seen as a preliminary step on the way to a more adequate derived etic understanding.

In an imposed etic approach, an investigator makes general statements about human functioning across communities based on imposing a cul- turally inappropriate understanding. This involves uncritically applying theory, assumptions, and measures from research or everyday life from the researcher’s own community. The ideas and procedures are not suffi- ciently adapted to the community or phenomenon being studied, and al- though the researcher may “get data,” the results are not interpreted in a way that is sufficiently congruent with the situation in the community being studied.

For example, an imposed etic approach could involve administering questionnaires, coding behavior, or testing people without considering the need to modify the procedures or their interpretation to fit the perspective of the research participants. An imposed etic approach proceeds without sufficient evidence that the phenomenon is being interpreted as the re- searcher assumes. Even when a researcher is interested in studying some- thing that seems very concrete and involves very little inference (such as whether people are touching), some understanding of local practices and meanings is necessary to decide when and where to observe and how to in- terpret the behavior (for example, whether to consider touching as evidence of stimulation or sensitivity to an infant). Mary Ainsworth critiqued the use of preconceived variables in imposed etic research: “Let us not blind

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ourselves to the unusual features of the unfamiliar society by limiting our- selves to variables or to procedures based on the familiar society—our own” (1977, p. 145).

In a derived etic approach, the researcher adapts ways of questioning , observing , and interpreting to fit the perspective of the participants. The resulting research is informed by emic approaches in each group studied and by seeking to understand the meaning of phenomena to the research participants.

Cultural researchers usually aspire to use both the emic and the derived etic approaches. They seek to understand the communities studied, adapt procedures and interpretations in light of what they learn, and modify the- ories to reflect the similarities and variations sensitively observed. The de- rived etic approach is essential to discerning cultural patterns in the variety of human practices and traditions.

It may be helpful to think of the starting point of any attempt to un- derstand something new as stemming from an imposed etic approach. We all start with what we know already. If this is informed by emic observations accompanied by efforts to move beyond the starting assumptions, we may move closer to derived etic understanding. But derived etic understanding is a continually moving target: The new understanding becomes the current imposed etic understanding that forms the starting point of the next line of study, in a process of continual refinement and revision.

Because observations can never be freed from the observers’ assump- tions, interests, and perspective, some scholars conclude that there should be no attempt to understand cross-community regularities of phenomena. However, with sensitive observation and interpretation, we can come to a more satisfactory understanding of the phenomena that interest us, which can help guide our actions with each other. That this process of learning never ends is not a reason to avoid it.

Indeed, the process of trying to understand other people is essential for daily functioning as well as for scholarly work. The different perspectives brought to bear on interpreting phenomena by different observers are of in- terest in their own right, particularly now that research participants in many parts of the world contribute to the design and interpretation of research, not just responding to the questionnaires or tests of foreign visitors.

Research on issues of culture inherently requires an effort to examine the meaning of one system in terms of another. Some research is explicitly comparative across cultural communities. But even in emic research, in which the aim is to describe the ways of a cultural community in its own terms, a description that makes sense to people within the community needs to be stated in terms that also make sense outside the system. Often,

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descriptions are in a language different from that of the community mem- bers, whether the shift is from one national language to another or from folk terms to academic terms. All languages refer to concepts of local im- portance in ways somewhat different from others, reflecting cultural con- cepts in the effort to communicate. Therefore, the issue of “translation”— and consideration of the meaning and comparability of situations and ideas across communities—is inescapable.

The Meaning of the “Same” Situation across Communities

An issue for any comparison or discussion across communities is the simi- larity of meaning or the comparability of the situations observed (Cole & Means, 1981). Simply ensuring that the same categories of people are pres- ent or the same instructions used does not ensure comparability, because the meaning of the particular cast of characters or instructions is likely to vary across communities.

For example, in collecting data with American and Micronesian care- givers and infants, researchers had a difficult choice. They could examine caregiver-infant interactions in the most prevalent social context in which caregivers and infants are found in each community: The American care- givers and children were usually alone with each other; the Micronesian caregivers and infants were usually in the presence of a group. Or they could hold social context constant in the two communities (Sostek et al., 1981). The researchers decided to observe in both circumstances and com- pare the findings; they found that the social context of their observations differentiated caregiver-infant interaction in each community.

Following identical procedures in two communities, such as limiting observations to times that mothers and infants are alone together, clearly does not ensure comparability of observations. Studies examining mother- infant interaction across communities need to reflect the varying prevalence of this situation. For example, several decades ago in a study in the United States, 92% of mothers usually or always cared for their infants, whereas in an East African agricultural society, 38% of mothers were the usual care- givers (Leiderman & Leiderman, 1974). A study that compared mother- child interactions in these two cultural communities would need to inter- pret the findings in the light of the different purposes and prevalence of mother-child interaction in each.

In addition to considering who is present, comparisons need to attend to what people are doing together, for what purposes, and how their activ- ity fits with the practices and traditions of their community. Inevitably, the meaning of what is observed must be considered.

