Multicultural Issues Multicultural Issues in Clinical in Clinical Supervision Supervision Jamylah Jackson Ph.D., North Jamylah Jackson Ph.D., North Texas Texas and the and the Multicultural & Diversity Multicultural & Diversity Committee (2009-2010) Committee (2009-2010) VA Psychology Training Council VA Psychology Training Council Contact persons: Contact persons: Daryl Fujii Ph.D., Honolulu ([email protected]) Daryl Fujii Ph.D., Honolulu ([email protected]) Rachael Guerra Ph.D., Palo Alto Rachael Guerra Ph.D., Palo Alto ([email protected]) ([email protected])
Transcript
Multicultural Issues in Clinical Multicultural Issues in Clinical Supervision Supervision
Jamylah Jackson Ph.D., North TexasJamylah Jackson Ph.D., North Texas and the and the
Rachael Guerra Ph.D., Palo AltoRachael Guerra Ph.D., Palo Alto
Jamylah Jackson Ph.D., North TexasJamylah Jackson Ph.D., North Texas
Tina Liu-Tom Ph.D., HonoluluTina Liu-Tom Ph.D., Honolulu
Monica Roy Ph.D., BostonMonica Roy Ph.D., Boston
Miguel Ybarra Ph.D., San AntonioMiguel Ybarra Ph.D., San Antonio
Jay Morrison Ph.D., San Francisco (Postdoc)Jay Morrison Ph.D., San Francisco (Postdoc)
Velma Barrios, Greater Los Angeles (Intern)Velma Barrios, Greater Los Angeles (Intern)
Learning ObjectivesLearning Objectives
Explore the role of supervisor as a cultural beingExplore the role of supervisor as a cultural being Learn to promote supervisee self-awareness.Learn to promote supervisee self-awareness. Describe ways of providing a safe environment for Describe ways of providing a safe environment for
discussion of multicultural issues, values, and ideas.discussion of multicultural issues, values, and ideas. Communicate acceptance of and respect for Communicate acceptance of and respect for
supervisees’ cultural perspectives.supervisees’ cultural perspectives. Discuss realities of racism/oppression, acknowledging Discuss realities of racism/oppression, acknowledging
that cultural considerations are relevant.that cultural considerations are relevant. Address a broad range of differences such as learning Address a broad range of differences such as learning
styles, interpersonal needs, sexual orientation, styles, interpersonal needs, sexual orientation, religious/spiritual beliefs, race, and physical religious/spiritual beliefs, race, and physical disabilities.disabilities.
The Role of Clinical SupervisionThe Role of Clinical Supervision
One of the most salient variables One of the most salient variables influencing multicultural competence is influencing multicultural competence is receiving supervision related to receiving supervision related to multicultural issuesmulticultural issues
Clinical supervision plays a critical role in Clinical supervision plays a critical role in assisting trainees with linking assisting trainees with linking coursework/didactics with practical coursework/didactics with practical experienceexperience
What is Multicultural Competence?What is Multicultural Competence?
Self-awarenessSelf-awareness General knowledgeGeneral knowledge Self-efficacySelf-efficacy Understanding unique client variablesUnderstanding unique client variables Capacity to effectively form a working alliance Capacity to effectively form a working alliance
across differencesacross differences Capacity to effectively implement culturally-Capacity to effectively implement culturally-
informed interventions and assessment strategiesinformed interventions and assessment strategies
Cultural Factors Within Supervision:Cultural Factors Within Supervision:Multiple IdentitiesMultiple Identities
Two dyads with multiple identitiesTwo dyads with multiple identities– Supervisee-clientSupervisee-client
– Supervisor-superviseeSupervisor-supervisee
May or may not parallel trainee experience with May or may not parallel trainee experience with other supervisors, as well as patientsother supervisors, as well as patients
Cultural Factors Within Supervision: Cultural Factors Within Supervision:
Power DynamicsPower Dynamics Power differentialPower differential
– Occupied roles of client, supervisor, superviseeOccupied roles of client, supervisor, supervisee
– Multiple roles of evaluator, teacher, and mentorMultiple roles of evaluator, teacher, and mentor
– Socio-historical power differentialsSocio-historical power differentials
Supervisors often have less training in Supervisors often have less training in multicultural competence than their superviseesmulticultural competence than their supervisees
Facilitating Growth Among Facilitating Growth Among SupervisorsSupervisors
Continuous and regular faculty development Continuous and regular faculty development regarding multicultural issuesregarding multicultural issues– Continuing EducationContinuing Education
– Experiential TrainingsExperiential Trainings Faculty development aimed at maintaining or Faculty development aimed at maintaining or
increasing multicultural competence among increasing multicultural competence among supervisorssupervisors
Focus on lifelong pursuit rather than limited Focus on lifelong pursuit rather than limited content scope perspectivecontent scope perspective
Facilitating Growth Among Facilitating Growth Among SuperviseesSupervisees::Developmental Model (Bennett, 1986)Developmental Model (Bennett, 1986)
experiencesexperiences Emphasize cultural Emphasize cultural
commonalitiescommonalities Illustrate differences in Illustrate differences in
