Psychology

Many say that patience is a virtue. The difficulty of the battle against impulsivity varies from person to person. There are many points to consider when self-control is concerned. How long will it take Is it worth it For children, the answers to those questions are shaped mainly by three factors  the situation, personal factors and modeling.

There have been numerous studies conducted regarding situational factors that affect self-control. For the experiments done by Grosch and Neuringer, it was apparent that as reinforcements are visible, it would be more difficult to have self control. Mischel, Ebbesen and Zeiss on the other hand showed that as long as a child is kept occupied by something else, it would be easier for the child to wait for the preferred or latter reinforcer (as cited in Mazur, 2006, p. 344).

However, despite the trend in situational factors, there are still those children who are able to wait while others could not. This is where Mischels work pointing to personal factors comes to play. According to Mischel, the inclination to wait is related to age, IQ and presence of father at home with mother along with other factors (as cited in Mazur, 2006, p.344). Positive marks with these aspects mean better self-control.

As for modeling, Mischel also showed how observational learning impacts self-control. His experiments composed of an adult as an example to a child either preferring the quicker or delayed reinforcement. Mischel discovered that the adult models behavior greatly influenced the childrens behavior (as cited in Mazur, 2006, p.344).

There are many factors shaping self-control for children. These factors all fall under situational factors, personal factors or modeling. Though the aforementioned concentrated on findings on children, how they were shaped holds true to our ability for self-control.

The goal of the present study was to determine the relationship of parental attachment, self-esteem and academic performance of university students. This study also explored whether parental attachment was predicted by students self-esteem and academic performance. Thirty two undergraduate students completed the Inventory of Parent and Peer Attachment (IPPA), the Rosenberg Self-esteem Scale and their demographic data including their Cumulative Grade Point Average (CGPA) was collected. The results of the study showed that there is a positive and strong correlation between parental attachment, self-esteem and academic performance. However, it was also found that only self-esteem predicted parental attachment. It is concluded that parental attachment is more influential in the personality development of the students rather than on academic skills.
 
College is an extremely challenging period for most adolescents and young adults. It is the period when adolescents are asked to be more mature, be more independent and be responsible for their learning experiences. Being in college coincides with the transition from being an adolescent to being a young adult, where joining the workforce after college and figuring out the future are the most important concerns. 

Most developmental theorists advocate the importance of parental attachment to the healthy adjustment of children and even into adolescence and adulthood. It has been found that parents are the single most important factor that affects the psychological health of their children and even later in life (Essau, 2004 Perry, Silvera, Neilands, Rosenvinge,  Hanssen, 2008). A strong relationship between parental attachment, self-image, self-evaluation, psychological health and quality of relationships has been established by a number of studies (Amsden  Greenberg, 1987 Kerns, Klepac,  Cole, 1996 Maureen, Griffiths,  Grossman, 2005 Perry et al., 2008 Song, Thompson,  Ferrer, 2009).

Parental attachment had also been linked to the achievement and success in adulthood (Bakermans-Kranenburg,  van IJzendoorn  Juffer, 2003 Waters   Beauchaine, 2003 Fraley   Shaver , 2000) thus it would seem that strong parental attachment is associated with positive and healthy adjustment in lifes challenges. This is especially true in college when the youth have to deal with the competing tasks of academics and personal development. In this light, the present study aims to determine the relationship between parental attachment, self-esteem and academic performance. Also, this study will explore whether parental attachment can be predicted by self-esteem and academic performance.

Parental Attachment
Attachment theory was developed by Bowlby (1971) after his work and observation with infants and young mothers and caregivers. He was the first to put into theoretical perspective the need for infants and young children to form attachments to their parents or a permanent caregiver and espoused that inadeqaute and poor attachment would lead to problem behaviours later in life (Bowlby, 1971). Attachment is defined as the emotional and psychological bond between the infant and the caregiver, the caregiver may be any person who provides consistent care and attention to the infant. The infants attachment behavior is based on the infants safety and security needs which the caregiver provides (Bretherton, 1992). The infant then forms the attachment on the responses of the caregiver rather than on the caregiver. As the infant develops, the attachment behavior of the child becomes more differentiated from that of other individuals which the child interacts with, wherein the caregiver becomes the primary attachment figure.

Attachment theory was expounded by Ainsworth (1969) where she identified the different attachment patterns that young children exhibit especially in the first four years of life. Ainsworth (1969) identified four attachment patterns secure, avoidant, resistant and disorganized. Secure attachment is manifested when the child is able to explore his or her environmnet and the caregiver serves as the secure base that the child can return to, also the child will seek proximity to the caregiver and will be appeased upon the return of the caregiver. Avoidant attachment occurs when the child does not seem to be affected by the proximity or the  distance of the caregiver from the child. Resistant attachment is seen among children who appear to be clingy to their caregivers and who refuses to be separated from the caregiver. The disorganized attachment pattern refer to a childs contradictory attachment behavior, not seeking proximity but will approach when asked, disorientation and fear is also markedly present in the childs interaction with the caregiver.

