How do language differences affect the ability of the interviewer to communicate with the client? Ask: “What language would you prefer to use in counseling? Are you able to understand my ?” Or, if you cannot speak any other languages, ask: “How comfortable are you with my English?” INTERVIEWING CONTEXT AND PROCEDURES Thus far, we have discussed counselor awareness of himself or herself as a cultural being, and the importance of knowing the cultural characteristics of the client-whether those are attributable to group, universal, or individual in?uences. We have also covered the importance of broad contextual elements as they interact with the individual as a unique ethnocultural being. What has been left out until now is how the actual interviewing context and procedures might impact the interviewing process.

For many people raised in many cultures, consulting with a mental health professional comes as a last resort. Seeing an outsider for personal problems goes against traditional problem solving strategies. This means that clients from another culture may experience an enormous amount of stress or anxiety because of the counseling process-in addition to the stress that brought them in. Moreover, they have expectations for counseling that may or may not match the abilities or styles of the interviewer.

Therefore, extra care should be taken to ensure that clients feel welcome, to establish credibility, and to build trust . At the very least, the counselor must ensure that clients feel and believe their interests are being served without threatening their worldview.

Using standardized assessment instruments may produce anxiety, confusion, or anger in ethnoculturally different clients. For all the reasons described, standardized assessment procedures may be inappropriate for the ethnoculturally different client. In the past, testing procedures used to aid in diagnosis and treatment have been misused.

The chorda tympani is generally accepted as the pretrematic branch of the second branchial arch nerve. It passes from second arch tissue to first arch tissue through the tympanic membrane which is itself in the trema between the first and second arches. It contains two types of visceral fibre: afferent (taste) and efferent (parasympathetic). The embryological origin of the petrosal nerves is less certain.

17.6 Clinical notes 1 Frey’s syndrome After parotidectomy, cut ends of postganglionic fibres begin to grow. Should these sprouting fibres find their way into Schwann cells sheaths occupied before surgery by sympathetic fibres, stimuli normally producing salivation will instead induce sweating over the site of the parotid. This is Frey’s syndrome (gustatory sweating) (see Section 14.4).

2 Runny eyes, streaming nose Runny eyes, runny and blocked up nose might be produced by overactivity of the pterygopalatine ganglion. This is why the ganglion is sometimes called the hay fever ganglion although these symptoms are usually allergic.

104 Autonomic components of cranial nerves, taste and smell17.7 Clinical testing of visceral components 1 Salivary glands Ask the patient to suck something bitter (such as a lemon) to provoke salivary secretion. This is sometimes done to try to locate the position of a calculus in the duct of a salivary gland, usually the submandibular, but is not done to test the neural pathways since, as we have said, who cares? 2 Taste Testing taste is possible but hardly worth the trouble.

14.5 Clinical notes and clinical testing Gag reflex Sensation supplied by the glossopharyngeal nerve is different in quality to that supplied by the trigeminal. Place a finger on the anterior part of the tongue (V) and then the posterior part (IX) to demonstrate this. The gag reflex is mediated by the glossopharyngeal (afferent limb) and the vagus (efferent limb). It is a functional test of both nerves.

The glossopharyngeal nerve (IX) 85Chapter 15 THE VAGUS NERVE (X) 15.1 Functions The main functions of the vagus are phonation and swallowing. It also transmits cutaneous sensory fibres from the posterior part of the external auditory meatus and the tympanic membrane.

It supplies the gut tube as far as the splenic flexure of the transverse colon (roughly), and the heart, tracheobronchial tree and abdominal viscera. These fibres, though, are by no means essential to life, whatever others may tell you, since they can be cut, as in vagotomy. And do you suppose heart surgeons reconnect vagal branches during transplant operations? Of course not.

15.2 Origin, course and branches (Fig. 15.1) The vagus is the most extensively distributed of all cranial nerves. Its name reflects both its wide distribution and the type of sensation it conveys (Latin: vagus