Study Abroad: Mental Health & Crisis Management (I)

Mental Health and Crisis Management:
Assisting University of Notre Dame Study Abroad Students
2nd edition

A Handbook for International Educators
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Settle, W., Albers, S., Blake, E., Gaw, K., Hickman, L., Hogan, I., Newport, N., Shoup, J., & Utz., P. (2004) Mental Health and Crisis Management: Assisting University of Notre Dame Study Abroad Students,2nd. edition. University of Notre Dame Counseling Center, P.O. Box 564, University of Notre Dame, Notre Dame, IN 46556. Edited by Wendy Settle. This second edition contains updated links and added resources, as well as a new chapter on reverse culture shock. The first edition was published in 2002. Situations described in this manual are not based on actual cases. Language is intentionally gender-neutral or, when necessary, alternates between male and female pronouns. Please send feedback to Wendy Settle Ph.D.

Mental Health and Crisis Management, 2nd edition download. If you don't have Acrobat Reader on your computer, you can download a free copy from Adobe's web site.

Introduction

Susan Steibe-Pasalich , Ph.D.
UCC Director
University Counseling Center
University of Notre Dame

Over the years, the staff of the University Counseling Center has been directly and indirectly involved with Notre Dame's International Study Programs. When students return from these programs, they often contact us to talk about some of the difficulties they experienced while overseas or upon returning to Notre Dame. We also have had Directors, faculty, residence staff, international and on-campus administrators call us to seek consultation about individual students with problems or concerning conflicts among students.

When it was suggested that we prepare some materials for the staff of our International Programs, we saw this as an opportunity for us to take a preventive approach to these problems. We are hoping to describe some of the situations you can expect during a student's time in the program, provide some general information about typical problems and offer some suggestions for ways that you might intervene.

This handbook has been written to assist the International Study Programs’ On-Site Directors, Associate Directors and staff to deal with problems of students as they develop. Staff are not expected to be counselors or psychologists to the students. However having some basic notions about the nature of typical problems college students face along with some "do's and don'ts" can be useful in crisis situations.

Crisis = "Danger and Opportunity"

Mental Health and Crisis Management:
Assisting University of Notre Dame Study Abroad Students

Introduction

Section I. Mental Health and Related Issues: What You Need To Know

The Study Abroad Student and Culture Shock
Helping the Study Abroad Student who is Depressed or Suicidal
Assisting Study Abroad Students with Eating Disorders
Assisting the Study Abroad Student Dealing with Grief and Mourning
Students Studying Abroad who Abuse Alcohol
The Study Abroad Student who has been Raped or Sexually Assaulted
Sexual Harassment and Notre Dame Students Studying Abroad
Reentry and Reverse Culture Shock: Helping the Study Abroad Student Transition Back Home

Section II: International Educator Challenges and Dilemmas

Tips for Identifying, Assisting, and Referring Students in Distress
Consulting with the University Counseling Center
Assisting the Notre Dame Study Abroad Student Who Needs to Withdraw

Section III. Resources for International Educators on the Internet

University of Notre Dame Offices and Contacts
Mental Health Crisis Management Resources
General Mental Health Information
Crisis Management Resources for International Educators
Sources for Articles on Mental Health for International Educators

About the Authors

Section I:

Mental Health Issues and Disorders:
What You Need to Know

As you are well aware, study abroad can be a personally rewarding, culturally expanding, growth-producing -- as well as a somewhat stressful -- experience. Almost one-tenth of the student body at Notre Dame seeks services from the Counseling Center for issues related to personal growth, in addition to depression, anxiety, grief and loss, family problems, interpersonal relationships, eating disorders, problems with alcohol, and sexual abuse, to name a few. Most Notre Dame students are young adults going through the usual emotional ups and downs of college life. Some navigate more stressful and unusual transitions into adulthood, causing them to feel alone and apart from their peers. Students do not necessarily leave their stresses at home when they come to study abroad, which may leave you, as the international educator, assuming that you must take care of all of their issues on your own. To some extent, you are assuming responsibility, probably more than any one human could be trained to provide. We hope that as you read this document, you will learn that you have more support and resources than you previously realized, so that you do not need to bear the burden of dealing with students' crises completely on your own.

It is also helpful to realize that sometimes what seems to be a crisis to the new study abroad student is actually a normal developmental phase of adjustment, typically called "culture shock." We follow our chapter on culture shock with descriptions on how to talk to students who are dealing with what could be more severe or chronic disorders and stresses. These include helping students who are depressed/suicidal, showing signs of eating disorders, or dealing with grief and loss, alcohol problems, sexual harassment, assault and rape. If you are concerned about a student, you are not expected to "diagnose" culture shock versus other, more severe issues. However we do believe that the more you know, the more you will be able to distinguish when a student may need intervention from a local mental health specialist and/or intervention in consultation with another specialist at University of Notre Dame, such as from within Student Affairs.

~ Wendy Settle, Ph.D.

The Study Abroad Student and Culture Shock

Kevin F. Gaw, Ph.D.
Psychologist
Counseling & Testing Center
University of Nevada, Reno

Introduction

Culture shock is not a psychological disorder, but in fact, it is a developmental phase that is both common amongst sojourners and expected when one adjusts "properly" in a cross-cultural context. It is important to recognize culture shock since the symptoms can mimic more severe psychological disorders, such as depression. In addition, as an international educator, your role in assisting students to adjust to the new culture will help to prevent the development of psychological problems. This chapter describes culture shock and the common signs of the experience. In addition, approaches will be suggested on how to help your students adjust and work through the experience and how you can use the adjustment phase as an opportunity for the development of your students' intercultural sensitivity.

What is Culture Shock?

While there are many academic definitions of culture shock, the experience can be simply described as a clash between one's personal way of viewing and interacting with the world (which is determined by one's home culture) and the new cultural environment. This is the classic conflict between ethnocentric and ethnorelative views of the world, which is experienced as a perceived lack of control or a sense of helplessness. Anxiety, frustration, confusion, loss of perceptual cues, discrepant meaning systems - all these contribute to the "clash."

Culture shock has often been described as an adjustment cycle, with an initial high point upon entry marked by excitement and optimism, a low point during the sojourn (the culture shock phase), and a moderated "high point" near the end of the sojourn experience as the student learns to function more successfully. "W-Curve" model (Gullahorn and Gullahorn, 1963) is frequently cited because it describes not just the initial culture shock stages (Excitement, Disillusionment, Confusion, and Positive Adjustment), but replicates a similar adjustment cycle for reentry "back home." While reentry might seem a non-issue, in fact, it is often experienced as more stressful than initial culture shock.

Culture shock is about a student’s struggle in becoming culturally competent in a new cultural environment, where the rules, behaviors, expectations, food, language, and systems are all different from home. Culture shock is perfectly natural. When a person struggles through such a challenge, the person grows; they mature. Evidence demonstrates how study abroad students, when they approach their experiences in a developmental manner (that is, they intend to learn and grow as a person from their overseas experience), they develop psychologically and socially. Positive changes in attitudes, behaviors, global awareness, worldviews, values, cultural understanding and empathy, and ethnorelativism, have all been documented. Many times when a student is experiencing culture shock, no intervention is needed because it is natural and developmental – a capable, self-aware, interested student will work through the experience.

Some researchers have indicated culture shock lasts for a few weeks, while others have documented longer time frames, including over a year. Still, other researchers have found that culture shock seems to be proportionate with one's sojourn time frame. Because culture shock is a developmental process within the adjustment cycle, the time frame is individualized and depends upon the student's resources (internally and externally). For the high functioning, mature, curious, flexible (these seem to be critical variables) young person, culture shock typically resolves itself within six months or less.

The bottom line is this: culture shock appears to be a process of experience. With time, support, learning and mindfulness, it can become a positive developmental experience, much like how we think it’s good for our teenagers to leave home and "go out into the world" to become responsible young adults.

Is Culture Shock Always "Painful?"

This is an interesting question, as some sojourners seem to adjust with relative ease while others really struggle. What seems to make the favorable difference for many is their openness to cultural differences, readiness for change/growth, and tolerance for ambiguity and stress. For others, they may have a predisposition for some sort of disorder, and the stress of adjustment may bring this out. Culture shock can be exacerbated when a student is isolated or isolative. However, a difficult adjustment does not mean the student is in trouble; it may simply mean they are encountering a lot of challenges and a lot of questions. Support and assessment are essential.

Depression, discussed in the next chapter of this handbook, sometimes arises from cultural adjustment. Culture shock itself is not depression, though some of the signs mimic depression (see Table 1). What is important to watch for is if the student has the potential for depression; if so, then culture shock might bring the depression forward. The same can be said about substance abuse, eating disorders, anxiety disorders, or other difficult presentations. It is very important, though, to separate the adjustment data from more "clinical" data to avoid errors in labeling. Whenever in doubt, do what a competent mental health clinician does: consult!

Recognizing Culture Shock

Table 1 lists the more common signs of culture shock; the list is not complete but an introduction. It is fairly common for the "shocked" student to not even recognize culture shock because the student can "rationalize" the signs. Look for clusters, patterns, and behavioral changes; use the feedback of others who know the student. Remember that culture shock by itself is a normal part of the adjustment cycle to a new cultural environment.

Table 1. Some Emotional and Behavioral Signs of Culture Shock

Emotional Signs ------------------------------------------Behavioral Signs

Alienation	No friends "Self-imposed" isolation	Limited intercultural skill development
Anger Frustration Irritability	Acting out (physical, verbal) Excessive drinking Ethnocentrism	Defensiveness Complaining about the host culture/people
Anomie Loneliness	Isolation Withdrawal (social, academic)	Discontinues pleasurable activities Writing or calling home a lot
Anxiety	Nervousness Tension (muscles, "nerves") Insomnia	Poor concentration Fear of being misunderstood
Apathy	Regressive behaviors Social and academic withdrawal	Lack of care for self/others Poor personal hygiene
Confusion	Judgmental Stereotyping Communication problems	Poor decision making Questioning Self (identity, role, purpose)
Depression (See the Depression chapter)	Insomnia Substance abuse Weight change Appetite change	Social/Academic withdrawal Emotional swings Irritability/Anger Decline in self-care
Obsessions injury inadequacies not being understood threat/harm/persecution contamination	Compulsions compensation acting out behaviors withdrawal, defensive	no appropriate risk taking hand-washing, clothes avoidance behaviors

Providing Support as Students Adjust through the Stages of Culture Shock

The kind of support you provide will differ across students, as their culture shock is different. Perhaps one of the greatest forms of support is to listen in a manner that validates the student’s experience without solving their challenges for them (how else will they discover their competency?). Be comfortable with the expression of feelings – as there really is no such thing as a "good" or "bad" feeling – feelings just are feelings, and they give us good data on what’s going on within us. Strong affect is OK too, as long as it’s respectful of self and others. Below are some immediate ideas on support.