The different attachment patterns also result to different behaviors in children and during adolescence. The most positive attachment pattern would be the secure attachment as it facilitates the exploration of the child. Such exploration enables the child to discover his or her surroundings and serve as the basis from which the child learns that he or she is a separate individual from the caregiver (Berlin, Zeanah  Lieberman, 2008). The avoidant and resistant attachment patterns are not at all negative and would cause problematic adjustment in children but it would be a cause for concern as it predisposes them to negative and unhealthy relationships (Dunst   Kassow , 2008). The disorganized attachment pattern clearly denotes a problem, since most abused children have disroganized attachment patterns (Bugental, Ellerson, Rainey, Lin  Kokotovic, 2002).

Parental attachment defined in terms of attachment theory is the emotional bond between parents and the offspring. This would presupose that parents are the primary caregivers and the quality of their interaction had developed into attachment patterns. A positive and secure parental attachment had been found to be related to self-image (Maureen et al., 2005) empathy and self-esteem (Laible, Carlo,  Roesch, 2004), level of career in decision making (Emmanuelle, 2009) life satisfaction and gender differences (Ma  Heubner, 2008), and school success (Wong, Wiest,  Cusick, 2002). 

Self-esteem and academic performance
Self-esteem can be defined as ones overall sense of self-satisfaction and self-competence. Numerous studies showed a positive relationship between self-esteem and academic perfomance (Lawrence, 2000 Naderi, Rohani, Aizan, Sharir,  Kumar, 2009). However, a research done by Baumeister, Campbell, Krueger, and Vohs (2003) questioned the positive link between self-esteem and academic performance and concluded that the benefit of high self-esteem is less than we expected, but it is a useful tool to promote academic success.

The present study aims to determine the relationship of parental attachment to self-esteem and academic performance of undergraduate students. Also, this study would explore whether parental attachment is predicted by self-esteem and academic achievement. In doing so, this study would be able to provide evidence of the link between parental attachment and positive college students adjustment to college life. Moreover, this study would be able to identify whether there is a strong enough association between the variables that would predict parental attachment. It is hypothesized that there is a significant and positive relationship between parental attachment, self-esteem and academic performance of college students. A second hypothesis is that self-esteem and academic achievement will predict parental attachment of college students.

Method
Participants
A total of 32 undergraduate students were randomly selected in the campus to participate in this study and included 13 males (40.6) and 19 females (59.4). The participants age ranged from 19 to 23 (M  20.34, S.D.  1.13). The participants were composed of students in different year levels, year 1 (40.6), year 2 (40.6), and year 3 (18.8). English is the teaching language in Hong Kong.

Materials
The Inventory of Parent and Peer Attachment. The Inventory of Parent and Peer Attachment (IPPA Amsden  Greenberg, 1987) is a self-report measure to assess adolescents attachment to their parents and peers through three dimensions trust, communication and alienation. The IPPA originally contained two sections  parent attachment and peer attachment. Since the present study focused only on parental attachment, the parent attachment section was used. The abbreviated version of the IPPA contains 28 questions (e.g. My parents respect my feeling, my parents do not understand what Im going through these days I get upset a lot more than my parents know about). Participants completed the questionnaire by indicating how true each statement was for them with respect to their relationship with their parents on a 5-point Likert scale. If they had inconsistent relationships with parents, they answered the questions for the one that they felt had most influenced them which in this study was mother only (12.5), father only (9.4) and both parents (78.1). The 5-points Likert scale ranges from 1 (never true) to 5 (almost always or always true). The total attachment score was obtained by reverse-scoring items including question 3,5,7,10 and 15. Higher scores indicated higher level of secure attachment. The highest score obtainable for IPPA in the present study is 140 and lowest obtainable score is 28. 

Amsden and Greenberg (1987) conducted two studies with 179 college students aged from 16 to 20 years. The study found good test-retest reliabilities with .93 for the Parent Attachment mearsure and favarable internal reliability with  Cronbachs alpha  .91 for both trust and communication dimensions, and .86 for alimenation dimension (Amsden  Greenberg, 1987).  Thus the IPPA is a reliable and valid measure of parental attachment among adolescents.
 
Rosenberg Self-esteem Scale. Rosenberg self-esteem scale (RSE Rosenberg, 1965) is a self-report measure used to assess the adolescents global self-esteem. The RSE includes ten questions (e.g. I am able to do things as well as most other people, I wish I could have more respect for myself.). Participants completed the questionnaire by indicating to what extent they agree with the statement on a 4-point Likert scale ranging from 1 (Strongly disagree) to 4 (strongly agree). There were 5 reverse-scoring items which were reversed before calculating the total score. The higher the total score indicated higher levels of self-esteem. The highest score obtainable for RSE is 40 and lowest score obtainable is 10. 