interpretations of behaviorinterpretations of behavior Demonstrate relevanceDemonstrate relevance Apply knowledgeApply knowledge Develop cultural Develop cultural
mediation skillsmediation skills
Facilitating Growth Among Facilitating Growth Among SuperviseesSupervisees::Role of SupervisorRole of Supervisor
Safety and mutuality are essential elements of Safety and mutuality are essential elements of culturally informed supervisionculturally informed supervision
Supervisor self-disclosureSupervisor self-disclosure Modeling can facilitate parallel processModeling can facilitate parallel process Communicate acceptance of and respect for Communicate acceptance of and respect for
supervisees’ cultural and perspectivessupervisees’ cultural and perspectives Provide supervisees with diverse caseload to Provide supervisees with diverse caseload to
promote breadth of experiencepromote breadth of experience
Didactic TrainingDidactic Training
Information regarding specific group Information regarding specific group membershipsmemberships– Descriptions of theories of minority identity Descriptions of theories of minority identity
development (racial, sexual, disability, etc.)development (racial, sexual, disability, etc.)– Supervisors need to stress the idea that such Supervisors need to stress the idea that such
info is to be held tentatively and provides info is to be held tentatively and provides additional hypotheses to be explored additional hypotheses to be explored
Synthesizing ConceptsSynthesizing Concepts
Balance of didactic and experiential activities Balance of didactic and experiential activities connect multiculturalconnect multicultural knowledge knowledge with with culturally appropriate culturally appropriate interventionsinterventions
Initial didactic trainings are provided within Initial didactic trainings are provided within graduate programs and likely continue on graduate programs and likely continue on internship/post-docinternship/post-doc
Experiential training assists with crystallizing Experiential training assists with crystallizing the link between training and clinical practicethe link between training and clinical practice
Experiential TrainingExperiential Training
Targets self-awarenessTargets self-awareness Encourages integration of awareness and Encourages integration of awareness and
therapeutic strategytherapeutic strategy Facilitates examining effects of power Facilitates examining effects of power
and privilege on perceptionsand privilege on perceptions
Experiential Approaches in Experiential Approaches in Practice Practice (Finkel, et al 2003)(Finkel, et al 2003)
Safe Zone ProjectSafe Zone Project– 66 graduate students 66 graduate students
– Completed 2 or more experiential exercises aimed at Completed 2 or more experiential exercises aimed at increasing awareness, knowledge, and sensitivity to increasing awareness, knowledge, and sensitivity to important issues affecting LGBT students, faculty, important issues affecting LGBT students, faculty, and staffand staff
– 92% of students reported they would recommend 92% of students reported they would recommend the trainingthe training
– 94% reported it should be retained as a training 94% reported it should be retained as a training requirementrequirement
Experiential Approaches in Experiential Approaches in Practice Practice (Das Gupta et al, 2006)(Das Gupta et al, 2006)
Narrative methodNarrative method– Medical residents attended monthly reading Medical residents attended monthly reading
groupgroup– Training involved “neutral” culture bookTraining involved “neutral” culture book– Residents and staff reported the group helped Residents and staff reported the group helped
them recognize importance of acknowledging them recognize importance of acknowledging and learning about cultural differencesand learning about cultural differences
– Participants also reported feeling enabled to Participants also reported feeling enabled to examine their own prejudicesexamine their own prejudices
Group Supervision Group Supervision (Riva and Erickson, 2008)(Riva and Erickson, 2008)
Study explored group supervision practices at Study explored group supervision practices at psychology pre-doctoral internship programspsychology pre-doctoral internship programs
Authors suggest benefits include Authors suggest benefits include – vicarious learningvicarious learning– availability of multiple perspectivesavailability of multiple perspectives– receiving feedback from peersreceiving feedback from peers– Fostering more cohesions among the training cohortFostering more cohesions among the training cohort– Offering exposure to a greater number of clinical Offering exposure to a greater number of clinical
casescases
Group SupervisionGroup Supervision(Lassiter et al, 2008)(Lassiter et al, 2008)
Group supervision provides an effective means of Group supervision provides an effective means of minimizing traditionalism and fostering minimizing traditionalism and fostering understanding of cultural factors influencing livesunderstanding of cultural factors influencing lives
Model involved a systematic procedure for peer Model involved a systematic procedure for peer group supervision that included role play and group supervision that included role play and review of taped counseling sessions for the review of taped counseling sessions for the purpose of giving feedback.purpose of giving feedback.