Basic Listening: While this may seem really obvious, using basic listening skills will go a long way in supporting a student. Basic skills are attending, reflection, asking questions, and summarizing. Try to use the student's words rather than your words to frame their experience. Validate experience; avoid the temptation to problem solve.

Journaling: Reflective writing has served as a productive "refuge" for many, allowing them to gather thoughts and feelings in one safe place. Journaling does require reflection for it to be useful. Encourage students who journal to talk about their reflections (not necessarily the actual content of what’s written). Some students also write poetry, draw or paint as other forms of creative expression. Much of culture shock revolves around not connecting to (or fitting into) the host environment; questions and reflections should address these issues.

Field Trips: Design excursions that progressively allow students greater and greater autonomy, if your program has some control of this. Use trips to deliberately monitor how students interact with hosts and the environment; then promote skills acquisition based on assessed areas of competencies (e.g., language, systems knowledge, cultural knowledge, behavioral cues). This could be done through many approaches, such as an orientation class/program, a Talking Circle, or even individually.

Talking Circle: One approach to providing support is to allow your students and you to gather as a process group to talk about experiences and what's been discovered of the new environment. This nurtures the growthful aspects of culture shock and spreads the responsibility (and dynamics) of support to a network of peers. It is important the group avoids bashing the host environment, for this merely reinforces ethnocentrism, one of the keys to remaining locked in bitter dispute with one’s situation.

"Mentors": If your program allows pairing more seasoned students with newly arrived students, this could be helpful, but only for short-term contact. New arrivals want to feel a sense of mastery and having an "old hand" showing them around does convey a message that the new arrival needs "baby sitting." Instead, design short-term contacts, such as one-day tours to generally introduce the "lay of the land," yet refrain from teaching the subtleties of the new environment. This might help prevent conveying a message of inadequacy, one of the culture shock themes. Conversely, in situations that require interventions, a more experienced sojourner may be the ticket because he/she can cut to the chase and the distressed student will likely trust their experience.

Cultural Mediator: One reason why people experience culture shock is that they feel overwhelmed by all the new things in the host environment. The cultural mediator's role promotes both intercultural exchange and competencies. However, be mindful to design the use of a mediator so that it tapers off so as to intentionally increase your students’ competencies. Cultural mediators are almost always trusted "locals" who are sensitive to your students' needs and the student experience.

Identity: It is very important for individuals to have a sense of self – an identity. Sojourn experiences tax our identities beyond belief. Allow students to convene, to share experiences, to have a sense of national, ethnic and personal selves, to re-establish connection with Notre Dame through you and the program. Also allow for students to have personal time. No one expects a person to lose his or her identity to become "multicultural." In fact, to be really multicultural, one must start and end with oneself.

Conclusion

Culture shock is developmental and appropriate - it means a student is wrestling with cultural differences and trying to make sense of those differences. If the student remains in conflict, they may become "stuck" and experience depression, social problems, or even academic problems. Working through culture shock usually results in stronger, more interculturally competent students who are capable of resolving the daily stresses of living in a different country and culture. Perhaps one of the greatest joys as a country director is to be a part of this exciting (and challenging) growth experience of your students.

Selected Reference List

Bennett, M. J. (Ed.) (1998). Basic concepts of intercultural communication. Yarmouth, ME: Intercultural Press.¹

Gaw, K. F. (2000). Reverse culture shock in students returning from overseas. International Journal of Intercultural Relations, 24, 83-104. ²

Kauffmann, N. L., Martin, J. N., & Weaver, H. D. (1992). Students abroad: Strangers at home. Education for a global society. Yarmouth, ME: Intercultural Press.¹

Lewis, T. J., & Jungman, R. E. (Eds.). (1986). On being foreign: Culture shock in short fiction: An International anthology. Yarmouth, ME: Intercultural Press.¹

Paige, R. M. (Ed.). (1993). Education for the intercultural experience (2nd. ed.). Yarmouth, ME: Intercultural Press.¹

Ryan, M. E., & Twibell, R. S, (2000). Concerns, values, stress, coping, health and educational outcomes of college students who studied abroad, International Journal of Intercultural Relations, 24, 409-438. ²

Sorti, C. (1990). The art of crossing cultures. Yarmouth, ME: Intercultural Press.¹

Zapf, M. K. (1991). Cross-cultural transitions and wellness: Dealing with culture shock. International Journal for the Advancement of Counselling, 14, 105-119.

Sources:

¹ http://interculturalpress.com/shop/index.html

²http://lib.nd.edu/eresources/gateway/

Helping the Study Abroad Student who is Depressed or Suicidal

Wendy Settle, Ph.D.
Psychologist
University of Notre Dame Counseling Center

Imagine this scenario. You notice that one of your students in your study abroad program isn't spending as much time with her friends, preferring to stay in her room. She appears sad but also irritable, which alienates people. She's picking at her food and complaining that she isn't sleeping well. Whereas she used to be enthusiastic about her classes and learning the new culture, now she's lost interest. She's not concentrating well and would rather sleep in than go to class. The others in the program have moved on to become more adjusted but she has continued to feel depressed now for several weeks.

Are these symptoms a continuation of the normal process of cultural adjustment or clinical depression?

As previously described, the symptoms of "culture shock" are very similar to the symptoms of depression. Students normally go through a period of adjustment which can include symptoms such as anxiety, sadness, depression, lack of energy, headaches, anger, confusion, despair, changes in eating and sleeping habits, loss of interest in activities, frustration, and loneliness. This adjustment phase is normal and occurs for a short period of time.

When might these symptoms be indicators that the student is clinically depressed and needs a referral for an assessment?

You may suspect that a student is "clinically depressed" and needs immediate intervention if the student has had symptoms for a prolonged period of time (several weeks), and is unable to function (e.g., not going to class, isolating). Immediate intervention is warranted if the student shows self-destructive or violent behaviors, or is also abusing alcohol or substances. Depression usually begins in adolescence or early adulthood, and is very common in college age students. Types of clinical depression include major depression, dysthymia (persistent mild depression for two years), seasonal affective disorder, and bipolar disorder (moods swing from depression to grandiose, energetic, possibly irritable, abnormal "highs"). People with major depression often suffer with the following symptoms, which are significantly impairing their personal or academic functioning:

Change of appetite; significant weight loss or gain
Change in sleeping patterns, such as fitful sleep, inability to sleep, early morning awakening, or sleeping too much
Loss of interest and pleasure in activities formerly enjoyed
Loss of energy; fatigue
Feelings of worthlessness or hopelessness
Feelings of inappropriate guilt
Inability to concentrate
Recurring thoughts of death or suicide
Withdrawing from social interactions
Physical symptoms, such as headaches or stomachaches

Not everyone who is depressed experiences every symptom. Symptoms and their severity vary with each individual case of depression, and sometimes symptoms are not caused by depression but may be due to a general medical condition, such as problems with one's thyroid.

How do I refer a student who is depressed for an evaluation and/or treatment?

Students who are depressed should be referred to a local mental health practitioner, a psychiatrist, or a physician for an evaluation. Please note that in some countries (e.g., the U.K) a referral to a mental health practitioner must be made by a medical physician, and in other countries a mental health practitioner must make the referral to a psychiatrist. Consult your local embassy to learn about referral procedures in your country and to obtain sources for referrals. Ask the student to sign the practitioner's release of information form so that you may consult with the practitioner to obtain his/her recommendations. Fortunately, once diagnosed by a qualified professional, depression is easily treated. About 80-90% of people who seek treatment for depression respond well to treatment, which usually consists of a combination of therapy and antidepressant medication. It is possible in a few cases that treatment may be able to be handled locally on an outpatient basis if the depression is mild and intervention is begun early. After the student has begun treatment, or if the student's depression is evaluated not to be severe enough for treatment, refer the student to self-help resources to alleviate their feelings of sadness (refer to the web sites listed below). Continue to provide support but do not attempt to provide treatment yourself. If the student's depression is moderate to severe, or is significantly impacting the student's cultural adjustment and/or academics, you will most likely counsel the student to go home for treatment. These decisions can be made through consulting with the student's local mental health practitioner or physician.

What if I suspect that a student is suicidal?

Studies show that depression underlies the majority of suicides. Suicide is the third leading cause of death among Americans aged 15-24. One of the best strategies for preventing suicide is early recognition and treatment.

Eight out of ten people who commit suicide give overt or covert warnings that they are considering suicide. The student may make verbal hints or jokes, such as "You won’t have to worry about me anymore," or "I want to go to sleep and never wake up," or "Does God punish suicides?" or "Voices are telling me to do bad things." The student may give away possessions, write emails, IMs (instant messages), or make telephone calls to people to "say goodbye." Another warning signal is if you notice that the student's depression suddenly and inexplicably lifts (perhaps because he has decided to end his pain).

Although you may be hesitant, for all students who are depressed, especially if you suspect that a student is suicidal, we highly recommend that you go ahead and privately talk to the student about her depression and then directly ask the student if she is suicidal. Asking will not put "the idea" in the student's head. You may say, "Sometimes people who are depressed think about harming themselves or attempting suicide. Are you thinking about harming yourself?" If the student is not, she will tell you. If so, most likely she will be relieved to be able to talk about it. Some students say, "Well, yes, I have thought about wanting my pain to end but I would never hurt myself because [it is against my religious beliefs, it would hurt my family, etc]." Other students do have suicidal thoughts and their thinking leads them to make plans for how they would do it. Remember -- suicidal thoughts usually even scare the person who is having them. People who are suicidal are usually ambivalent about killing themselves and haven't done it yet because they are afraid. Ask the student, "If you've been thinking about hurting yourself since [date], what has kept you from killing yourself so far?" Then listen to her answer and stress her own (not your own) reasons she has offered for living. Next, find out if she has ever attempted before, and if so, how. Also ask how she is now planning to harm herself. Ask if she has been using alcohol or other drugs. All of these factors help you to judge the potential risk that the student might attempt suicide.

If the student is suicidal but has no specific plans, gently negotiate with him to allow you to help him to stay safe. Do not do this in a controlling, "punishing" manner, but with an attitude that is matter-of-fact and authoritative, showing concern for his safety. If he becomes passively or actively resistant, again, approach the situation with an attitude of, "Since my job is to keep all of the students safe in this program, I must take [this] action to help keep you safe and to help the community function." Your options include requiring that you or someone provide a 24-hour "watch" to help keep him safe while the risk is high, negotiating a "no suicide" contract, and requiring that he meet with a local mental health practitioner or a physician for an assessment. It is possible that you will eventually arrange for him to go home to the care of his parents and for treatment. Consult with university officials, including the University Counseling Center.

If the student is suicidal and does have a means to harm themselves (pills, access to a weapon), gently but firmly negotiate with the student to give it to you or a security officer for safekeeping, or otherwise arrange their environment so that she would not have access to the means. Again, she will most likely feel relieved that you are now helping her to stay safe. Tell the student that you are requiring her to go to the hospital for an evaluation by a physician, psychiatrist, or psychologist to provide an assessment. If the student refuses, consult with legal authorities to determine how to require an involuntary hospitalization. Maintain a connection with the student by talking to her. Have security officers on hand in the immediate vicinity if necessary. Go with the student to the hospital and make sure the student signs a release of information form with your name on it so that you may consult with the mental health practitioner to obtain his or her recommendations. Consult with the mental health practitioner about the decision to call the student's parents or people listed on their emergency list. Consult with university officials, including the University Counseling Center. In most cases if a student has been suicidal with specific plans for harm, you will eventually make arrangements for the student to go home for treatment.