In a study conducted by McCarthy and Hoge (1982), a total of 1970 students from grade 7 to 12 completed the RSE. McCarthy and Hoge (1982) reported good test-retest reliablity of the RSE measure of alpha  .74 and a year later with alpha  .77. Besides adolescents, Shahani, Dipboye, and Philips (1990) examined the RSE with 1726 employees of a state agencty. The study found a good relability with alpha .80 for the total RSE scale (Shahani et al., 1990). The RSE is therefore a reliable and valid measure of self-eteem among adolescents and adults.

Demographic information. Aside from the measures of parental attachment and self-esteem, the participants demographic information was collected through a survey questionnaire. The participants gender, age, year of study, and cumulative GPA were collected. Cumulative GPA is used to determine a students academic performance. Hong Kong universities use CGPA to determine how well a student has performed in courses since 1998 (Chiu, 2010). Higher CGPA values indicate that students overall had attained high grades in all courses that they have taken. The highest obtainable score of CGPA is 4.00. Family background of the participants was not considered in the present study.

Procedure
Before the actual participation in the present study, participants were asked to complete informed consent forms. The questionnaire booklet consisted of 2 questionnaires including IPPA, RSE and demographic information. Students were randomly selected in the University premises and were currently enrolled in the university (e.g. outside the canteen, in the computer centre). A brief introduction was done before the participants signed the informed consent form. The introduction included a discussion of the purpose of the research, keys for answering the questionnaires, and the researcher clarified the concerns and questions of the participants. Questionnaires were completed in a similar order for all participants IPPA, RSE and demographic information. Participation by students was strictly voluntary without any risk or reward on their part. Finally, the participants were assured of the confidentiality of their responses and were debriefed about the study after completing all questionnaires, and then the signed debriefing forms were collected from all of the participants.     

Results
Descriptive statistics. Mean and standard deviation of parental attachment scores, self-esteem scores and academic performance of undergraduate students are shown in Table 1. The participants of the study were found to have low parental attachment scores (45.80), high self-esteem (27.88) and a satisfactory CGPA (2.85).

Table 1
Mean and standard deviation of undergraduate students parental attachment scores, self-esteem scores and academic performanceMeanStd. DeviationNParental Attachment45.802.5032Self-esteem27.883.6132CGPA2.85.48932

Correlation analysis. In order to answer the first research question on the relationship of parental attachment, self-esteem and academic performance, a Pearson moment correlation was conducted on the scores of the participants of the three variables. Pearson moment correlation was conducted to determine significant relationships between the three variables  parental attachment, CGPA and Self-esteem. As we can see in Table 2, all variables had a positive and significant correlation at the 1 level of confidence (2-tailed). Parental attachment was positively associated with self-esteem (r.62) and CGPA (r.47). Moreover, it was also found that self-esteem was highly associated with CGPA (r.71).

Correlation analysis between parental attachment, CGPA and self-esteem
Self-esteemParental AttachmentCGPAParental AttachmentPearson Correlation.621.47Sig. (2-tailed).00.01N323232Self-esteemPearson Correlation1.62.71Sig. (2-tailed).00.00N323232CGPAPearson Correlation.71.471Sig. (2-tailed).00.01N323232. Correlation is significant at the 0.01 level (2-tailed).

Predictive analysis. Since it has been found that parental attachment, self-esteem and CGPA is positively associated, it is of interest to determine which of the two variables-self-esteem and CGPA will be able to predict the quality of parental attachment. In other words, this statistical analysis will identify whether self-esteem or academic achievement is indicative of the students parental attachment. It is hypothesized that the self-esteem and CGPA of the students can adequately predict the level of parental attachment.

The table shows that only self-esteem predicted parental attachment ( 0.258), this would indicate that the student s self-esteem levels are associated with parental attachment scores. The results also showed that CGPA is not a good predictor of parental attachment, indicating that the association between parental attachment patterns and student s academic achievement is not as strong as that of self-esteem.

Discussion
The present study determined the relationship between parental attachment, self-esteem and academic performance of undergraduate students. In addition, this study identified that self-esteem is predictive of parental attachment while academic performance is not. The findings of the study indicate that parental attachment is positively associated with self-esteem and academic performance, wherein the more secure the parental attachment, the more it is likely that students have high self-esteem and high CGPA. The positive correlation relationships between the three variables  level of parental attachment, self-esteem and academic performance are consistent with previous studies (Amsden  Greenberg, 1987 Laible et al., 2004 Maureen et al., 2005 Wong et al., 2002). On the other hand, the present study showed that the relationship between academic performance and parental attachment is weaker than the relationship between self-esteem and parental attachment. That is high level of secure parental attachment has high predictor power on high self-esteem than high academic performance.However, upon further analysis, it was found that only self-esteem predicted parental attachment, that is, a students self-esteem is more a function of parental attachment than academic performance is.

