How do You say “Rafting”
in Spanish?
The Challenges of
Language Mismatches in
Supervisory Dyads
Valerie Minchala, Ph.D.
California State University, Fullerton
1
September 22, 2013
Outline
 Why this topic
 ACCTOIDS Q&A
 Background
 Trainee Challenges
 Ethical considerations
 Supervisory Suggestions
2
Why This Topic?
 It was suggested
 “Hot topic” among Spanish-speaking professionals and
students
 Personal experiences as a bilingual clinician and
supervisor
3
ACCTOIDS Q&A
 Does anyone identify as bilingual?
 Has anyone conducted therapy in a language other than
English?
 Has anyone supervised a trainee who has conducted
therapy in a language other than English?
4
Background
 Recent growth of immigrant and bilingual populations
 Professional guidelines require us to “interact in the
language requested by the client”
 Language and culture are tied together
 Both bound to therapy process and cannot be overlooked
 Language:
 Expresses heritage
 Is a source of identity and pride
 Is the means through which emotions are articulated
5
(APA, 1993; Biever, Castaño, Gonzalez, Levy Navarro, Sprowls, & Verdinelli, 2004;
Clauss, 1998; Fuertes, 2004; Santiago-Rivera & Altarriba, 2002)
Background
 Language capabilities are often context specific
 Bilingual people can think, feel, interact, and experience
themselves in dual ways
 Certain characteristics of an individual’s cultural identity may be
linguistically represented in one language and others associated
with another language
 Therapy has been called the “talking cure”
 Yet language choice is often not a focus of training
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(APA, 1993; Biever, Castaño, Gonzalez, Levy Navarro, Sprowls, & Verdinelli, 2004;
Clauss, 1998; Fuertes, 2004; Santiago-Rivera & Altarriba, 2002)
Bilingual Trainee Challenges
What do you think/know are
some challenges faced by
bilingual trainees?
7
Bilingual Trainee Challenges:
Burdens
 Feel burdened and stressed by:
 Added responsibilities = greater demand on time
 Sense of obligation to the Spanish-speaking clients
 Sense of concern about services to clients
 Felt they should perform well for “their people”
 Added responsibilities:
 Extra work due to lack of bilingual professionals
 Asked to interpret for other professionals
 Find themselves educating the majority
 Feel the need to advocate for their clients
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 Burdens + stress + responsibilities = Burnout or fear of
burnout
(Biever et al., 2004; Verdinelli & Biever, 2009)
Bilingual Trainee Challenges:
Language
 Recognized they expressed themselves differently in each language
 Felt insecure about translating due to their lack of training
 Aware of differences in language and word meaning, depending on
the country of origin of the speaker
 Wondered about the effects of having supervision in English
 Expected they should understand everything their clients
communicated
 Those more comfortable speaking English:
 Felt self-conscious or lacked confidence in their proficiency in the
other language
 Spoke less during sessions conducted primarily in the other
language, which slowed down the therapeutic process
 More focused on keeping track of what they had to say and how they
were going to say it than on listening to clients
 Felt interventions were less powerful due to the translation process
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(Biever et al., 2004; Verdinelli & Biever, 2009)
Bilingual Trainee Challenges:
Isolation, Rejection & Exploitation
 Felt isolated when working in settings with few or no other
Spanish-speaking or Latino/a trainees or professionals
 Exacerbated when peers and supervisors did not understand their
dilemmas
 Difficulty expressing concerns about culturally inappropriate
suggestions from their supervisors
 Supervisors often did not see the difference between providing
services in different languages
 Supervisors ignored the difficulties and dilemmas that emerged
when providing Spanish-language services
 Often had to figure things out on their own
 Felt their ethnic identities or bicultural backgrounds were not
valued or nurtured
 Work environment was not always receptive to their needs
 Felt exploited as the result of the pressures to do extra work
and provide training for others
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 Declining these tasks put them in a difficult position as a trainee
(Verdinelli & Biever, 2009)
Bilingual Trainee Challenges:
Supervision
 Recognized supervision as an essential aspect of effective
training for services in another language
 Often dissatisfied with supervision received
 Did not have a supervisor proficient in the language
 Supervisors lacked cultural knowledge and sensitivity
 Felt uncomfortable working with them
 Had difficulty accommodating their ideas and cultural understandings with
those of their supervisors
 Supervisors would not initiate discussion of cultural issues or how to
adjust therapeutic approach
 Supervisors were not aware of the extra effort or complexity of
working bilingually
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 Felt that providing services in another language was
disadvantageous to their training due to the poor supervision
received around this work
(Biever et al., 2004; Verdinelli & Biever, 2009)
Bilingual Trainee Challenges:
Supervision
 Supervision process
 Did not receive relevant feedback that would contribute to
their development as therapists
 Received less direction and feedback regarding their work
with non-English-speaking clients
 Were only supervised to ensure the minimum requirements
of assuring clients’ welfare
 Supervisors only focused on content, not on process
 Felt left alone to decide the best course of treatment
 Discovered how to best work with clients through trial and error
 There were no available means to evaluate the quality of
their services
12
(Biever et al., 2004; Verdinelli & Biever, 2009)
Ethics
We sometimes have to violate
one ethical principle to fulfill
another.