If the student has attempted suicide, handle the situation as a medical emergency and arrange for the student to receive treatment from medical authorities immediately. If the student makes a "minor attempt," and, for example, says he "only took a few pills," don't believe him, and have the student examined anyway. Once medical attention has been provided, the hospital is likely to refer the student for a psychiatric evaluation. Talk with the hospital personnel to make sure that a release form is signed so that you may consult with the mental health practitioner. Once the student is evaluated not to be in immediate danger of harming himself, the student will be released from the hospital. Be aware that the risk for a suicide attempt immediately after the student is released from the hospital may still be high, and take precautions. Consult with university officials, including the University Counseling Center, to make a plan of action for the likelihood of going home after the student is released.

The impact of a suicidal student on the other students in the program

It is likely that you will have become aware that a student in your program is suicidal because other students have come to you out of concern. Students may also find out that a student is depressed or suicidal from a friend or due to the student's behavior. Reassure them that it is indeed morally right for them to come to you with this information, even if the suicidal student tries to make them "promise to keep it a secret." When a life is concerned, they do not need to make or keep promises. However, it is very important that you stress to students who already know that they need to respect the suicidal student's privacy and to not whisper the situation to everyone else in the program. Offer information on how to help a friend who is depressed or suicidal (refer to web sites, below). Give them support while they are dealing with their friend's crisis. Help them to deal with and normalize the inevitable guilt that occurs when they start to second guess themselves with "I should have known…" or "I should have helped more," or "I feel bad that I'm burnt out from helping and I don't want to help more."

Carefully make decisions in consultation with a mental health professional about how to talk to the student yourself. You can also consult about whom to tell yourself, on a need-to-know basis, and if possible with the suicidal student's knowledge first. For example, in some cases the roommate or housemates will need to know so that they can help to provide a 24-hour watch during a high-risk period.

Be aware that when a student is suicidal, or attempts or commits suicide, it can severely affect other students who may also be unknowingly depressed and suicidal, to the point that they may consider attempting themselves. Watch and listen for signs that other students in the program may be depressed or suicidal and intervene accordingly.

Finally, be aware that you, too will be affected by the student's suicidal crisis. We highly recommend that you seek confidential support for yourself.

Resources for the International Educator on the Internet:

Self-help tips for depression and "the blues:"
http://www.nd.edu/~ucc/ucc_beyondblues.html

Helping someone in a suicidal crisis:
http://www.nd.edu/~ucc/ucc_suicide1.html

For those who are considering medication for depression:
http://www.utexas.edu/student/cmhc/booklets/meds/meds.html

Assisting Students Studying Abroad with Eating Disorders

Susan Albers, Psy.D.
Psychologist
Counseling Center
Ohio Wesleyan University

Students living abroad are likely to experience dramatic chances in routine eating habits. Initially, students may have difficulty adjusting to eating unique dishes and food traditions that significantly contrast with American foods. In addition, students may consume meals at different times of the day or may be cooking their own food for the first time. Therefore, students will experience a normal adjustment period in their eating habits. As a result, it may initially be difficult to determine if an eating issue is present. In contrast to normal adjustments to eating habits, eating disorders are a psychological disorder that continue for an extended period of time and will not diminish with familiarity to the culture.

Why do eating disorders begin?

One maladaptive way people cope with stress or difficult problems is through one’s eating behavior. When individuals have an eating disorder, eating can play a variety of psychological functions such as numbing or soothing emotions, or increasing self-esteem. The behavioral symptoms (bingeing, purging, restricting) are similar to the tip of an iceberg. Although you can see these behaviors, there are broader and deeper issues under the surface that you may not be aware of or recognize. For this reason, healing from an eating disorder requires more than changing eating habits and is only likely to improve with psychological treatment.

Unfortunately, anorexia and bulimia are prevalent psychological problems among college students. According to some studies, 20% of college women have a diagnosable eating disorder. Anorexia is characterized by a significant weight loss resulting from excessive dieting. Anorexic individuals consider themselves to be fat, no matter what their actual weight. Bulimia is characterized by a cycle of binge eating followed by purging to try and rid the body of unwanted calories. Purging methods usually involve vomiting and laxative abuse. Other forms of purging can involve excessive exercise, fasting, use of diuretics and diet pills. Although the number of women who have an eating disorder far exceeds men, it is a common misperception that only women are affected by eating disorders. Approximately 10% of those with eating disorders are men.

SIGNS OF AN EATING PROBLEM:

Dramatic weight loss
Intense fear of gaining weight or becoming fat
Obsessed with calories, fat content or exercise
Food restriction
Isolation; fear of being around others while eating
Hiding food
Preoccupied with thoughts of food and weight
Mood swings, depression, fatigue
Perfectionism-desiring the perfect body, grades etc.
Purging behaviors (vomiting, diet pills, etc.)

If you have observed these symptoms or if other students have raised concerns about a particular student, it is important to approach the student as soon as possible. Do not wait until you see dramatic signs of each of the symptoms. Early intervention is important. More people die from anorexia than any other psychological problem. An estimated 10 to 20% will eventually die from complications related to anorexia. Although fewer individuals die from bulimia, the disorder leads to a variety of serious medical problems and emotional difficulties.

What if I suspect that a student has an eating problem?

The first step is to approach the student privately. Tell the student you are concerned about her. Make a list of specific behaviors that are causing you or others to be concerned (vomiting, restricting food, isolating herself, lack of energy). Stay calm, empathetic and use "I" statements such as "I have noticed that you don’t go to meals with others" or "I am concerned about you and your eating." Describe her current behavior without using labels (anorexic) and avoid commenting on appearance. Never say, "you look terrible" or "you are wasting away." Statements like these can mistakenly be identified with a positive meaning. They may be interpreted by someone with an eating disorder as "I look really thin," which can inadvertently reinforce the problem behavior. Instead, comment on her unhappiness, lack of energy or mood. Do not watch her eating or force her to eat. This tactic will likely motivate the student to engage in eating disordered behaviors in secret. The goal is to help the student feel safe enough to discuss the problem and to feel confident she will not be judged or criticized for her behavior. Instead, you will communicate a desire to help.

Often, students who are in the beginning stages of an eating disorder are in a state of denial. Therefore, you should expect your suspicions to be rejected. The student may become angry, refuse help or deny he has a problem. Do not argue with him. If you do not feel he is in serious danger, revisit the issue with him again after he has time to reflect on the matter. However, be prepared with a list of resources or suggestions in case the student is ready to obtain help. If the student has received treatment in the past and has obtained therapy, you may recommend self-help suggestions or web sites that offer support.

Although you desire to be of assistance to the student, there is a limit to what you are able to do. You should refer the student to a professional counselor and contact the University Counseling Center for a consultation. Also, due to the myriad of physical problems produced by anorexia and bulimia, a physician should be contacted. Nutritionists are another valuable resource for helping students structure meals.

If the student has significant physical complaints, is fainting, is abusing drugs or alcohol, and/or is thinking about suicide, immediate intervention is warranted. At this point, consider requiring the student to contact a hospital or the student’s parents. If the student is treated by a medical or psychological professional, ask the student to sign releases so you can obtain information about treatment and assist in making sound decisions. If the severity of the eating disorder is interfering with her ability to enjoy being abroad or functioning in her classes, you will likely speak with her about returning home and coming back when she is better able to fully enjoy her study abroad experience.

How can I assist friends and roommates of an eating disordered student?

Other students are likely to be the first to suspect a problem and may bring it to your attention. Provide the concerned friends with eating disorder information and alert them to eating disordered signs and symptoms that are likely to be present. Other students may wish to approach the individual with the suspected problem and speak about their concern. Provide the suggestions listed above or the web sites listed below to find more information about strategies for approaching a friend with an eating disorder.

When one student has difficulty with eating, often other students become more conscious and concerned about their body image and eating behavior. Emphasize that eating disorders are a serious and potentially dangerous problem. If the friends are having difficulty coping, encourage them to seek their own support. Talk with friends about setting limits for themselves that allow them to take care of their own needs. Often, friends can become overwhelmed when attempting to help someone with their eating disorders. Their efforts to help should not include dramatically altering their own lifestyle, such as how they eat, socialize, go to classes or travel. Altering one’s own habits often leads to resentment rather than help.

INTERNATIONAL TREATMENT CENTERS

To contact or obtain information from International Treatment Centers in Argentina, Australia, Canada, England, France, Germany, Hong Kong, Israel, Mexico, Paraguay, South Africa, Switzerland consult
http://www.something-fishy.org/treatmentfinder.php

Resources on the Internet for the International Educator and for Students:

Web sites concerning general eating disorder information:
http://www.something-fishy.org
http://www.mirror-mirror.org
http://www.findinfo.com/anorexia.htm

College Student Eating Disorder Information:
http://www.nd.edu/~ucc click on Self Help
http://www.dr-bob.org/vpc/ click on Eating Disorders

Males with Eating Disorders:
http://www.caringonline.com/eatdis/topics/males.htm

Eating Disorder Organizations:
http://www.aedweb.org/
http://www.nationaleatingdisorders.org

Assisting the Study Abroad Student Dealing with Grief and Mourning

Adapted by
Len Hickman, Ph.D.
Psychologist
University of Notre Dame Counseling Center

More than likely some of your students are dealing with issues related to the death of a loved one. A few students may have recently lost a parent or a sibling prior to leaving for study abroad or they may have lost a significant loved one while in your program. The following are issues and suggestions to consider when supporting these students.

What are the Stages of Grief?

While each person’s experience with grief differs, there are some common patterns of reactions. Experts who have researched grief and loss have suggested several stages. The first stage is characterized by numbness, shock, and disbelief. The sense of the loss is not fully felt until the second stage, when emotions are intense and fluctuate considerably. Individuals move through periods of disorganization, reorganization, and adaptation to a new type of life. Individuals also vacillate from avoiding painful cognitions and emotions to confronting the multiple realities of the loss. Healthy grieving eventually concludes with a return to productive functioning, although this process may take longer than most Americans expect.

Keep in mind that every person's experience with grief is unique. A person’s previous experience with loss, her relationship with the deceased and the type and circumstances of death all affect the grieving process. For most people stages of grief are not experienced in a linear fashion. Recycling occurs, and healing may occur in one area while some other issues take longer. Regression to earlier stages with some issues is also possible throughout the grief process.

How Can Students Manage Grief?