The present study focused on the importance of parental attachment to the positive adjustment of adolescents to college life. Hence the findings have significant implications for the role of parent-chid relationships in preparing children for lifes challenges that they have to face3 on their own. Since parental attachment serves as a secure base where the individual can go back  to at any time, it gives the students a certain advantage in surviving college life. Moreover, the reuslts pointed out that self-esteem is more influenced by parental attachment than acadmeic performance, this underscores the importance of the parent-child relationship to the positive perosnality development of the child. It is important to develop parents education program that encourage parents to develp a positive relationship with their children in order to help the child become a healthy and effectively functioning individual. Furthermore, assessing students relationship with parents might help counsellors develop a helping plan focusing on the quality of the students relationship with his or her family, parents and siblings.   
A number of limitations that influence the interpretation of the results should be mentioned in the study.

First, in the present study, the sample size is too small thus, generalizing the significant relationships between the variables should be done with caution. The participants selected for the research was in the campus, therefore, possible selection bias may exist and hence sampling error may have occurred.Therefore the results should be generalized with caution. For reducing sampling error, it is suggested that future studies should select a larger sample size. Second, the family background was not available in the study. It is noted that family background (i.e. parents education level and age, family income, and number of siblings) may be an important factor that would greatly influence the findings of this study. Third, the measures used were self-report questionnaries and self-report CGPA and hence the answers may be open to faking and deception on the part of the participants. Fourth, the development of self-esteem is a long term process and academic knowledge are cumulative which imply long term effect as well. However, the present study only assess the current parental attachment but ignore the long term relationships that may influence the interpretation of the results. 

It is stated that individuals are diverse, and they have various characteristics which separate them from other individuals. This is why Attention Deficit Hyperactivity Disorder (ADHD) is difficult to diagnose amongst children. It is necessary to state that while children are undergoing different growth stages, and sometimes they may get easily distracted, may become impulsive or may have difficulty in concentrating. While there are those children who seem to have symptoms of ADHD, it does not necessarily mean that they are afflicted with the condition.

The researcher aims to determine as to whether a clear and adequate diagnosis of ADHD amongst children is possible. Since it is given that certain characteristics may be mistaken for ADHD, it is necessary to determine whether ADHD may be properly diagnosed in order to avoid the possibility of a wrong diagnosis which may cause problems to the patient. For the purpose of this study, the researcher has chosen three articles which may give valuable information on whether ADHD may be adequately and properly diagnosed among children.

Summary and Critique of Articles
The first article is The Effects of Patient Characteristics on ADHD Diagnosis and Treatment A Factorial study of Family Physicians. According to Christopher Morley (2010), ADHD is an affliction which is prevalent in the youth of the United States it affects around 7 percent to 9 percent of individuals ranging from ages 4-17. However, despite the fact that a lot of individuals are suffering from the affliction, it still remains unclear on whether a proper  diagnosis and treatment occurring in primary health settings  (Morley, 2010, p. 11) is possible. This is important for most ADHD treatments are done in  primary care settings  (Morley, 2010, p. 11). However, Morley (2010) states that diagnosis and treatment of ADHD can be affected by outside factors. It is stated in the aforementioned discussion that ADHD diagnosis may be problematic because of the varying characteristics of individuals which may be mistaken for the affliction however, these characteristics may not be the only ones which can affect diagnosis. Morley (2010) states that various social factors, specifically insurance status and race may affect which children are going to be and not going to be diagnosed.

In the statistical data presented by Morley (2010),  the ADHD diagnosis amongst uninsured individuals lessen by almost half compared to the diagnosis amongst individuals who are insured. Apart from this, Morley (2010) states that if an individual, particularly a male patient, is uninsured, this will lessen his chances of being diagnosed with ADHD. It is, of course, necessary to state that such result from the statistical analysis needs to be studied further, as there are currently no available explanations on why such would occur. What is clear is that being uninsured lessens the male childs chances of being diagnosed with ADHD.

Another article related to this discussion is Validity and Clinical Feasibility of the ADHD Rating Scale (ADHD-RS) A Danish Nationwide Multicenter Study. This research states that it is necessary to establish the reliability of the rating scale used in the diagnosis of ADHD. The researchers conducted the study with a 873 children as sample, and they were assessed using the ADHD-RS they were rated by their teachers and their parents.

The results of the study states that the ADHD-RS is reliable, however, it must be taken into consideration that the researchers have stated that the diagnoses are not as reliable if they are not the results of a  randomized, controlled trial using standardized diagnostic tools  (Szomlaiski, Dyrborg, Rasmussen, Shumann, Koch,  Bilenberg, 2008, p. 401).

And the last article which deals with the discussion of whether ADHD may be adequately diagnosed is Adam Zolotors  Jill Mayers Does a Short Symptom Checklist Accurately Diagnose ADHD (2004). Zolotor (2004) states that it is necessary to evaluate whether the checklists used in diagnosing ADHD are reliable. A lot of experts suggest that such checklists may be subjected to personal interpretation and have limitations. Since the checklists are limited, they may not be as reliable as most physicians believe they are.

