Multicultural Issues in Clinical
Jamylah Jackson Ph.D., North Texas
and the
Multicultural & Diversity Committee (2009-2010)
VA Psychology Training Council
Contact persons:
Daryl Fujii Ph.D., Honolulu ([email protected])
Rachael Guerra Ph.D., Palo Alto ([email protected])
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)
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
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
What is Multicultural Competence?
General knowledge
Understanding unique client variables
Capacity to effectively form a working alliance
across differences
Capacity to effectively implement culturallyinformed interventions and assessment strategies
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
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
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
Focus on lifelong pursuit rather than limited
content scope perspective
Facilitating Growth Among Supervisees:
Developmental Model (Bennett, 1986)
Developmental Stage
 Denial
Suggested Intervention
Encourage cross-cultural
Emphasize cultural
Illustrate differences in
interpretations of behavior
Demonstrate relevance
Apply knowledge
Develop cultural
mediation skills
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
Didactic Training
Information regarding specific group
– 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
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
Experiential Training
Targets self-awareness
Encourages integration of awareness and
therapeutic strategy
Facilitates examining effects of power
and privilege on perceptions
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
Experiential Approaches in
Practice (Das Gupta et al, 2006)
Narrative method
– Medical residents attended monthly reading
– 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
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
– Offering exposure to a greater number of
clinical cases
Group Supervision
(Lassiter et al, 2008)
Group supervision provides an effective means
of minimizing traditionalism and fostering
understanding of cultural factors influencing
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
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
Exploring these issues with all cases is critical to
promote generalizing this conceptual approach to
evaluating appropriate interventions with all clients
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
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?
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
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 selfexploration and self-disclosure in supervision?
Ongoing trainings for supervisors encourage the
notion multicultural competence as an ongoing
Culturally informed supervision involves selfawareness 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

Supervision and Diversity module