Guidelines for managing grief in a healthy manner are suggested by Therese Rando, Ph.D. in her book, How to Go On Living When Someone You Love Dies:

Acknowledge the death (to oneself and others)
Understand what happened (including the actual cause of death and the circumstances around the death)
Be open to awareness of all that is involved in the loss (some loss experiences are not immediately apparent)
Experience the pain and allow grief to be expressed
Allow adequate time to work through the many feelings that arise. Usually it takes much longer than we first realize.

Be aware that grief for someone who is particularly significant is never completely resolved. However, through the work of expressing grief, one becomes more reconciled to the loss. There will likely be times in which the bereaved re-experiences the pain, but if the work of grieving is attended to, the pain is not as intense nor does it last as long.

Signs of Normal Grief Reactions (Source: Alan Wolfelt, Ph.D. in Death, Grief and Mourning)

Feelings	sadness, anger, fear, despair, irritability helpless, loneliness, depression, anxiety
Cognitions	disbelief, confusion, difficulty concentrating, preoccupation with thoughts of the diseased
Physical Reactions	stomach distress, physical aches, dry mouth, low energy, startle reactions
Behaviors	sleep difficulty, loss of appetite, restlessness, frequent crying, withdrawal, isolation

The above symptoms are common for those experiencing loss, however, if symptoms persist for over two months, a referral to a mental health professional is recommended.

What Additional Signs Would Indicate the Need for Referral?

Severe depressed affect/ Excessive guilt / Prolonged impairment in functioning

Chronic insomnia / Increased isolation / Frequent thoughts of one’s own death

Substance abuse / Excessive expressions of anger / Persistent decrease in appetite

Referral Suggestions:

Ideally, you should already have a list of mental health professionals available who have experience working with grief and loss issues. When suggesting a referral to a licensed mental health provider, emphasize that the person has training in providing a healing environment for normal, healthy individuals who are experiencing painful losses. The referral should be offered from a caring perspective rather than as a demand. Counseling that is not sought voluntarily is seldom beneficial. However, it is reasonable to require an assessment in very severe cases when the person’s functioning has deteriorated to a point where he is unable to function, or becomes a danger to himself or others. If this situation arises, you may find it helpful to consult with UCC or ORL staff.

What are Some Strategies for Helping A Student Deal with Grief?

Regardless of whether a student decides to take advantage of counseling or other mental health services, there are things you can do to support a grieving student. Included below are suggestions from A Time to Grieve, A Time to Dance by Janet Leszczynsk and Grief Counseling and Grief Therapy by J.Worden.

Initiate conversations. Ask questions about what happened, her reaction when she first heard, her funeral experience, her relationship with the deceased, how family members are doing. Don’t be afraid to ask questions about the deceased. The opportunity to talk allows the student to express many of the thoughts that she is thinking and aids in acknowledging the death and some of its impact.
If the student is comfortable enough to express emotions in your presence, be encouraging. Crying is a very healthy behavior. Don’t be quick to stifle someone’s tears. Instead offer comments that indicate you are comfortable being with his tears. Also, don’t be alarmed with negative emotions. It can be very helpful for a grieving person to express anger, despair, or guilt and feel accepted.
If you try to reassure with expressions that the deceased is no longer in pain and is rejoicing in the presence of God, your sentiments may not be comforting to those early in the grief process. Saying, "He is with God now" may be experienced by the bereaved as a negation of her anguish, and even anger at God. It’s important for the grieving student to know that anger at God is ok.
Don’t feel that you have to say just the right thing. You can’t fix what’s causing the student's distress and he won’t expect you to. Listening and asking questions shows you're interested and want to be supportive. This means a lot to someone who is grieving, particularly since so many people are uncomfortable with the expression of painful emotions. Your presence helps him feel less alone.
Encourage her to expand and utilize her support network so that there are also other people to talk to or be with. Sometimes the bereaved may not want to talk. Alone time can be beneficial but too much isolation usually isn’t helpful. Having company to eat with or just go for a walk with can be very supportive.
Encourage some experiences removed from active mourning. Sometimes going to a movie or a sporting event can provide a much-needed break from the on-going pain of loss. Timing is important and the student’s wishes need to be respected, but making the offer can be greatly appreciated. If the student doesn’t accept at first, ask again later. Your invitation serves as a reminder that you don’t find it disrespectful to the deceased for the student to take a break for some healthy diversions.
Remind the student not to expect that he can resume his responsibilities at full productivity. Concentration can be temporarily affected after loss and some cognitive tasks are more difficult than others. Many students feel they must do well "for" the deceased and get discouraged when they can’t. Students need to be reassured that getting extensions is not using the death "as an excuse."

Although the above suggestions may be implemented many times during the first few months after a loss, don’t assume that the bereaved is over the loss just because time has elapsed and they seem like they’re fine. Noninvasive questions about how they’re doing months after the loss or at significant anniversaries are very important. It reminds the person that others realize that things have not returned to normal, the deceased is still missed, and the grieving process continues. It’s also important to keep in mind that students may initially seem to be doing well shortly after a loss, but then they "crash" the following semester. Their grief reaction is delayed, but they don’t make the connection. Intervening with them and their professors can be especially beneficial during this difficult time.

Practical Suggestions for Helping A Student when A Parent Dies:

When a student is informed of a parent or another significant person’s death, some specific interventions can be immensely helpful. In some cases you may be called upon to break the news.

Find out who the student is closest to and if that person is available to be a support. Also make arrangements for contact with appropriate clergy for the student’s religious background.
Arrange to talk to the student in person and provide factual information in a calm manner. Indicate who died and how. Include expressions of your sadness. If an accident was involved provide accurate updates on who is safe and/ or their medical status.
Reassurance that others are ok is very important.
Help the student make travel arrangements including calls to schedule flights. Some students may also need emergency financial aid.
If the student has a delay in travel plans, arranging a small prayer ceremony may be beneficial depending on the student’s religious beliefs.
Help the student prepare for the trip home. Some students may be too much in shock to remember to pack formal clothing for funeral services.
Arrange for someone to travel home with the student if possible.
If possible, also have an official of the program attend the funeral.
Contact the dean of student’s program or individual professors notifying them that the student has returned home for the funeral of a family member.
Make arrangements for someone to pick up the student at the airport when he/she returns to resume classes. Some students in may decide to withdraw for the semester and may need long distance help with the process.

References

Rando,T. (1991). How to Go On Living, When Someone You Love Dies.. New York: Bantam Books.

Smith, S. & Smith, C. (1990). Personal Health Choices. Boston: Jones & Bartlett.

Wolfelt, A. (1992). Death, Grief, and Mourning. Muncie: Accelerated Development, Inc.

Worden, J.W. (1982). Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner. New York: Springer Publishing Co.

Students Studying Abroad who Abuse Alcohol

Adapted by
Leonard Hickman, Ph.D., Psychologist
University of Notre Dame Counseling Center

Problems you may encounter related to alcohol abuse will likely fall into one or all of the following categories: acute crisis due to alcohol poisoning; problematic behaviors related to incidents of alcohol abuse, some of which may be chronic in nature; and complaints of non-alcohol abusing students, staff, and faculty related to secondary effects of binge alcohol use by others. The following will provide suggestions and referral information for dealing with crisis situations, chronic alcohol abuse, and the secondary effects of alcohol abuse.

Alcohol poisoning occurs when a person consumes more alcohol than her body can metabolize. At low levels one may become drunk and suffer the effects of a hangover the next morning. At higher levels a person may vomit as the body tries to rid itself of what is now a toxic substance. Some people drink to the point that they pass out, and still others drink to the point that their brain shuts down respiration and they eventually die. Over twenty or more college students typically die every year from alcohol poisoning. Some of those who die drink themselves into a state of unconsciousness. High proof alcohol, drinking games, hazing rituals, and 21^st birthday drinking are often associated with incidences in which a young person drinks him/herself to death. Often victims of alcohol intoxication are left alone to "sleep it off." The decision to leave a significantly intoxicated individual alone can be a fatal one. Many victims literally drown in their own vomit.

If you become aware of a situation in which a person is seriously drunk, be sure that someone remains with the person who is vomiting so that he/she is protected from choking while throwing up. If the intoxicated person cannot be roused or is having respiratory problems, get medical attention immediately. Blood alcohol levels of 3.0 can be fatal for many individuals. For some, death can occur at even lower levels. If other drugs are involved (such as some types of sleeping pills) a synergistic effect may occur that induces death at lower blood alcohol levels than would typically cause serious problems. You should also consult medical experts if large quantities of alcohol have been consumed by someone who is taking medication. If an intoxicated person is found unconscious in a prone position, he should be laid on his side unless injuries preclude such positioning. If an injury requires that the intoxicated person be placed on his back, turn his head to either side so that the person not choke on anything that might be regurgitated. However, if neck or back injuries are suspected, do not turn the head.

Alcohol abuse involves a pattern of alcohol use leading to significant impairment or distress manifested by one (or more) of the following within a 12 month period.

Recurrent drinking resulting in a failure to fulfill major role obligations at work, school, or home.
Recurrent drinking in situations in which it is physically hazardous.
Recurrent alcohol-related legal problems.
Continued alcohol use despite having persistent social or interpersonal problems caused or exacerbated by the effects of alcohol.

Although individuals who abuse alcohol typically develop abuse patterns over time, negative events can occur for moderate drinkers and even first time alcohol users if on occasion they consume large amounts. Among the possible outcomes include the following:

Problems Related to Intoxication:

Death or serious injury through car accidents, bicycle accidents, falls, drownings, and overdose.

Physical and sexual assaults.

Unwanted sexual contact, promiscuous sexual behavior, risky sexual behaviors, and unwanted pregnancy.

Problems Related to Binge Use:
Lower GPA / Missed Classes / Behind in Work

Arguments/Fights / Unwanted Sex / Promiscuous Sex

Vandalism Physical Assaults/ Regrets About Behavior

Legal Difficulties / Accidents / Driving Under the Influence

Binge Use Defined

A male "binge drinker" is defined as a male who drinks FIVE or more drinks in a row during a two-week period. A female "binge drinker" is defined as a female who drinks FOUR or more drinks in a row during a two-week period. Binge drinking is defined differently for males and females since similar amounts of alcohol has a more significant impact on a woman’s body due in part to metabolism and absorption rates. Frequent binge drinkers are defined as those that binge drink three or more times in a two week period.

Frequent binge drinkers are 15 times as likely to experience the problems listed above compared to moderate and light drinkers.

Binge Related Issues

Increasingly non-alcohol abusing members of university communities are voicing their frustrations about the second hand effects they are experiencing due to binge alcohol abuse by other students.

Second Hand Binge Problems that non-binge drinking students, faculty, and staff experience include:

Car accidents / Physical assault/ Unwanted sexual advances

Arguments/ Sexual assault/ Disrupted study time

Property destruction / Uncivil behavior / Disrupted sleep

Bathrooms "trashed" with vomit

Intervention and Referral

Your involvement with students who abuse alcohol will obviously depend on the type of negative consequence they have experienced due to their drinking. Some students may need prompt medical attention and medically supervised recovery. Others will benefit from rape support counseling and counseling for other forms of victimization. Some will benefit from pregnancy aid counseling and related support services.