Zolotor  Mayer (2004) states that the checklist or the scale used for the diagnosis of ADHD uses the concept of the  effect size. This is the estimate of how normal or abnormal an individuals behavior may be. However, the findings of the research state that since the scales are limited and may be subject to interpretation, it would be possible to misdiagnose a patient. It must be taken into context that the one who is answering the checklist has his or her subjective perspectives regarding the patient. Apart from this, there are instances wherein the possible patient may be less disruptive and passive, and will not match with the checklist.

Conclusions and Recommendations
In analysis, of the aforementioned articles, it could be said that all three seem to have the underlying message that diagnosing ADHD is extremely difficult. It can be seen in Morleys discussion states that ADHD diagnosis is not merely determined by an individuals characteristics. In fact, it may be said that insurance plays a large factor on whether an individual may be diagnosed with ADHD, regardless of whether he or she really manifests the affliction. An assumption that may be made regarding such data would be that the factor of health insurance is far more important than the real situation. While the situation would not be amenable to various individuals, and may even raise ethical issues, it is necessary to state that the aforementioned discussion is, indeed, occurring. 

However, it must be taken into consideration that the Morley was not able to present information that would justify such actions of the physicians when it comes to creating pragmatic decisions when it comes to diagnosing ADHD. It is stated in the article that such information needs further investigation for it is not present at the moment. Therefore, it is necessary to expand the research in order to attain information regarding this issue. However, what the article clearly states is that there is proof that diagnosing ADHD may be as simple as people think it should be. In a sense, this article provides insight on whether ADHD may be accurately diagnosed or not.

It is also necessary to state that although Szomlaiski et al was able to prove that the ADHD-RS can be reliable, its reliability decreases in an uncontrolled setting. It must be understood that these questionnaires may not always be controlled, and the answers depend on the perception of the individual answering it. Zolotor  Mayers article supports this fact, for it could be seen that although checklists which are used to determine ADHD may permit the physician to collect information about patient, it does not necessarily guarantee that the checklist is foolproof, for it may be subject to other factors such as personal interpretation and various limitations. It is necessary to state that not all individuals who have ADHD have the same characteristics therefore, the checklist would fail its purpose.

In summary, the three aforementioned research articles show that diagnosing ADHD can be extremely difficult. There are various factors which may affect the diagnosis, from the one answering the ADHD-RS to the physician. While there may be instances wherein the diagnosis may be correct, it is necessary to always re-evaluate, since the future of the patient is at stake on whatever diagnosis he or she may receive.

Science experts around the world has come up with different hypothesis and theories about how exactly human memory functions, it is said that the memory processes information from separate parts of the brain and it has extraordinary ability to retain these informations scientist has not been able to apprehend how exactly we retain information or what transpires when the brain recall, human memory is a complex, brain-wide process that is essential to whom we are (Mohs).

What brought about who we are mostly encompass our past events, experiences, conversation education acquire, books we read or things we were told or stuffs said to us and all of these attribute to the causes physical transformation or change in our brain, changes that may last forever within us, altering our perspective about life and the world around us.

The author state that the memory is physically lodged inside you like a shard of glass healed inside a wound, practically because of the great retention ability of the memory to hold information, consequently this ability gives people the power to inflict change in an individuals attitude, character, thinking, behavior, way of life e.t.c these changes occur either positively or negatively depending on what was done or said to such person either by assaulting, appraising, commending, insulting or humiliating such person (Johnson, 1991).

With reference to the last paragraph of the text, the establishment of the fact that the memories cause physical change by science and seeking distension between mental or psychological violence and physical or substantial violence with been both protected by law. It should be agree that mental violence causes physical change as well as physical violence but it should be noted that physical violence can easily treated otherwise healed but the case of metal or psychological violence or memory take longer process that is if it can be treated of healed.

In studying all this, the question about knowing what we know can be a very complex case to deal with, it is like the mind trying to study itself with reference to the author, although Johnson mentioned that people from various discipline ranging from science to medicine, law, business, economist e.t.c has come together are trying to understand the concept of how we became knowledgeable about the things we know and if the statement by Johnson is right about science proving that thought causes mental change then the study on the relation between mind and brain should concentrated on, however, should we let go the dualist notion of mind and body being separate entities and agree that thought is a biological function of the brain (Johnson, 1991).

What are the main characteristics of the culturally skilled practitioner Develop an outline of a training program designed to enhance multicultural competency. Include the beliefs, attitudes, knowledge, and skills needed for culturally skilled practitioners.

As each one of us may come to agree, being culturally competent is essential in the practice of ones profession, especially in the field of healthcare, allied health and other professions whose nature is to constantly interact and deal with diverse people. As such, it is important that practitioners must be equipped with knowledge, attitude, skills, and values in order for them to be hailed as culturally skilled practitioners.