13
Ethical Dilemmas:
Competence
2.01 Boundaries of Competence
 (a) Psychologists provide services. . .with populations
and in areas only within the boundaries of their
competence, based on their education, training,
supervised experience, consultation, study, or
professional experience.
 Are interns, by ethical or licensing standards, competent to
practice independently?
 What is an intern doing if he/she is practicing without
proper supervision?
 If, as a supervisor, you could not work with a client because
of competence concerns (such as providing therapy in a
non-English language), could you competently supervise an
intern’s work?
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(APA, 2002; Schwartz & Domenech Rodriguez, 2010)
Ethical Dilemmas:
Competence
2.01 Boundaries of Competence
 (d) When psychologists provide services to individuals
for whom appropriate services are not available and for
which psychologists have not obtained the competence
necessary, psychologists with closely related prior
training or experience may provide services to ensure
services are not denied.
 Does being able to speak a language informally mean that
one is competent to provide services in that language?
 Does having linguistic competency mean one has cultural
competency?
 Does having received training in English necessarily mean
that one has received “closely related prior training or
experience”?
15
(APA, 2002; Schwartz & Domenech Rodriguez, 2010)
Ethical Dilemmas:
Human Relations
3.01 Unfair Discrimination
 In their work-related activities, psychologists do not
engage in unfair discrimination based on age, gender,
gender identity, race, ethnicity, culture, national origin,
religion, sexual orientation, disability, socioeconomic
status, or any basis proscribed by law.
 If a trainee is available to provide services to non-English
speaking, historically underserved clients, could denying
those clients services on the basis of language barriers be
considered discrimination?
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(APA, 2002; Schwartz & Domenech Rodriguez, 2010)
Ethical Dilemmas:
Human Relations
3.08 Exploitative Relationships
 Psychologists do not exploit persons over whom they
have supervisory, evaluative, or other authority such as
clients/patients, students, supervisees, research
participants, and employees.
 What effect could the power-differential in the supervisory
dyad have on an intern when he/she is asked to take on:
 Clients, in general?
 Specific clients, particularly when receiving the message those
clients will not otherwise receive services?
17
(APA, 2002; Schwartz & Domenech Rodriguez, 2010)
Ethical Dilemmas:
Education & Training
7.06 Assessing Student and Supervisee Performance
 (b) Psychologists evaluate students and supervisees on
the basis of their actual performance on relevant
and established program requirements.
 If bilingual supervision is not available, or if sessions are
not being observed, are evaluations being based on the
intern’s actual performance?
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(APA, 2002; Schwartz & Domenech Rodriguez, 2010)
Ethical Dilemmas:
Education & Training
7.02 Descriptions of Education and Training Programs
 Psychologists responsible for education and training
programs take reasonable steps to ensure that there is a
current and accurate description of the program
content, training goals and objectives, stipends and
benefits, and requirements that must be met for
satisfactory completion of the program. This information
must be made readily available to all interested parties.