Provide direct feedback and clear messages about the impact of their alcohol abuse to students who have chronically abused alcohol and have experienced repeated negative consequences and recurrent problems. When providing feedback to a student, use specific examples when her use of alcohol is clearly linked to negative outcomes. When confronting someone about alcohol-related abuse, avoid opinions and generalizations but instead present specific behaviors that have occurred in a non-judgmental manner. You may find it useful to contact the University Counseling Center or the Office of Alcohol and Drug Education to discuss guidelines for confronting someone who may have alcohol abuse problems. Also encourage the student to take the self-assessment tests available on the UCC web page in the self-help section at http://www.nd.edu/~ucc.

As part of your confrontation, include referral information. Find out what alcohol abuse treatment professionals are available in your area. An Alcoholics Anonymous support group, if available in your country, may be appropriate for some students. Some students in the early stages of alcohol abuse are more likely to benefit from work with a counselor knowledgeable about alcohol abuse. Licensed mental health professionals can also provide services related to problems that may have occurred when alcohol was abused such as rape, promiscuous sexual behavior, suicidal statements, and anger management.

During your confrontation, recognize that the student may likely choose to minimize their problems with alcohol. Sometimes the more abuse present, the greater the denial. Make clear to the student that he has the choice whether to seek treatment, abstain from all alcohol use, or limit the amount he consumes. Emphasize, however, that if problematic behaviors occur, there will be clear consequences. Conclude your discussion with the student expressing your genuine concern and encourage him at the very least to complete an alcohol assessment with a qualified professional.

Prevention of Secondary Binge Problems:

A three-stage response can be used to deal with problems related to binge drinking.

1. Information: Provide factual information about binge drinking and the associated negative behaviors. Consequences for problem behaviors related to alcohol abuse should be made clear to the study abroad program participants. Also provide information on legal issues and educational materials regarding safe drinking behaviors and the dangers associated with alcohol intoxication.

2. Guidelines: Guidelines should be implemented that encourage social functions and recreational opportunities that are alcohol free. In social situations in which alcohol is present, responsible use can be encouraged by limiting the amount and types of alcohol available (i.e., no kegs, no punch bowls with indeterminate amounts of alcohol, and beer and wine in standard servings versus mixed drinks).

3. Consequences: When problem behaviors occur appropriate negative consequences should be implemented for those involved in the binge use. As part of the consequences it will most likely be useful to require an alcohol assessment.. Consultation with the Office of Drug and Alcohol Education or the Office of Student Affairs will be beneficial in determining other appropriate consequences and responses.

References / Sources

Smith, S. & Smith, C. (1990). Personal Health Choices. Boston: Jones & Bartlett.

Wechsler, H. (1995). Binge Drinking on College Campuses. Boston: Harvard School of Public

Health, College Alcohol Study, Department of Health and Social Behavior.

Resources on the Internet

Dealing with Alcohol, Pre-Departure Health Training Handbook, SAFETI Adaptation of Peace Corps Resources: http://www.usc.edu/dept/education/globaled/peacecorps/dealing.html

Study Abroad Programs: No Respite From the Drug Free Schools and Campuses Act by Joel C. Epstein, Associate Director & Senior Attorney, Higher Education Center for Alcohol and Other Drug Prevention Education Development Center, Inc., SAFETI On-Line Newsletter, Volume 1, Number 1, Fall 1999-Winter 2000 http://www.usc.edu/dept/education/globaled/safeti/v1n1_abroad.html

A Discussion About Alcohol and Student Exchange, by Joel Epstein, Director of Special Projects, Higher Education Center for Alcohol and Other Drug Prevention and Gary Rhodes, Director of the Center for Global Education and SAFETI Newsletter Editor. SAFETI On-Line Newsletter, Volume 1, Number 2, Spring - Summer 2000 http://www.usc.edu/dept/education/globaled/safeti/v1n2_rhodes_epstein.html

Early Signs of Alcohol Problems, by Len Hickman, Ph.D., University of Notre Dame Counseling Center (includes an Alcohol Use and Abuse Tutorial and a Self-Test for early signs of alcohol problems): http://www.nd.edu/~ucc/ucc_alcohol1.html

Assisting the Study Abroad College Student who has been
Raped or Sexually Assaulted

Nancy Newport RN, LPC
Consultant to Peace Corps

adapted for Notre Dame study abroad students by
Jeff Shoup, M.A., Director, Office of Residence Life and Housing and
Wendy Settle, Ph.D., Staff Psychologist,
University of Notre Dame

Rape is a crime of violence. It is motivated by the desire to control, dominate and humiliate, not the desire for sex. College-age students are more likely to be raped than any other age group. Nationally, the majority of reported victims and offenders are of college age, with the rate of rape victimization highest among 16 to 19 year olds. The second highest victimization group is women between 20 and 24 years of age. The offender population shows a similar age distribution. (Adams & Abarbanel, 1988). While most rapes are committed against women, men are also victims of sexual assault. Sexual assault can be just as traumatic as rape. Rape or sexual assault may be committed by either a stranger or by someone known to the victim. Many victims of rape or sexual assault involving college students are assaulted by an acquaintance. An acquaintance may be a date, friend or someone the victim knows only casually through their place of residence, a class or mutual friends.

How Study Abroad Program Staff Can Support

Promote safety: The most important role that staff can play after a student has been raped is to get to him or her as soon as possible and begin creating an environment where he or she can feel safe. This includes, if at all possible, arranging the victim’s environment so that he or she is not likely to personally come in contact with his or her attacker again.

Allow the victim to be in control: It is paramount to allow the victim to be in as much control of making decisions as possible, even in small ways. (Obviously, if there are injuries in which a victim is not able to make decisions, you may need to assist.) Don't decide everything for him/her. Examples:

"Do you want to talk to the police?"

"Do you want to drink a soda or have some water?"

"Where or with whom would you feel safe spending the night tonight?"

Provide supportive messages: There are three basic messages she or he needs to hear verbally and behaviorally from everyone who is in a supportive role:

"It was not your fault."

"You are not alone. I / We are with you."

"I am so sorry this happened to you."

It is NOT helpful to point out ways that the victim may have used poor judgement. Avoid all statements or attitudes that would imply blame, criticism or judgement. Remember that no matter what the victim did or did not do, she or he did not ask to be attacked. The rapist is to blame for the rape, not the victim.

Respect privacy: Except for those who "need to know," respect the victim’s need for privacy. Do not tell others that she or he has been raped unless you have the victim’s permission.

Encourage access to medical services: Following a sexual assault, the victim’s physical well-being is a primary concern because of the risk of sexually transmitted diseases, pregnancy and/or physical injuries which may not be visible. If the rape just occurred, victims would especially benefit from immediate medical assistance; however, even if time has passed, it is still very important to obtain medical care. Not seeking medical attention could have long-term physical and emotional consequences. It is important for study abroad program administrators to be aware of local hospitals that have services for rape victims.

Before a victim goes to the hospital, she or he should be advised to avoid changing clothes, showering, rinsing one’s mouth, cleaning under the fingernails, douching or using the toilet, because such activities may destroy important evidence. Inform the student that this request is to help obtain evidence, which might later be used in court and is not in itself for medical reasons.

A victim’s clothing may be kept as evidence, so she or he may want to bring a change of clothing to the hospital. At the hospital, a physical exam will occur. Medical exams can be a source of stress and fear for a victim, so a calm, supportive, non-judgmental support person accompanying the victim to the hospital and remaining throughout the examination is crucial. Allow the victim to have input into who will be accompanying him or her as the support person. In addition, hospital staff may be required to contact the police. Seeking medical attention, however, usually does not mean that a victim will be forced to talk to the police or cooperate with criminal prosecution. Asking the hospital staff about the process will be helpful for the victim during the crisis. Because of the trauma, a victim may not recall all the information, so it is helpful for you to be aware of the information, so information can be clarified at a later date if necessary.

Victim’s Options for Reporting Sexual Assault

The University of Notre Dame encourages the reporting of any sexual misconduct, especially sexual assault. At times, victims are hesitant to report to university officials because they are concerned that they themselves may be charged with university policy violations, such as intoxication. The university recognizes that it is in the community's best interest that victims feel supported and encouraged to report sexual assaults or misconduct; accordingly, student victims will not be subject to disciplinary action in connection with their reporting of sexual assault or misconduct.

Legal Options

Legal options vary according to the laws of the host country, but if the student is assaulted by a U.S. citizen, including a Notre Dame student, faculty, or staff, U.S. laws for criminal prosecution and/or civil litigation may apply. See the SAFETI Rape Response Handbook’s recommendations for legal counsel at http://www.usc.edu/dept/education/globaled/peacecorps/rapecontent.html#5 . Program Directors are encouraged to consult with the University of Notre Dame’s Legal Counsel for legal advice. Contacting local police agencies or attorneys to determine how a criminal or civil case is handled will also be helpful when assisting a victim. The victim needs to be accompanied by a responsible program staff member to the police station or to any legal proceeding. Never leave him or her alone there.

On-Campus Disciplinary Options

If the victim was assaulted by a University of Notre Dame student, the victim may elect to pursue university disciplinary options. The same procedures will be followed and the same sanctions will be imposed as those outlined in University Standards of Conduct and Disciplinary Procedures (see also duLac: A Guide to Student Life, which can be found at http://www.nd.edu/~orlh/dulac/index.htm ). A student seeking further information, clarification or assistance in pursuing the on-campus disciplinary option may make confidential inquiries through the Office of Residence Life, or with the University’s Victim’s Resource Person, Ava Preacher, Ph.D., mailto:preacher.1@nd.edu. A student making such inquiries will not be required to give her or his name, describe the alleged incident in detail or submit anything in writing to the Office of Residence Life. Requesting information does not commit a student to any subsequent course of action. The Victim’s Resource Person or an Office of Residence Life staff member will answer questions and thoroughly review Administrative Hearing procedures with the student victim so that she or he can make her or his own decision about exercising this option. If a student chooses to proceed, the Office of Residence Life will request a report of the incident.

If the victim was sexually assaulted by a University of Notre Dame-affiliated faculty or staff, the victim may choose to report the assault to university officials and pursue university disciplinary options. See the next chapter on sexual harassment, in addition to reading the information and procedures under Notre Dame's Sexual Harassment Information web site at http://www.nd.edu/~harassmt

Arrange for Counseling/Support; Decisions About Withdrawing from the Program

It is recommended that all sexual assault and rape victims have access to the option of receiving professional counseling for the treatment of symptoms of post-traumatic stress ("PTSD"). Symptoms of psychological trauma can be subtle and even misleading. Denial, shock, numbness, and a strong desire to avoid thinking/talking about the trauma can create the illusion that the student is okay. In fact, avoidance is the strongest symptom that keeps victims from even reporting or acknowledging that a traumatic event has occurred. These symptoms rarely resolve on their own and trauma specialists are not located in many countries.