What does it take to be a culturally skilled practitioner is a good question that necessitates a conscientious enumeration of the main characteristics in order to become one. According to literatures, a culturally competent and skilled practitioner embodies traits or elements that include (1) self-awareness, (2) trustworthiness, (3) cultural sensitivity, and (4) ability to communicate effectively (Berman et al., 2008 Videbeck, 2006).

Videbeck (2006) upholds that self-awareness is important in examining ones own culture, beliefs, and personal prejudices, and how these qualities affect others. It is considered as the first step in realizing that a practitioner is different from other peopleclient a separate entity (Videbeck, 2006, p. 13). For this reason, before a practitioner can begin understand othersclients, he or she must first know himself or herself (Videbeck, 2006, p. 89).

Trustworthiness is also an imperative characteristic as practitioners need to win the trust of the clients in order to cross individual gaps, thereby paving the way to sharing of delicate information and exchange of ideas. In other words, trust must first be established before clients can be expected to divulge sensitive details about them (Berman et al., 2008, p. 324).

In the same way, being sensitive to the culture of others lets the practitioners to be more careful of their choice of words and be wary of their actions. Moreover, cultural sensitivity roots from the knowledge and understanding of the similarities and differences between cultures. Sensitivity also goes with respect respect for dissimilarities that may be present between the cultures of the practitioner and the client, respectively. In this way, culturally skilled practitioners will be able to convey a genuine desire to understand the clients beliefs and values (Berman et al., 2008, p. 324).

The ability to effectively handle communication is vital in the emergence of a true culturally skilled practitioner. This is because communication is the only means by which exchange of ideas and constant interaction between practitioners and clients are made possible. Notably, timing is a crucial aspect in communicating with clients that must be considered, particularly in introducing questions (Berman et al., 2008).  According to Berman and associates (2008), it matters as to how and when questions are asked, thus requiring correct timing coupled with sensitivity and clinical judgment.
Consequently, the most essential characteristics that help an ordinary practitioner to transcend and transform as culturally skilled practitioner have been explicated in the above discussion. With all those traits, the perceived outcomes in practice include promotion, maintenance, regaining or acquisition of mutually desired and attainable levels of health within the realities of life circumstances (Kagawa-Singer and Kassim-Lakha, 2003, p. 580). As such, the emergence of a culturally competent and skilled practitioner who delivers careservice that integrates the mind, the body, the spirit, and the cultural values of the individual could highly be evident (Fontane, 2005, as cited in Berman et al., 2008, p. 325).

In line with the key characteristics that are listed above, a training outline has been formulated in this paper in order to typify the culturally skilled practitioners multicultural competency.

A Proposed Training Program for the Enhancement of Multicultural Competency for Culturally Skilled Practitioners
Preparation Stage
Encouragingpromoting self-awareness among practitioners.
Orientation to possible cultures that could be encountered in practice (e.g. Asian, African American, Hispanics, etc.)
Strengthening of communication skills.
Strategic planning of activities including immersion and familiarization of languagesdialects spoken by prospective cultures.
Application Stage
Assessment of actual culturally diverse clients.
Conscientious practice application of multicultural knowledge base and relevant learned concepts.
Evaluation Stage
Appraisal of actions taken through reflection. This entails the use of a reflective model like the Gibbs Reflective Model (1988).
Assessment of outcomes on both parties (the clients and the practitioners).
Augmentation of multicultural knowledge base and possible re-training in line with the outcomes and perceptions derived from the application stage.

Theories of Counseling and Psychotherapy
In managing mental health conditions, the care-provider utilizes different treatment modalities. Among these modalities is psychotherapy which can be administered solely or as part of a regime inclusive of other modalities such as pharmcotherapy  and special modalities like electroconvulsive therapy (Murdock, 2009). Psychotherapy is of particular importance as it obligates the provider to interact with the patient at a personal level with the aim of helping the patient deal with stressors in their lives (Murdock, 2009). Various approaches have been adopted by health professionals in conducting psychotherapy. These approaches are guided by various theories developed in behavioral sciences, as a result, a myriad of approaches are in use today with each of them useful but also individually deficient in certain regards (Murdock, 2009). This paper examines four of these approaches namely narrative, feminist and solution focused therapy.