 Important to be mindful of advertising a site as one in
which bilingual interns can obtain the necessary experience
to work in a language other than English if there is not
adequate supervision available.
19
(APA, 2002; Schwartz & Domenech Rodriguez, 2010)
Supervisor Suggestions
What can you do as a
TD/supervisor to facilitate the
experience of bilingual
trainees?
20
Supervisor Suggestions:
Cultural Sensitivity
 Assess differences in cultural knowledge between
supervisor and supervisee
 Discuss the possible implications of these disparities
 Be knowledgeable of the other culture
 Be aware of relevant cultural issues for the population
 Have cultural knowledge and be culturally sensitive
 This enhances the supervision experience of the supervisee
 Be sensitive to subgroups within the population
 Discuss cultural issues and how to adjust therapeutic
procedures to meet the client’s needs
21
(Biever et al., 2004; Castaño, Biever, Gonzalez, & Anderson, 2007; Fuertes, 2004;
Verdinelli & Biever, 2009)
Supervisor Suggestions:
Bilingual Sensitivity/Understanding
 Be educated about the challenges faced by mental health professionals
who provide services in more than one language
 Vocabulary may not be as readily available as in English
 Responses may be delayed while one searches for the correct word or phrase
 Difficulty translating or communicating with the same level of proficiency while
using technical and professional language
 Due to differences in when and how language was acquired
 Clinicians who have not received training in the other language may process info in
English, requiring them to translate their thoughts and ideas before expressing them to
clients
 Be able to acknowledge and address the complexity of providing services
bilingually, including choice of language, effects of language switching,
and detachment effects
 Recognize amount of energy it takes to conduct therapy in 2 languages
 There may be an internal process of translation, slowing down, finding the words
and thinking twice about possible interventions
 Working in two languages and cultures can reduce feelings of confidence in one’s
ability to provide the “best” therapy for clients
22 Be aware of the burdens placed on bilingual supervisees and closely
monitor their caseloads
(Biever et al., 2004; Castaño et al., 2007; Verdinelli & Biever, 2009)
Supervisor Suggestions:
Feedback
 Encourage and model flexibility in the use of theory and
technique
 Directly address cultural and language issues
 Even if you lack knowledge about the language, listen to
the problems and look for answers with your supervisee
 If you do not speak the language, watch session videos
and focus on body language, voice inflection, and clients’
nonverbal reactions
 Nonverbal behaviors may differ in one language compared
with the other
 Focus on the process of sessions, not just the content
23
(Fuertes, 2004; Santiago-Rivera & Altarriba, 2002; Verdinelli & Biever, 2009)
Supervisor Suggestions:
Language
 Recognize that language fluency and cultural fluency do not go
hand in hand
 Remember that the fact that a supervisee is bilingual does not
guarantee that he/she will do “good” bilingual counseling
 Do not assume a trainee has the same skill level in Spanish
 He/she could potentially regress to earlier levels of functioning given
the new challenges of providing culturally and linguistically
competent psychotherapy
 Monitor language-switching of both supervisee and client
 When and why
 Code switching or language mixing is typically not a random process, nor
does it imply any kind of language deficit
 Language choice may affect both emotional expression and
recall/interpretation of events
 Can be a defense mechanism used to disengage from emotionally intense
experiences
 There may not be an accurate translation for what is being said
24
(Biever et al., 2004; Clauss, 1998; Field, 2010; Fuertes, 2004;
Santiago-Rivera & Altarriba, 2002)
Supervisor Suggestions:
Language
 Encourage exploration of language-related dynamics
 So trainees are not caught in the patient’s defensive
maneuvers
 So they are aware of how language contributes to a
resistant process
 Foster exploration about how the client and trainee
experiences himself or herself in each language
 Inquire about any shifts in trainee’s sense of self in bilingual
treatment
 Encourage increasing vocabulary development through
immersion programs, Spanish classes, reading,