Serious doubts have been raised as to whether situations are ever strictly

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comparable in cross-cultural research, as the idea of comparability may as- sume that everything except the aspect of interest is held constant. In an evaluation of personality research, Rick Shweder (1979) concluded that sit- uations cannot be comparable across cultural communities:

To talk of personality differences one must observe behavior differ- ences in equivalent situations. . . . The crucial question then be- comes, How are we to decide that the differential responses we ob- serve are in fact differential responses to an equivalent set of stimuli. . . . With respect to which particular descriptive components must stimuli (situations, contexts, environments) be shown to be equivalent? . . . A situation (environment, context, setting) is more than its physical properties as defined by an outside observer. . . . It is a situated activ- ity defined in part by its goal from the point of view of the actor. “What any rational person would do under the circumstances” de- pends upon what the person is trying to accomplish. (pp. 282–284)

Shweder argued that because local norms for the appropriate means of reaching a goal must be written into the very definition of the behavioral situation, “two actors are in ‘comparable’ or ‘equivalent’ situations only to the extent that they are members of the same culture!” (p. 285).

Perhaps the most crucial issue in the question of comparability is de- ciding how to interpret what is observed. It cannot be assumed that the same behavior has identical meaning in different communities. For exam- ple, native Hawaiian children were observed to make fewer verbal requests for help than Caucasian children in Hawaiian classrooms (Gallimore, Boggs, & Jordan, 1974; cited in Price-Williams, 1975). However, before con- cluding that this group was making fewer requests for assistance, the re- searchers considered the possibility that the children made requests for as- sistance differently. Indeed, they discovered that the Hawaiian children were requesting assistance nonverbally: steadily watching the teacher from a distance or approaching, standing nearby, or briefly touching her. These nonverbal requests may be directly related to the cultural background of the children, in which verbal requests for help from adults are considered inap- propriate but nonverbal requests are acceptable.

Identical behavior may have different connotations and functions in different communities (Frijda & Jahoda, 1966). Some researchers have pro- posed that phenomena be compared in terms of what people are trying to accomplish rather than in terms of specific behaviors. Robert Sears (1961) argued for distinguishing goals or motives (such as help seeking in the Hawaiian study) from instrumental means used to reach the goals (such as whether children request assistance verbally or nonverbally). In his view, although instrumental means vary across communities, goals themselves

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may be considered transcultural. John Berry proposed that aspects of be- havior be compared “only when they can be shown to be functionally equivalent, in the sense that the aspect of behavior in question is an at- tempted solution” to a recurrent problem shared by the different groups (1969, p. 122; see figure 1.5).

A focus on the function (or purpose or goal) of people’s behavior facil- itates understanding how different ways of doing things may be used to accomplish similar goals, or how similar ways of doing things may serve different goals. Although all cultural communities address issues that are common to human development worldwide, due to our specieswide cul- tural and biological heritage, different communities may apply similar means to different goals and different means to similar goals.

The next two chapters focus in more depth on how we can conceive of the cultural nature of human development. They examine the idea that human development is biologically cultural and discuss ways of thinking

34 T H E C U L T U R A L N A T U R E O F H U M A N D E V E L O P M E N T

f i g u r e 1 . 5

John Collier and Malcolm Collier suggested that family mealtimes could provide a basis for comparisons that would help define relationships within families in different communities. The first picture shows an evening meal in a home in Vicos, Peru; the second shows supper in a Spanish American home in New Mexico; the third picture shows breakfast in the home of an advertising executive’s family in Connecticut.

 

 

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about similarities and differences across cultural communities in how peo- ple learn and develop. They discuss concepts to relate individual and cul- tural processes, expanding on the overarching orienting concept: that hu- mans develop through their changing participation in the sociocultural activities of their communities, which also change.

 
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Unit 5 Theoretical Analysis Assignment 1

Unit 5 Theoretical Analysis Assignment 1

Unit 5 Discussion 1 & Unit 5 Assignment 1 – Due date 2/02/2019 (Saturday) – $30.00

Unit 5 Assignment 1

Theoretical Analysis

Submit the theoretical analysis portion (4–5 pages) of your final project in which you analyze theories for the treatment of compulsive and addictive behaviors as they apply to group methods and synthesize trends in compulsive and addictive behavior research as they apply to group methods. Note that analysis means more than just describe. For example, to analyze, you might compare and contrast theories and explore the pros and cons of the use of the theory. Please refer to the Personal Model for Group Leadership course project description for more instructions and details.

Multimedia

Complete the Cultural Scenarios presentation. When you complete this media piece, consider some of the specific ethical concerns pertaining to group counseling that you may have. This study activity is in preparation for the first discussion in this unit.

Complete the Ethical Considerations in Group Treatment presentation to be able to consider ethical choices that you would make in certain situations related to group counseling.

Unit 5 Discussion 1

Cultural Scenarios

Select one of the scenarios from the Cultural Scenarios clip and discuss what an ethical group counselor would need to consider when working with the selected client in a group setting. Assume that the client selected is the only group member representing that cultural subgroup (not only ethnicity but also age and socioeconomic status can be considered a cultural subgroup).

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Resources

· Discussion Participation Scoring Guide.

· Cultural Scenarios.

References

American Counseling Association. (2014). 2014 ACA Code of Ethics. Retrieved from https://www.counseling.org/Resources/aca-code-of-ethics.pdf

Association for Specialists in Group Work. (2000). Professional standards for the training of group workers. Retrieved from https://docs.wixstatic.com/ugd/513c96_af51b0b1fa894b19a9f62bd8826e71c3.pdf

NAADAC, the Association for Addiction Professionals. (2016). NAADAC/NCC AP Code of Ethics. Alexandria, VA: NAADAC. Retrieved from https://www.naadac.org/assets/2416/naadac-code-of-ethics.pdf

 

 
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