The goal in psychotherapy is to enable the patient gain insight (Murdock, 2009). Insight is the ability of a person to understand what is happening to them both internally and externally, thus the patient  becomes aware of their own behavior and emotions, and concurrently of those in contact with them (Murdock, 2009). Thus the care-provider does not merely offer advice but through dialogue offers support, imparts the patient with new skills and educates the patient on behavior and emotion. Psychotherapy is thus a process that is heavily reliant on logic and facts which the care-provider discusses with the patient (Murdock, 2009). It is a collaborative process as the final decision on how any given concern will be tackled is left to the patient, the patient is thus an active participant in their own therapy (Murdock, 2009). It is in these regards that the previously named approaches meet, the choice of any particular approach is dependent on the type of patient seeking remedy (Murdock, 2009). It should be remembered that each of the theories was developed in search of alternative that would satisfy failings of existent approaches

Feminist theory was developed in the sixties driven by the women rights movement at the at time in an attempt to solve apparent demographic differences that showed that the majority of people seeking care were women while the traditional theories in use failed to serve them well as they were partanity based (Murdock, 2009).Feminist theory focuses on how society, culture and politics define the well-being of the individual at the expense of the role the particular individual plays in their own mental health condition (Murdock, 2009) .This approach therefore proposes that the patients problems can be solved via changes in their sociopolitical environment. The patients are thus encouraged to involve themselves in pushing for social change in order to empower themselves (Murdock, 2009).

Solution focused therapy as the name suggests involves finding solutions that are specific to the individual (Murdock, 2009). Like in the feminist theory, it assumes that the individual is the master of themselves and thus decide on their own fate (Murdock, 2009).In this approach, change is  perceived to be constant and inevitable and thus problems arise when solutions available fail to adapt accordingly (Murdock, 2009). The focus is on moving forward with less regard to previous events with reinforcement of solutions that have worked and effecting appropriate change in ineffective solutions (Murdock, 2009).The care-provider focuses on identifying and fostering change thus problems per-se are not discussed (Murdock, 2009).This approach was developed by De Shazer and Insoo Kim Berg who built upon Milton Erickson and MRI models which enabled shift from traditional research which was based solely on what the therapist considered as successful means of psychotherapy (murdock, 2009).

Narrative therapy refers to theory fronted by Micheal White and David Epston. A narrative includes an introduction, a plot, subplot and a conclusion. In its development certain notion take priority over others , when this is viewed in a larger paradigm, the effect is suppression of certain ideals and concurrently people who hold these ideals (Murdock, 2009). This is the central premise in narrative therapy. In this approach, the client is viewed in a manner similar to feminist approach where the sociopolitical situation of the client is considered (Murdoch, 2009). This is because stories influence the perspective individuals perspective of their own life e.g the christian story of creation may discriminate against believers in evolution theory (Murdock, 2009). The therapist in this approach encourages the client develop their own story by highlighting the richness that experience holds over narrative (Murdock, 2009). In this way perceptions about self are change as the oppressive problem filled story is replaced by the untold story (Murdock, 2009). Recently, postmodernism, the premise that the is no universal truth and events have multiple valid interpretations, has been integrated into narrative therapy.

In conclusion, the above discussed psychotherapy approaches offer useful insights that are of use in the work of the modern therapist. This fact is reinforced by the realization that patients are not as simple as each of these models propose (Murdock, 2009). For instance relying on the feminist approach only may lead to mismanagement of cases as it is unlikely that the mental health condition of a patient will be solely determined by sociopolitical factors in isolation (Murdock, 2009). In addition, they guide the therapist as they offer improvements on traditional approaches such as determinism which proposes that the present behavioral characteristics of the individual develop only early in life and thus cannot be altered (Murdock, 2009). These approaches, in particular narrative and solution focused therapy, help in defining the role of the caregiver as a guiding light rather than the ultimate authority as concerns solving mental health problems thus negating the possibility of mismanagement as therapists being human are not always right (Murdock, 2009).

Communication is the action or exchange of information, thoughts, ideas and feelings or anything that one wants to pass over to another person. Communication is done either verbally, writing, signals or body language, as long as the message has been transmitted, that is communication.  In a workplace, constant and effective communication is vital in the organizations productivity and success.  Being able to correctly publicize instructions andor information, the faster the work will be made in a much accurate manner.

Interpersonal Communication Defined
Interpersonal Communication is the process of message transaction between people (usually two) who work toward creating and sustaining shared meaning (West Turner, 2009, p.8).  Interpersonal communication is the act of sending and receiving or an exchange of information, thoughts, feelings, and ideas between two individuals or parties. 

Interpersonal communication goes through a process that includes four elements.  These are the sender, who gives out the information receiver, one who receives the information the message, the information that was given, and the feedback, which is the reaction or answer to the message given.

