Competencies and Strategies for Multicultural Supervision

“COMPETENCIES AND
STRATEGIES FOR MULTICULTURAL
SUPERVISION”
Continuing Education Workshop
Presented by Shelly P. Harrell, Ph.D.
March 4, 2017 – CPA Division II
1

SUPERVISION AND TRAINING
-Psychotherapy supervision is one of the most fulfilling
professional activities
-Contributing to the development of future therapists
-Forming mentoring relationships
-Witnessing professional development
-Sharing your knowledge and experience
-Giving back
-Learning and developing ourselves!
“One who teaches, learns.” –Ethiopian Proverb
2

WHAT IS
MULTICULTURAL COMPETENCE
FOR MENTAL HEALTH PRACTITIONERS?
The demonstrated ability to consistently and
carefully consider the cultural dimensions of
self, other and context, and to engage in ethical
and multiculturally-informed behavior and
interactions through the application of
multicultural awareness, knowledge, and skills
in multiple professional roles (e.g., assessment,
intervention, research, teaching, consultation,
supervision, administration, advocacy,
collaboration, etc.).(S.P. Harrell, 1997; revised 2006)
3

IMPORTANCE OF INTEGRATING MULTICULTURAL
CONTENT AND PROCESS IN CLINICAL
SUPERVISION
 Demographic Imperative
 Ethical Principles
 Policy Guidelines
 Evidence-based Practice
 APA Multicultural Guidelines
 Research Evidence
 Culture and Human Behavior
 Implicit Bias,Intergroup Relations, Prejudice
Reduction
 Cultural Adaptation of Evidence-based Practice
4

STATUS OF CULTURAL COMPETENCE
Value of considering culture outpaces behavior
What we’ve done well
• Modified explicit attitudes
• Integration into professional norms
• Identified specific competencies
Where we still need to go
• Modify implicit attitudes (Smith, Constantine, Dunn, Dinehart, &
Montoya, 2006)
• Increase Knowledge of relevant conceptual and empirical
literature (MC Psych 101)
• Improve Skills: Cultural adaptation and Cultural
attunement
Copyright 2016. Shelly P. Harrell, Ph.D. All Rights Reserved

MULTICULTURAL EDUCATION AND
TRAINING
 Academic Courses
 Diverse Clinical Opportunities
 Exposure AND Integration
 SUPERVISION!!!!!
6

SUPERVISOR CULTURAL COMPETENCIES
(Falender And Shafranske, 2004,p. 149)
1) A working knowledge of the factors that affect worldview;
2) Self-identity awareness and competence with respect to
diversity in the context of self, supervisee, and client or
family;
3) Competence in multimodal assessment of the
multicultural competence of trainees;
4) Models diversity and multicultural conceptualizations
throughout the supervision process;
5) Models respect, openness, and curiosity toward all aspects
of diversity and its impact on behavior, interaction, and
the therapy and supervision processes;
6) Initiates discussion of diversity factors in supervision.
7

DETERMINANTS OF MULTICULTURALLY-
COMPETENT SERVICE DELIVERY FOR THERAPIST-
TRAINEES
 Therapist-trainee multicultural
competence
 Supervisor multicultural
competence
 Program multicultural competence
 Institutional multicultural
competence
8

TRAINEE COMPETENCE IS RELATED TO
SUPERVISOR COMPETENCE
Contributions to the development of supervisor
multicultural competence
AWARENESS: Increase awareness of dynamics of
difference and ethnocultural
transference/countertransference
KNOWLEDGE: Increase knowledge of
multicultural psychology and cultural
adaptation processes for evidence-based
practice
SKILL: Introduce a strategy for integrating
multicultural considerations into supervision
9