One person within the group is assigned to the One person within the group is assigned to the multicultural counselor role multicultural counselor role
Facilitating DiscussionFacilitating Discussion
Can involve encouraging trainee to discuss personal Can involve encouraging trainee to discuss personal reactions/biases with respect to the case reactions/biases with respect to the case
Modeling by sharing your own personal reactions/biases Modeling by sharing your own personal reactions/biases with respect to the casewith respect to the case
Help trainee identify if and how their personal values or Help trainee identify if and how their personal values or aspects of their identity are influencing the therapeutic aspects of their identity are influencing the therapeutic relationship and/or implementation of the therapeutic relationship and/or implementation of the therapeutic interventionsinterventions
Exploring these issues with all cases is critical to Exploring these issues with all cases is critical to promote generalizing this conceptual approach to promote generalizing this conceptual approach to evaluating appropriate interventions with all clientsevaluating appropriate interventions with all clients
Possible QuestionsPossible Questions
What are some of your personal reactions to your client What are some of your personal reactions to your client and any aspects of their identity?and any aspects of their identity?
What cultural or spiritual values may be biasing or What cultural or spiritual values may be biasing or affecting how you view the issues your client is affecting how you view the issues your client is presenting? presenting?
How are your own perspectives distinct or similar to How are your own perspectives distinct or similar to those of your client?those of your client?
How you are implementing your therapeutic strategy and How you are implementing your therapeutic strategy and interventions? Are there ways your personal values or interventions? Are there ways your personal values or aspects of your identity are influencing your therapeutic aspects of your identity are influencing your therapeutic relationship and/or your implementation of the relationship and/or your implementation of the therapeutic interventions?therapeutic interventions?
Case VignetteCase Vignette
An intern is working with a 32 year old, African An intern is working with a 32 year old, African American, OEF/OIF veteran with PTSD. They American, OEF/OIF veteran with PTSD. They are using the CPT protocol. The supervisee are using the CPT protocol. The supervisee approaches you, the supervisor, with questions approaches you, the supervisor, with questions about how to address the spiritual conflicts the about how to address the spiritual conflicts the veteran is presenting with the CPT framework. veteran is presenting with the CPT framework. The veteran expresses thoughts that he will be The veteran expresses thoughts that he will be condemned for taking the lives of others while in condemned for taking the lives of others while in combat.combat.
Questions to considerQuestions to consider
What does the manner in which the supervisee What does the manner in which the supervisee brings up the issue suggest to you? brings up the issue suggest to you?
Is the distinction between religion and Is the distinction between religion and spirituality relevant here?spirituality relevant here?
How can the supervisor provide a “safe” How can the supervisor provide a “safe” environment in which to allow the intern to take environment in which to allow the intern to take risks in crossing boundaries of cultural self-risks in crossing boundaries of cultural self-exploration and self-disclosure in supervision? exploration and self-disclosure in supervision?
SummarySummary
Ongoing trainings for supervisors encourage the Ongoing trainings for supervisors encourage the notion multicultural competence as an ongoing notion multicultural competence as an ongoing processprocess
Culturally informed supervision involves self-Culturally informed supervision involves self-awareness of supervisor as well as superviseeawareness of supervisor as well as supervisee
Supervisory relationship may act as a model for Supervisory relationship may act as a model for therapeutic relationshiptherapeutic relationship
Addressing cultural factors consistently Addressing cultural factors consistently throughout supervision fosters awareness and throughout supervision fosters awareness and increased likelihood that such factors will be increased likelihood that such factors will be appropriately addressed in therapyappropriately addressed in therapy
