Multicultural Issues in Clinical Supervision

1. Multicultural Issues in Clinical Supervision Jamylah Jackson Ph.D., North Texas and the Multicultural & Diversity Committee (2009-2010) VA Psychology Training Council Contact persons: Daryl Fujii Ph.D., Honolulu (Daryl.Fujii@va.gov) Rachael Guerra Ph.D., Palo Alto (Rachael.Guerra@va.gov)

2. Multicultural/Diversity Committee Committee 2009-2010 Loretta E. Braxton Ph.D., Durham, (Co-Chair) Linda R. Mona Ph.D., Long Beach (Co-Chair) Lenora Brown Ph.D., St. Louis Daryl Fujii Ph.D., Honolulu Rachael Guerra Ph.D., Palo Alto Jamylah Jackson Ph.D., North Texas Tina Liu-Tom Ph.D., Honolulu Monica Roy Ph.D., Boston Miguel Ybarra Ph.D., San Antonio Jay Morrison Ph.D., San Francisco (Postdoc) Velma Barrios, Greater Los Angeles (Intern)

3. Learning Objectives • Explore the role of supervisor as a cultural being • Learn to promote supervisee self-awareness. • Describe ways of providing a safe environment for discussion of multicultural issues, values, and ideas. • Communicate acceptance of and respect for supervisees’ cultural perspectives. • Discuss realities of racism/oppression, acknowledging that cultural considerations are relevant. • Address a broad range of differences such as learning styles, interpersonal needs, sexual orientation, religious/spiritual beliefs, race, and physical disabilities.

4. The Role of Clinical Supervision • One of the most salient variables influencing multicultural competence is receiving supervision related to multicultural issues • Clinical supervision plays a critical role in assisting trainees with linking coursework/didactics with practical experience

5. What is Multicultural Competence? • Self-awareness • General knowledge • Self-efficacy • Understanding unique client variables • Capacity to effectively form a working alliance across differences • Capacity to effectively implement culturally-informed interventions and assessment strategies

6. Cultural Factors Within Supervision:Multiple Identities • Two dyads with multiple identities • Supervisee-client • Supervisor-supervisee • May or may not parallel trainee experience with other supervisors, as well as patients

7. Cultural Factors Within Supervision: Power Dynamics • Power differential • Occupied roles of client, supervisor, supervisee • Multiple roles of evaluator, teacher, and mentor • Socio-historical power differentials • Supervisors often have less training in multicultural competence than their supervisees

8. Facilitating Growth Among Supervisors • Continuous and regular faculty development regarding multicultural issues • Continuing Education • Experiential Trainings • Faculty development aimed at maintaining or increasing multicultural competence among supervisors • Focus on lifelong pursuit rather than limited content scope perspective

9. Facilitating Growth Among Supervisees:Developmental Model (Bennett, 1986) Developmental Stage • Denial • Defense • Minimization • Acceptance • Adaptation • Integration Suggested Intervention • Encourage cross-cultural experiences • Emphasize cultural commonalities • Illustrate differences in interpretations of behavior • Demonstrate relevance • Apply knowledge • Develop cultural mediation skills

10. Facilitating Growth Among Supervisees:Role of Supervisor • Safety and mutuality are essential elements of culturally informed supervision • Supervisor self-disclosure • Modeling can facilitate parallel process • Communicate acceptance of and respect for supervisees’ cultural and perspectives • Provide supervisees with diverse caseload to promote breadth of experience

11. Didactic Training • Information regarding specific group memberships • Descriptions of theories of minority identity development (racial, sexual, disability, etc.) • Supervisors need to stress the idea that such info is to be held tentatively and provides additional hypotheses to be explored

12. Synthesizing Concepts • Balance of didactic and experiential activities connect multicultural knowledge with culturally appropriate interventions • Initial didactic trainings are provided within graduate programs and likely continue on internship/post-doc • Experiential training assists with crystallizing the link between training and clinical practice

13. Experiential Training • Targets self-awareness • Encourages integration of awareness and therapeutic strategy • Facilitates examining effects of power and privilege on perceptions

14. Experiential Approaches in Practice (Finkel, et al 2003) • Safe Zone Project • 66 graduate students • Completed 2 or more experiential exercises aimed at increasing awareness, knowledge, and sensitivity to important issues affecting LGBT students, faculty, and staff • 92% of students reported they would recommend the training • 94% reported it should be retained as a training requirement

15. Experiential Approaches in Practice (Das Gupta et al, 2006) • Narrative method • Medical residents attended monthly reading group • Training involved “neutral” culture book • Residents and staff reported the group helped them recognize importance of acknowledging and learning about cultural differences • Participants also reported feeling enabled to examine their own prejudices

16. Group Supervision (Riva and Erickson, 2008) • Study explored group supervision practices at psychology pre-doctoral internship programs • Authors suggest benefits include • vicarious learning • availability of multiple perspectives • receiving feedback from peers • Fostering more cohesions among the training cohort • Offering exposure to a greater number of clinical cases

17. Group Supervision(Lassiter et al, 2008) • Group supervision provides an effective means of minimizing traditionalism and fostering understanding of cultural factors influencing lives • Model involved a systematic procedure for peer group supervision that included role play and review of taped counseling sessions for the purpose of giving feedback. • One person within the group is assigned to the multicultural counselor role

18. Facilitating Discussion • Can involve encouraging trainee to discuss personal reactions/biases with respect to the case • Modeling by sharing your own personal reactions/biases with respect to the case • Help trainee identify if and how their personal values or aspects of their identity are influencing the therapeutic relationship and/or implementation of the therapeutic interventions • Exploring these issues with all cases is critical to promote generalizing this conceptual approach to evaluating appropriate interventions with all clients

19. Possible Questions • What are some of your personal reactions to your client and any aspects of their identity? • What cultural or spiritual values may be biasing or affecting how you view the issues your client is presenting? • How are your own perspectives distinct or similar to those of your client? • How you are implementing your therapeutic strategy and interventions? Are there ways your personal values or aspects of your identity are influencing your therapeutic relationship and/or your implementation of the therapeutic interventions?

20. Case Vignette An intern is working with a 32 year old, African American, OEF/OIF veteran with PTSD. They are using the CPT protocol. The supervisee approaches you, the supervisor, with questions about how to address the spiritual conflicts the veteran is presenting with the CPT framework. The veteran expresses thoughts that he will be condemned for taking the lives of others while in combat.

21. Questions to consider • What does the manner in which the supervisee brings up the issue suggest to you? • Is the distinction between religion and spirituality relevant here? • How can the supervisor provide a “safe” environment in which to allow the intern to take risks in crossing boundaries of cultural self-exploration and self-disclosure in supervision?

22. Summary • Ongoing trainings for supervisors encourage the notion multicultural competence as an ongoing process • Culturally informed supervision involves self-awareness of supervisor as well as supervisee • Supervisory relationship may act as a model for therapeutic relationship • Addressing cultural factors consistently throughout supervision fosters awareness and increased likelihood that such factors will be appropriately addressed in therapy