Please review the following list of symptoms of post-traumatic stress. In spite of what the student says about being okay, play close attention to:

Sleep disturbances
Appetite changes
Impaired concentration
Mood instability (irritability, anger, tearfulness, fear, sadness)
Flashbacks (intrusive memories / images of the event)
Avoidance (of places, people, things that remind him/her of the event, also avoidance of thinking about it, feeling it, and therefore talking about it)
Isolating self -- not participating in usual activities

If a student is not able to function and carry on with her studies, she would be best served to withdraw from the program and return to the states for treatment. Avoidance, numbing of responses, and impaired concentration are potentially dangerous symptoms to be carrying in a foreign country where one needs to be fully alert and present. Unresolved PTSD places a student at greater risk for subsequent attack. You may refer the student for an assessment with a local mental health treatment provider, if available, to assist you with the decision about withdrawing from the program. Be sure to ask the student to sign the treatment provider's release of information form so that you may consult.

Sometimes students are reluctant to leave their host country and their friends to go back to the U.S. Yet at the same time they do not feel safe in their host country, if this was where the assault occurred. It can be helpful to validate that concern and point out to the student that others have felt the same way at first. Tell him/her that those who have gone to the U.S. have been very glad they allowed themselves to benefit from the care they received there. Although individual circumstances must be taken into account, there are a number of advantages for the traumatized student to going "back home." Students who return to the U.S. can access immediate medical and psychological treatment in a more familiar environment, and with a treatment provider who speaks their primary language. "Going home" also gives students an opportunity to talk to and perhaps see friends and family for additional support and sense of safety. One of the most important factors in creating a healthy recovery from assault is to establish a consistent environment of safety and support, something that is almost impossible to do in country where there are so many reminders of the trauma.

You may consult with the University Counseling Center or the University Health Center to discuss the option of the student taking a medical withdrawal. Notre Dame students who take a medical withdrawal are able to withdraw without penalty to their grades, and will also be able to receive a pro-rated tuition remission. Students who take a medical withdrawal for psychological reasons stay out of school for a year to receive treatment. See the chapter in this handbook on withdrawals and consult with Student Affairs for further information on this option.

Once the person is re-enrolled as a student at Notre Dame back in Indiana, he or she may choose to seek further counseling through the University Counseling Center on the main campus. The University Counseling Center is staffed by trained professionals who can provide specialized support and help toward continued recovery. Enrolled students may seek counseling at any time, whether it be days, months or years later. This confidential service is available to the victim and her or his friends who may need support in assisting a victim.

If the student strongly desires to stay in your program, with or without treatment in your host country, we recommend that you ask the student to see a mental health provider at least one time for the purposes an assessment so that you may consult regarding the decision to stay. You may contact the Embassy for lists of treatment providers. Ask the student to sign the treatment provider's release of information form so that you may consult. Realize that if the student wants to stay, he or she will most likely need support from you, your staff, and/or other students in the program -- are you prepared and trained to provide this? Be aware that she/he may have a number of fears and reactions, many of which may occur for weeks or months after the attack:

Fear of remaining in the same residence or site
A need for continuous support from family or close friends
Difficulty sleeping, recurrent nightmares, intrusive thoughts about the event
Fear that the assailant will return
Fear of crowds but also fear of being alone
Fear of being either indoors or outdoors, depending on where the rape occurred
Fear of sex or lack of sexual desire
Periods of depression or anger
Feelings of guilt
Feelings of being damaged or unclean
Feelings of paranoia that other people are talking about her or laughing at her/him
Feelings that s/he can't trust anyone

Research indicates that, depending on the situation, about 90% of those exposed to trauma experience adverse psychological reactions in the hours immediately following the trauma. By 12 weeks the number drops to 20-50%, and by 12-24 months the number drops to around 25%. Some survivors' symptoms will surface up to two years after (National Center for PTSD Fact Sheet, 2002). Most programs are short term, and therefore it is highly likely that your student would experience adverse reactions while enrolled, especially without treatment. If the student stays in the program, you and/or your staff must be knowledgeable and well trained to provide continued support while the student is healing from any trauma, even if the assault happened a long time ago. In very few cases would this option be viable, but if it is, we recommend that you consult with the University Counseling Center to receive suggestions for providing on-going support. We also recommend that you read the excellent suggestions listed in the "counseling and support" section of the SAFETI Rape Response Handbook: http://www.usc.edu/dept/education/globaled/peacecorps/rapecontent.html#6

References

Adams, A. & and Abarbanel G. (1988). Sexual Assault on Campus: What Colleges Can Do. Santa Monica Hospital Medical Center, Santa Monica, California.

Resources for International Educators on the Internet

Treatment of Sexual Assault in College Students Studying Abroad: Read the full text version of the article excerpted and adapted for this handbook by Nancy Newport:
http://www.usc.edu/dept/education/globaled/safeti/usc_art2.html

Sexual Harassment And Prevention In College Students Studying Abroad: We recommend that you develop an orientation session designed to increase awareness of safety issues. This article, also by Nancy Newport, makes a number of excellent suggestions that you might include in such a program (also see the next chapter on sexual harassment):
http://www.usc.edu/dept/education/globaled/safeti/v1n2_newport.html

SAFETI Adaptation of the Peace Corps Resources: Rape Response Handbook:
http://www.usc.edu/dept/education/globaled/peacecorps/rape.html

Sexual Harassment and Notre Dame Students Studying Abroad

Jeff Shoup, M.A., Director, Office of Residence Life and Housing and
Wendy Settle, Ph.D., Staff Psychologist, University Counseling Center
University of Notre Dame

What is Sexual Harassment?

The University of Notre Dame prohibits sexual harassment by all faculty, students and employees, and by any other person associated with Notre Dame. Sexual harassment is a barrier to the educational, scholarly and research purposes of the University of Notre Dame and is a violation of the law and University policy. The University of Notre Dame affirms its commitment to maintaining a learning and working environment that is fair, respectful, and free from sexual harassment. Additional information regarding sexual harassment may be obtained on the University of Notre Dame web site at http://www.nd.edu/~harassmt , from the Sexual Harassment Ombudspersons, from any of the Contact Persons, from supervisors and department heads, or from duLac: A Guide to Student Life, which can be found on the web at http://www.nd.edu/~orlh/dulac/index.htm .

Definition of sexual harassment

The determination of what constitutes sexual harassment will vary with the particular circumstances, but may be described generally as:

Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature when:

Submission to or rejection of such conduct is made either explicitly or implicitly a term or condition of education, employment, or participation in other University activities;
Submission to or rejection of such conduct by an individual is used as a basis for evaluation in making academic or personnel decisions affecting that individual; or
Such conduct has the purpose or effect of unreasonably interfering with an individual’s performance or creating an intimidating, hostile, or offensive University environment.

Educating Study Abroad Students about Sexual Harassment

I would like to educate my students about sexual harassment so that they 1) understand our host country's cultural variations in expectations and boundaries and 2) are prepared to respond to sexual harassment if it occurs. What can I tell them?

We highly recommend that you spend some time with your students to educate them about sexual harassment and inform them about the cultural expectations and gender relations in your country. A guideline to use for planning your program would be Nancy Newport's article on Sexual Harassment And Prevention In College Students Studying Abroad, which can be read at http://www.usc.edu/dept/education/globaled/safeti/v1n2_newport.html . You may wish to invite residents from your host country who are able to speak candidly about dating, gender relations, and how various non-verbal behaviors are interpreted or misinterpreted. In addition, inform students about how they can obtain information and assistance regarding sexual harassment from the university's ombudspersons and contact persons, along with general procedures to follow if sexual harassment needs to be reported.

How can I assist a student who reports she/he has been sexually harassed?

Listen carefully and do not judge -- Provide the complainant the opportunity to discuss the incident informally. Take all complaints seriously and offer the complainant emotional support and guidance, without any conclusionary comments on the validity or merits of the complaint. Ask the complainant to describe in non-evaluative terms (facts only) the specific incident or incidents of sexual harassment. Listen carefully to the complainant. Complainants of sexual harassment often feel "powerless," worry about retaliation, and are afraid of being branded or labeled a "trouble maker" or "whistle blower." Complainants also may feel that they will not be believed or will be blamed by others for the incident. Therefore, it is very important for members of the campus community to offer genuine support and timely assistance.

Questions not to ask [Source: http://www.admin.mtu.edu/aao/sexwww.htm#supervisor Please note that this link is no longer active and has not been updated ]

Avoid "why" questions such as, "Why didn't you do something about this before?" 'Why' questions are perceived as being judgmental, implying the complainant did something wrong.
Don't ask leading questions such as, "Would you want to continue studying here if he/she continues his/her behavior?"

Highly encourage the complainant to consult a University of Notre Dame Sexual Harassment Ombudsman or Contact Person. It is important for the student to have someone with whom to discuss the harassment situation and to obtain information on informal and formal resolution options. If, however, the complainant chooses to handle the situation on his/her own, tell the complainant that you wish to confidentially consult with the Ombudsperson to obtain advice to pass on to the complainant. The complainant may only wish to consider self help approaches, such as assertively telling the harasser to stop or writing the harasser a letter to request an end to the harassing behavior. The complainant should also consider keeping detailed records of the incidents of sexual harassment, in addition to keeping records of efficiency reports, progress reports, grades, etc. Encourage the complainant to consult written materials on how to respond to sexual harassment, such as web sites listed at the end of this chapter.

Important! You yourself may not take any actions to investigate or resolve the matter informally without contacting the Ombudsperson. If the student asks you to assist with an informal resolution, the student needs to know that you will not be able to keep the matter completely confidential. Tell the student that you will consult with an Ombudsperson, a Contact Person, or other appropriate University official to informally or formally resolve the matter. If the matter is resolved informally to the satisfaction of the reporting party, the person to whom the report was initially made shall send a written summary of the matter to a Contact Person in the Office of Residence Life, the Office of the Provost, or the Office of Human Resources, depending on the status of the alleged harasser. See http://www.nd.edu/~harassmt for more information on this procedure. If the matter is not resolved informally to the satisfaction of the reporting party, the person to whom the report was originally made must immediately report the allegations to an appropriate Contact Person (in the Office of Residence Life, Office of the Provost or the Office of Human Resources), or to a Sexual Harassment Ombudsperson, to begin the formal report process, regardless of whether the person reporting the harassment requests or desires this action.

Keep the complainant informed: As soon as possible, inform the complainant what actions you have taken or intend to take in response to the complaint.

Refer the complainant: You may refer the complainant to a professional counselor or a member of the clergy as a confidential resource to discuss sexual harassment and its effects. Because of the confidentiality afforded to these relationships, however, one should know that counselors and members of the clergy are not in a position to report the harassment to University officials or to end the sexual harassment. If the student wishes University involvement, the student must report the harassment through either the informal or formal reporting process.