Principles of Interpersonal Communication
Effective interpersonal communication may be achieved by 1. Treating each other with respect. By valuing ones thoughts and feelings makes the other feel that they are worth listening to and that what they have to say matters and is important. 2. Dont interrupt one another. Allowing one other to speak freely makes the communication lines clearer than of not. The information is given with clarity thus, the conversation becomes more enjoyable and informative. 3. The right to pass. This is an indication that we maturely make wise decision and choices not to control or change other peoples perception or views. 4. Speak for yourself. Speaking for yourself means to talk about you, your feelings and thoughts. Do not put words in someone elses mouth. It is impossible to speak of someone elses thoughts and feelings. Let that person express themselves. 5. That we speak but not too often and too long. Filling in the gaps or the air time is generally okay, but when we speak for a long period of time, we might already be boring and taking much time of others and leaving them no room to say something or let out their own thoughts. 6. Challenge the behavior and not the person. This is pointing out the persons behavior and not attacking him or her personally. Though it is hard to put our emotions aside when in a heated conversation, however, it is also ethical and professional to let your cool down and addressing the misbehavior and not the one you are speaking to. Being able to separate these two things will make wonders and help you achieve interpersonal communication in your work place. 7. Confidentiality.  It is never polite to talk about someone about something without their consent or knowing.  This is especially true, when one has approached you for something or opened up to you and later telling everyone about the conversation. Respecting another ones privacy will win you the respect of your colleagues and co-workers and subordinates as well. 8. Its okay to make mistakes. We are only human and we were created to make mistakes. Committing mistakes are occasions and chances for growth. Without the mistakes that we make, we will not learn from them and unable to learn is being stagnant. Evolving is a mans must do in order for him to survive.

Conflict
Conflict is an expressed struggle between at least two interdependent parties who perceive incompatible goals, scarce rewards, and interference from the other party in achieving their goals ( HYPERLINK httpwww.members.tripod.comnwacc_communicationid21.htm)
httpwww.members.tripod.comnwacc_communicationid21.htm). When there is a difference of opinion between two parties, and that both believe that their opinions are exclusive, chances are there is a conflict.  Although the term conflict does not really make a ring to the ears, conflicts can also be beneficial to both parties.  Being able to voice out and make your thoughts known, this can be educational and informative to each one. From here, it becomes a learning experience and help one another grow and develop themselves.

Techniques on Reducing Conflict in a Conversation
When we are in a gathering, be it in a party or at work there is always the possibility of getting into a heated conversation. It is all but normal and natural for individuals to feel this way especially when opinions do not match. However normal this situation may be, there is always a good and healthy way of doing things and addressing them. Going head to head with another person will most likely get you nowhere and probably gain more enemies than friends.  There are ways to rationally get out of a conflicted argument or conversation. According to DBR Alternatives, Inc. in one of their on-line pages entitled, Interpersonal Conflict and Effective Communication, there are 5 techniques to reduce conflict. These are a. the Defusing technique.  Your goal is to address the others anger and you do this by simply agreeing with the person. When you find some truth in the other point of view, it is difficult for the other person to maintain anger. For example, I know that I said I would call you last night. You are absolutely right. I wish I could be more responsible sometimes. The accusation might be completely unreasonable from your viewpoint, but there is always some truth in what the other person says. At the very least, we need to acknowledge that individuals have different ways of seeing things. This does not mean that we have to compromise our own basic principles. We simply validate the others stance so that we can move on to a healthier resolution of the conflict. This may be hard to do in a volatile situation, but a sign of individual strength and integrity is the ability to postpone our immediate reactions in order to achieve positive goals. Sometimes we have to lose in order, ultimately, to win. B. Empathy Try to put yourself into the shoes of the other person. See the world through their eyes. Empathy is an important listening technique which gives the other feedback that he or she is being heard. C. Exploration Ask gentle, probing questions about what the other person is thinking and feeling. Encourage the other to talk fully about what is on his or her mind. For example, Are there any other thoughts that you need to share with me D. Using I Statements Take responsibility for your own thoughts rather than attributing motives to the other person. This decreases the chance that the other person will become defensive. For example, I feel pretty upset that this thing has come between us.

This statement is much more effective than saying, You have made me feel very upset. And, E. Stroking Find positive things to say about the other person, even if the other is angry with you. Show a respectful attitude. For example, I genuinely respect you for having the courage to bring this problem to me. I admire your strength and your caring attitude.

When trying to communicate and express your thoughts and ideas, though faced in a tight situation of variance there are ways to reduce if not avoid clash or conflict. And if avoiding and reducing is not possible and find yourself in a snag, there are ways to resolve arguments and still achieve something positive and productive.

Resolving Conflicts
It has been mentioned that interpersonal communication is an act of transmitting information, feelings, thoughts and ideas.  Because emotions and feelings are involved, conversations may get heated up and turn into something that you hope to be productive and positive actually turns into an argument. There are ways to counter and resolve a heated up conversation. The first rational way in resolving conflicts is, identify the problem. Talk and understand each others problem or dilemma. Listen to what the other has to say and speak when it is your time to.  Second, think of possible solutions. Two heads are better than one. Talk amongst yourselves and carefully discuss what your options are. Third, decide on the best solution. Choose a solution that not only suit you but is acceptable to both of you. Fourth, Implement the chosen solution. Agree on the details and activity delegation. Make clear of who is responsible for implementing one thing from the other. And Fifth, evaluate the solution. This is a work in progress. Check among yourselves if the solution is working or not. Is it doing you and the other good.