communicating by e-mail, or listening to music
25
(Biever et al., 2004; Clauss, 1998; Field, 2010; Fuertes, 2004)
Supervisor Suggestions:
Trainee’s Professional Development

Explore how trainees’ personal and professional development can be
facilitated in supervision
 Particularly with regard to their racial/cultural and linguistic self-awareness and
attainment of multicultural competence

Identify supplemental training strategies, such as finding consultants or
supervisors in the community, engaging in additional readings in the
language of service

Recognize the importance of peer support and networking with other
therapists who speak the same language
 Help supervisees network with peers and professional who provide services in
languages other than English, both in the community and through professional
organizations

Ensure that trainees are exposed to clients with diverse ethnic
backgrounds to enrich their training
 Their work should not be limited to that one population

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Help trainees examine how their cultural knowledge and cultural identity
affects their work with these clients
(Biever et al., 2004; Fuertes, 2004; Schwartz & Domenech Rodriguez, 2010;
Verdinelli & Biever, 2009)
Supervisor Suggestions:
Supervisor’s Professional Development
 Be aware of the potential ethical pitfalls
 Assess how you can ethically and competently supervise
services provided in a language that you do not
understand
 Evaluate your own level of development as a supervisor
 Your developmental level may regress in the context of this
supervisory dyad if you do not have experience of comfort
in providing supervision to Latino trainees and supervising
bilingual/bicultural psychotherapy
 Consider how your ethnic and racial identity level can
positively or negatively factor into your ability to
supervise a bilingual trainee
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(Field, 2010; Fuertes, 2004; Schwartz & Domenech Rodriguez, 2010;
Verdinelli & Biever, 2009)
Supervisor Suggestions:
Supervisor’s Professional Development
 Have thorough knowledge of the culture and an
understanding of bilingualism, biculturalism, and crosscultural communication before supervising
 Be aware of your own limits and know when and how to
consult or refer
 Consider taking classes in another language to increase
your understanding of the complexity of working in two
languages
28
(Field, 2010; Fuertes, 2004; Schwartz & Domenech Rodriguez, 2010;
Verdinelli & Biever, 2009)
Questions?
Comments?
29
Thank you!
30
References
 American Psychological Association. (1993). Guidelines for
providers of psycholical services to ethnic, linguistic, and
culturally diverse populations. American Psychologist, 48, 4548.
 American Psychological Association. (2002). Ethical principles of
psychologists and code of conduct. American Psychologist, 57,
1060–1073.
 Beiver, J. L., Castaño, M. T., Gonzalez, C., Levy Navarro, R.-E.,
Sprowls, C., & Verdinelli, S. (2004). Spanish-language
psychotherapy: Therapists’ experiences and needs. Advances in
Psychology Research, 29, 157-182.
31
 Castaño, M. T., Biever, J. L., Gonzalez, C. G., & Anderson, K. B.
(2007). Challenges of providing mental health services in
Spanish. Professional Psychology: Research and Practice, 38,
667-673.
References
 Clauss, C. S. (1998). Language: The unspoken variable in
psychotherapy practice. Psychotherapy, 35, 188-196.
 Field, L. (2010). Ethical considerations for supervisors when
they don’t speak the language: Frameworks to support
culturally competent supervision. Professional Psychology:
Research and Practice, 41, 218-220.
 Fuertes, J. N. (2004). Supervision in bilingual counseling:
Service delivery, training, and research considerations. Journal
of multicultural counseling and development, 32, 84-94.
32
References
 Santiago-Rivera, A., L., & Altarriba, J. (2002). The role of
language in therapy with the Spanish-English bilingual client.
Professional Psychology: Research and Practice, 33, 30-38.
 Schwartz, A., & Domenech Rodriguez, M. M. (2010). Beyond
wordsmithery: Ethical considerations when clients and
psychotherapist use a language the supervisor can’t speak.
Professional Psychology: Research and Practice, 41, 211-215.
 Verdinelli, S., & Biever, J. L. (2009). Experiences of
Spanish/English bilingual supervisees. Psychotherapy Theory,
Research, Practice, Training, 26, 158-170.
33