Notre Dame Resources: Obtaining Information and Reporting Sexual Harassment

We highly encourage you to thoroughly read the university's web site on sexual harassment procedures and policies at http://www.nd.edu/~harassmt We have highlighted a few relevant points from the web site below:

Ombudspersons

Notre Dame has designated two Sexual Harassment Ombudspersons to provide information and assistance regarding sexual harassment to the entire University community (students, faculty, and employees). The Ombudspersons are Notre Dame faculty or employees appointed by the President. It is important to understand the role of the Ombudsperson, which is described in greater detail on the university's web site at http://www.nd.edu/~harassmt . Please advise study abroad students who wish to discuss sexual harassment with an Ombudsperson to read the web site thoroughly. Once the Ombudsperson has knowledge that sexual harassment (by a Notre Dame-affiliated faculty, staff, or student) is or could be occurring, he/she has a duty to take action to make sure the harassment ends. Therefore, if the study abroad student wishes to consult via telephone or email on a general, confidential basis, the student should not reveal the details of the harassment such as the name of the harasser and the details of the incident. In some situations, with the agreement of the reporting party, an Ombudsperson may attempt to work directly with the parties involved to resolve the matter informally. However, it is noted that the Ombudspersons have a duty to ensure that all allegations of sexual harassment that are not resolved informally are reported to the appropriate University Contact Person to initiate the formal report process. The Ombudspersons will be available to advise and guide reporting parties prior to and throughout the formal report process, and to serve as a liaison between reporting parties and the University representative handling a formal report of harassment.

Contact Persons

Contact Persons are those individuals to whom formal reports of harassment should be made. Please advise study abroad students who wish to discuss sexual harassment with a Contact person to read the web site thoroughly. The appropriate Contact Person with whom to initiate a formal report is determined by the status of the harasser (student, faculty or employee, see below). The reporting party may also choose to proceed informally on a report of harassment made directly to a university Contact Person. Therefore, individuals reporting harassment to a Contact Person may be asked to specify whether they wish to initially proceed informally or formally. Information regarding the current Contact Persons and the differences between informal and formal resolutions may be found on Notre Dame’s web site at http://www.nd.edu/~harassmt .

Reporting Harassment

Informal Resolution

Selecting informal or formal resolution is initially the decision of the person who is being harassed. Informal resolution may be particularly appropriate if the conduct is isolated and of the following nature: sexual innuendo; display or distribution of drawings, pictures or other materials with a sexual content; sexual or "dirty" jokes; or comments with sexual content. On the other hand, the student is encouraged to submit a formal report if the harassment involves multiple instances of the conduct described above; sexual assault; sexual or inappropriate touching of any kind; or sexual advances or "come-ons." Please note that the formal report process is available for harassment of any nature, and that these examples are not intended to discourage use of the formal report process.

Formal Report Process

If the reporting party initially chooses to proceed with a formal report, or if informal resolution is unsuccessful, to whom the harassment is reported and the nature of the resulting investigation and resolution process depends upon the status of the harasser, as described in http://www.nd.edu/~harassmt.

If the harasser is a student (undergraduate or graduate) then the formal report is made to the Contact Persons in the Office of Residence Life.
If the harasser is a faculty member, postdoctoral research associate or student with teaching or classroom responsibilities, and if the allegations are related to such responsibilities, then the formal report is made to the Contact Person in the Office of the Provost.
If the harasser is an exempt or nonexempt employee then the formal report is made to one of the Contact Persons in the Office of Human Resources.

False Reports

A reporting party who was intentionally dishonest in making the allegations or who acted maliciously is subject to appropriate discipline/corrective action, from warning to termination or dismissal.

Education to Prevent Sexual Harassment

The faculty, staff, and students in my study abroad program want to know how to try to prevent students from perceiving their behavior as sexual harassment. What should I tell them?

Consult with the Provost's office, Residence Life, and/or Human Resources to obtain materials on sexual harassment prevention. We have included below a few short guidelines that may be helpful for you and your staff:

Could my behavior be viewed as sexual harassment?
[Source: http://www.admin.mtu.edu/aao/sexwww.htm#behavior Please note that this link is no longer active and has not been updated]

Remember that the receiver of the behavior decides what is welcome or unwelcome. Here are some signs to look for in determining if what you're doing is okay or not okay.

If the other party is not participating - STOP.
Look for non-verbal cues: lack of eye contact, nervousness, lip biting, variations in voice pitch, and physical withdrawal.
Avoid teasing. What you view as humorous may be considered offensive to others.
Caution is advised. All faculty and staff in positions of authority need to be sensitive to the hazards in personal relationships with students or subordinate employees. When disparities in age or authority are present, questions about professional responsibility and the mutuality of consent to a personal relationship may arise. It will be up to you to prove the situation actually was with mutual consent. (Note the University of Notre Dame's policy on consensual relationships).

The organization, "9 to 5," urges the following short-hand test if you're not sure what you're about to say or do is ok:

Would I say or do this if my significant other were present?
Would I want someone to say or do this to my daughter or someone I love like a daughter?
Would I want to be seen on the national news saying or doing this?
If it's a picture or poster, would I have it in my home?
Will what I'm about to say or do make this person feel good or uncomfortable?

Are You the Harasser?
Accused harassers are often surprised to learn how others view their behavior.
[Source: http://www.northwestern.edu/sexual-harassment/harasser/index.html ]

Review your attitudes and actions toward others. Do you base your behavior on stereotypes of others? Is your behavior sex neutral and bias free?
Consider the impact you have on others' attitudes toward their work, education, and self-esteem.
Examine how others respond to what you say and do.
Do not assume that colleagues, peers, employees, or students enjoy sexually oriented comments, remarks about their appearance, being touched, or being stared at.
Do not assume that others will tell you they are offended - or harassed - by what you say and do.
Be aware that unwelcome sexual humor and innuendoes may violate the University's sexual harassment policy.

What Notre Dame policies apply to those who could be accused of sexual harassment?

Notre Dame's Policy on Retaliation

According to University of Notre Dame policy, any attempt by a faculty member, exempt or nonexempt employee, or a student to penalize or retaliate in any way against a person making an informal or formal sexual harassment report is completely prohibited. The University will treat retaliation as a separate incident subject to appropriate discipline/corrective action, from warning to termination or dismissal.

Notre Dame's Policy on Consensual Relationships

Because of the potential for abuse or the appearance of abuse and the inherent differential in authority, the University prohibits any faculty member or employee of the University from engaging in a romantic and/or sexual relationship with any student currently enrolled as an undergraduate at Notre Dame. Furthermore, because of the potential for abuse or the appearance of abuse and the inherent differential in authority between graduate students and their educators, counselors and others holding positions of authority over them, the University prohibits any member of the University community from engaging in a romantic and/or sexual relationship with any graduate student whom he or she educates, counsels, coaches, supervises or evaluates in any way. Likewise, because of the potential for abuse or the appearance of abuse and the inherent differential in authority, the University prohibits any member of the University community from engaging in a romantic and/or sexual relationship with any employee whom that person supervises or evaluates in any way. Exceptions to these prohibitions will be considered by the Office of the Provost or the Office of Human Resources on a limited, case-by-case basis.

If you have any questions about the application or effect of this policy to an existing or potential relationship, it is your duty to ask your supervisor and/or a member of the Office of the Provost or the Office of Human Resources. In keeping with this University philosophy, if charges of sexual harassment are made, the existence of a consensual relationship in any of the contexts stated above shall not be a defense in any proceeding brought by the Office of Residence Life, Office of the Provost or Office of Human Resources.

Resources for the International Educator on the Internet

Information on Sexual Harassment: This highly recommended web site provides definitions, legal information, international perspectives, case narratives specifically for university settings. http://www.de.psu.edu/harassment/

Sexual Harassment And Prevention In College Students Studying Abroad: Nancy Newport's article written for students who are enrolled in a study abroad program -- http://www.usc.edu/dept/education/globaled/safeti/v1n2_newport.html

Reentry and Reverse Culture Shock:
Helping the Study Abroad Student Transition Back Home

Elissa M. Blake, Psy.D.
Psychologist
The Citadel Counseling Center

Kevin F. Gaw, Ph.D.
Psychologist
Counseling & Testing Center
University of Nevada, Reno

Introduction

Every year college students from across the country travel to foreign places to study and live abroad. There is generally much discussion to prepare or at least make students aware of the possibility of experiencing culture shock upon their arrival to the host country. The culture shock that occurs when students return home is often ignored. The expectations are generally that study abroad students should feel "happy to be home" or "back to normal", however, students are confronted with an equally difficult challenge to readjust to their homeland. As an international educator, your role is not only to assist students to adjust to their new foreign culture, but also to prepare students for their readjustment back to their home culture. This chapter defines reverse culture shock, common symptoms of reverse culture shock, and suggestions to consider when helping prepare students for their reentry to their home country.

What is Reverse Culture Shock?

The experience of reverse culture shock has many scholarly definitions, however, it may be simply described as the difficulties one experiences readapting and readjusting to one’s own home culture after one has sojourned or lived in another cultural environment (Gaw, 2000). Similar to culture shock, students who return from studying abroad and reenter into their home environment will often feel out of place in their own home country and culture and question American cultural norms and values. While everything seems familiar, the student may feel different. They may experience a sense of estrangement from their former selves and lives. Students have likely gained a new world view, helping them to see choices where formerly there was no question of how something should be done. The everyday routines of eating, bathing, dressing, commuting, and sleeping can all be affected by different customs and beliefs.

A student’s return home is usually characterized by two unique elements or mistaken attitudes, which frequently result in frustrated expectations, various degrees of alienation, and mutual misunderstanding between returnees and their friends and family (La Brack, 1999-2000). The first element is an idealized view of home. Students often have a picture perfect memory of their home life that they cling to while away, often as a coping strategy to manage homesickness. This memory may be challenged and dislodged upon their return home, leading to feelings of disappointment and discontentment.

The second element is a familiarity with the home culture. This familiarity fosters the illusion that neither home nor the sojourner will have changed since he/she has gone away. This illusion often evokes confusion and frustration, as the student becomes more aware that he/she has changed and his/her home is different.

There are four recognized states that seem to be relevant to reverse culture shock (adapted from the orignal SUNY-Buffalo's web site on reverse culture shock which has since been changed, http://wings.buffalo.edu/studyabroad/ret_reverse.htm ).

1) Disengagement: The anticipation the student experiences while still abroad as he/she begins to think about moving back to his/her home country and move away from his/her overseas experience and friends. Although they may generally remain very involved and engaged in their overseas experience, their mind begins to shift towards returning home.

2) Euphoria: The initial excitement of being back in his/her country, which includes others’ equal delight to have him/her back home. However, after the initial welcoming weeks, the student may experience sudden or painful realizations that others may not be particularly interested in his/her overseas experience, or may not be able to understand or relate to the student’s overseas experience.

3) Alienation : The student may feel disengaged, frustrated, and angry for feeling like an outsider in his/her own home, school, and country. The returnee may feel resentment, loneliness, and a sense of helplessness as he/she feels disoriented in his/her home country. It is often during this phase that the returnee experiences a "hidden immigrant" identity – they might look like their peers, but they feel very different.

This state may also include confronting confusing changes in identity. Returning home for many students highlights how their prior immersion in another country has changed their cultural and personal identities. Students tend not to realize the full extent of their changes until they return and see themselves anew, in contrast to how they used to be and in contrast to how people still treat them. Developmentally, the college years are ripe for identity confusion and reintegration, and this process can be both accelerated and further confused by immersion in another culture. While immersed in the other culture, the student has hopefully been able to experiment with new roles and try out new choices. The student may also have adopted a new lens through which they view the self, judging some self characteristics more positively and some more negatively. Students may experience both validation and transformation of their world views, and they may reexamine such issues as competition vs. cooperation, degree of emotional expression, independence vs. interdependence, and individual vs. extended self.

Students may have absorbed the impact of the host country’s stereotypes of Americans or other cultures, which can affect their self image and self esteem. They may assume inappropriate guilt and shame for being American as if they are individually responsible for causing negative views.

Students develop a new lens through which to view their home country, for better or for worse. Particularly for American students, many come home disillusioned and critical of such differences as the American consumer-focused lifestyle. For example, some students who return are surprised at the intensity of their feelings when they return and walk into an American grocery store, viewing the American’s over abundance of food when the people in their host country had either just enough or too little. Additionally, American politics and news media may be viewed with greater distrust and disillusionment.

Students returning to campus may be surprised to notice how much they have changed in relation to the campus culture, which taken as a whole, may be stereotyped as reinforcing rigid, narrowly-defined roles for interpersonal relationships, gender, culture, beauty, and achievement. Many study abroad returnees may have grown in maturity and they may be impatient when they encounter some college students’ "petty" interpersonal conflicts, narrow views of the world and cultural differences, and emphasis on partying and having a good time. Students who return from studying abroad usually tend to want to hang out with their new "abroad" friends, but they don’t want to lose their "old stateside" friends either, thus they may feel torn between the two groups and may feel frustrated as they try to accommodate both. Their old stateside friends may treat them as if they had never changed and may respond to the returnee’s stories by changing the topic or minimally listening when their "abroad" stories are told. And yet returnees also feel distanced from their returned study abroad friends as well, now that they no longer currently share the experience of surviving in their host country. Once they are back on campus, their abroad friends generally scatter back into their various former social groups or cliques. When they get together they may reminisce, but it is generally not experienced the same as being there. The returnee begins to realize that some of his/her abroad friendships were formed not due to true compatibility, but due to proximity and the bonding that formed from being placed together into unfamiliar circumstances. Students go through a process of assimilation and accommodation- changing the self-and they may want to be with people who appreciate their new selves. But they may not know where they fit anymore.

For some, the process of going through reverse culture shock can be more difficult than the initial culture shock. Culture shock may be an easier transition to make because the student expects to have to adjust, which involves opening oneself up. Unfamiliarity forces change and assimilation. Whereas reverse culture shock can be more challenging because it involves a reintegration of the old with the new self. The student can never quite return "home" again because the student has likely changed and home has changed – both literally and in how the student may view home.

4) Gradual readjustment: The student readjusts to life at home and/or school as he/she begins to resolve the problematic cultural conflicts, begins to behave with competence, and feels less shocked by his/her surroundings and readjusts. Readjustment is commonly noticed by a new sense of self and a broader definition of identity.

On the positive side, the process of navigating reverse culture shock is more than just readjusting to one’s former culture. Study abroad can facilitate an identity crisis, which, once integrated and resolved, is good for normal self development. Returning home and wading through the mess of an identity crisis allows students the opportunity to crystallize their self-awareness, accommodate and validate new characteristics and choices, and give new purposes and meaning to life. Some students’ reverse culture shock propels them to change majors and career choices, realize that there is more to life than getting A’s, reexamine old friendships and relationships, decide to get out of the bar scene as a way to meet dates, express their sexual identity, find a renewed purpose in religion/spirituality, or join new service organization. They may also become more dissatisfied with relationships that they may not consider to be genuine. After trying to remain friends with all of their returned study abroad and stateside friends, they may inventory and cull through them, new and old, deciding who is truly a close friend and who will be treated more like an acquaintance. They may take risks to be more assertive not only with friends, but also with professors, bosses, and family.

Possible Symptoms of Reverse Culture Shock

self-isolation
uncertainty
restlessness
inability or unwillingness to fit in
boredom
increased need for sleep
irritability
crying spells
loss of interest in activities
feeling overly focused on how things were done in the student’s place of sojourn

disorientation
loneliness
communication problems
confusion
withdrawal
change in goals and priorities
compulsive eating or drinking
exaggerated cleanliness
physical ailments
degrading home culture and people
intense identification with non-nationals

It is important to recognize that some of the symptoms of reverse culture shock may mimic more severe psychological disorders, such as depression. To ensure that adjustment symptoms are not confused with more clinical symptoms, consult with a competent mental health professional who, in particular, understands reverse culture shock and the stresses of intercultural adjustment.

What Does Reverse Culture Shock Feel Like?

During students’ sojourns overseas, they may have acquired a new way of thinking or expressing themselves, or simply become more empathetic or sympathetic to other ways of viewing things. They may have made significant life choices that have influenced changes in their identity. They may also have become critical of their home culture or questioned their patriotic feelings. As a result, students may experience a significant challenge to their self-concept when they return, triggering questions and possibly leading to confusion and disorientation (Wang, 1997). It should be noted that much of this intensity is appropriate when considering intercultural development (Bennett, 1998). Intercultural development postulates that a sojourner must confront his/her own biases and social biases and injustices, as well as develop a strong identity stance, prior to resolving the relative differences observed across cultures and people.

When students return home, they may realize that their expectations of what home would be like are disconfirmed. They may find themselves being more critical of others, disappointed with family and friends, and feeling like they don’t have much to say to those closest to them. In addition, the student’s family and friends’ expectations may be disconfirmed, as they may think that the student should be thrilled to be home and should want to hear only about what has happened at home since the student left, rather than talking solely about his or her experience.

Finally, it is natural for a student to experience a sense of loss and miss the lifestyle, cultural advantages, sense of community, sense of uniqueness, and the friends he or she had overseas, as all of these aspects were a significant part of his or her experience and life (Wang, 1997).

Preparing Students for Reverse Culture Shock

Prepare Early: Rather than wait to prepare sojourners for reentry right before they leave, consider ways you can begin preparing them as they prepare to leave, as they arrive, and at various times throughout their stay (La Brack, 1999-2000). Remind students to keep the needs and limitations of their home situations in mind to maintain a realistic memory.

Reverse Culture Shock is Normal: Educate students about the positive aspects of reverse culture shock and emphasize the benefits that can come from the developmental process of changing identity. Prepare them for the normal process of identity shifting and reorganization.

Education: Make students aware that reentry may be problematic for some people and encourage them to think about it before it happens. Encourage the students to make plans that will preempt some of the problems and come up with solutions that work for them as individuals.

Recording Experiences: Encourage students to journal throughout their stay about how their study abroad experience may be changing how they view themselves. Encourage students to share aspects of their journal with each other. Possible questions to ask self and journal about include:

1. What did I learn about the host culture? About myself?
2. How can I apply what I learned to my life back in the U.S.?
3. Who will listen to my stories? Who could I meet with to get more involved in international activities? (Study Abroad Office, campus organizations, etc.)
4. Do I think of the U.S. any differently now that I have returned? What do I like most about my home culture? The least?
5. How could I describe the "world" that now surrounds me? How does this differ from the "world" I am originally from?

Encourage Student to Seek Support Services Upon Returning to Notre Dame: Encourage students to take advantage of Notre Dame services such as the International Study Abroad Programs Office and the University Counseling Center to discuss normal reactions that may result from reverse culture shock such as alienation, loneliness, isolation, anxiety, friendship difficulties, shyness, or feelings of inferiority. Encourage them to take advantage of academic support services as well.

Encourage students to prepare themselves and others for change: Encourage students to prepare themselves by finding out all they can about their home culture before returning, asking questions about changes to expect. Also encourage students to prepare those to whom they will be returning by relaying their thoughts and concerns about returning, as well as to prepare them for the changes in them.

Stay Involved: Place returnees in touch with "alumni" or people who have insight into what their international/intercultural experience was like and who can help them understand the reentry process and avoid common areas of conflict. Encourage students to immerse themselves in an international community upon their return home who may have shared in similar experiences to reduce feelings of alienation. Encourage returnees to continue their intercultural development by staying involved – as speakers for the study abroad program, as community volunteers, or as student activists for diversity work on campus.

Conclusion

Reverse culture shock is a natural process that occurs as students reenter and transition back to their home culture. Returning sojourners will likely experience frustrations, disappointments, and confusion as they reacquaint themselves with their home life, school, family, and friends. They may experience changes in their identity evoking confusion upon their return. Working through reverse culture shock may be challenging, but international educators may facilitate this process by helping prepare and support the returning students by promoting awareness, discussions, and sensitivity. It is important for those involved in study abroad programs to offer thoughtful and structured settings within which the returning students may discuss their foreign experience and the impact of the reentry into their own culture and society.

Selected Reference List

Bennett, M. J. (Ed.). (1998). Basic concepts of intercultural communication: Selected readings. Yarmouth, MA: Intercultural Press.

Gaw, K.F. (2000). Reverse culture shock in students returning from overseas. International Journal of Intercultural Relations, 24, 83-104.

La Brack, B. (1999-2000). The missing linkage: The process of integrating orientation and reentry. SAFETI On-Line Newsletter, 1(1), 241-279 (see link below).

Wang, M.M. (1997). Reentry and reverse culture shock. In K. Cushner & R. Brislin (Eds.), Improving intercultural interactions: Modules for cross-cultural training programs, Vol. 2 (pp. 109-128). Thousand Oaks, CA: Sage Publications.

Resources on the Internet

The Missing Linkage: The Process of Integrating Orientation and Reentry, Bruce La Brack (2000)
http://www.usc.edu/dept/education/globaled/safeti/v1n1_la_brack.html

Study Abroad Handbook: Reentry or Reverse Culture Shock, USC Center for Global Education
http://www.usc.edu/dept/education/globaled/studentsabroad/reentrycultureshock.html

For Returned Students: Reentry Issues and Reverse Culture Shock, Cornell Abroad
http://www.cuabroad.cornell.edu/returned/reentry.asp

University of Toronto Safety Abroad: Reentry
http://www.utoronto.ca/safety.abroad/Guide/reentry.html

Go to the beginning of the International Educaator's Handbook, Sections II and III

Section II: International Educator Challenges and Dilemmas

Tips for Identifying, Assisting, and Referring Students in Distress
Consulting with the University Counseling Center
Assisting the Notre Dame Study Abroad Student Who Needs to Withdraw

Section III. Resources for International Educators on the Internet

University of Notre Dame Offices and Contacts
Mental Health Crisis Management Resources
Recommended General Mental Health Information
Crisis Management Resources for International Educators
Sources for Articles on Mental Health for International Educators

About the Authors