EXAMPLE OF DIMENSION-
SPECIFIC MULTICULTURAL
COMPETENCIES:
RACE
10

RACE-RELATED MULTICULTURAL COMPETENCIES IN
THERAPY AND SUPERVISION
Awareness, Values, and Attitudes (AVA)
• Competence Goals:
• (1) the development of a strong personal awareness of the role and meaning
of race and racial content, and
• (2) the cultivation of a set of professional attitudes and values related to
racial material
• AVA Core Competencies
• Racial self-awareness
• Race-related empathy
• Respect for race-related experiences
• Race-related bias awareness
• Additional AVA competencies
• Self-awareness of thoughts, needs, and internal processes during
interracial and intraracial encounters; self-awareness of interpersonal
behavior in both interracial and intraracial interactions; awareness of
power and privilege dynamics in one’s own relationships; awareness of ways
that one colludes with the maintenance of racism and white privilege;
awareness of attitudes and opinions on race-related topics; an attitude of
openness to learning about and discussing race-related issues; and valuing
the exploration of the relationship of race to psychological experience.
11

Knowledge of Theory and Research (KTR)
• Competence Goal:
• Familiarity with empirical, conceptual, and applied literature relevant
to race and racial issues
• Core KTR Competencies
• Racial identity
• Racial socialization
• Racism-related stress
• Internalized racism
• White privilege
• Study of aversive racism, implicit prejudice, and in-group bias within
the social cognition literature
• Additional Areas of Theory and Research
• Intraracial heterogeneity, intergroup conflict, prejudice reduction and
anti-racism strategies, critical race theory, liberation psychology,
neuroscience of race, history of race in psychology, and ecological
theory (Adams, 2009; Burgess et al., 2007; Comas-Diaz & Jacobsen,
1991)
12

Race-related Multicultural Competencies: Interpersonal and
Professional Skills (IPS)
• Competence Goals:
• Demonstration of the application of AVAs and KTRs in the conduct of the
case and therapeutic/supervisory relationship
• IPS Competencies
• Authenticity and genuineness in interracial interactions
• Demonstration of empathy when experiences of racism are reported
• Ability to co-create a safe and open environment for discussion of race-
related content
• Recognizing and attending to the specific impact of one’s own race-related
issues on the content and process of interactions
• Recognizing and processing the influence of the client’s race-related
experiences and perceptions on the therapeutic alliance
• Ability to work through and recover from race-related ruptures in the
therapeutic relationship
• Inclusion of race-related inquiries during the intake process
• Integrating race-related considerations into case formulation
• Incorporation of racial content into psychotherapy interventions
• Ability to process any overt expressions of racism
13

IMPORTANCE OF METACOMPETENCE
Metacompetence
 Ability to assess what one knows and what one doesn’t know
 Introspection about one’s personal cognitive processes and
products
 Dependent on self-awareness, self-reflection, and self-
assessment.
 Supervision guides development of metacompetence through
encouraging and reinforcing supervisee’s development of skills
in self-assessment
(Falender & Shafranske, 2007)
15

OUR BIASES
“An important component of working with any
culture is to understand your own biases,
expectations, and beliefs about members of a
cultural community.”
from: http://deploymentpsych.org/self-awareness-exercise
Why do health disparities persist despite
strong stated values of equity among health
care providers?
IMPORTANT: Conscious attitudes toward
diversity may not reflect subtle, hard-to
control bias.

IMPLICIT BIAS
Part of the evolving and accumulating body of research that is
informing our understanding of “unconscious” mental
processes.
Connected to research on implicit memory, implicit attitudes,
and implicit cognition
Underlying assumption is that “actors do not always have
conscious, intentional control over the processes of social
perception, impression formation, and judgment that motivate
their actions” (Greenwald and Krieger, 2006)
A process is implicit when a person cannot voluntarily retrieve or
identify a mental process and where there is simultaneously
evidence in behavior that process is present (memory, etc.)

IMPLICIT MENTAL PROCESSES
Implicit mental processes can be understood as “introspectively
unidentified (or inaccurately identified) traces of past
experience” that mediate
• favorable or unfavorable feeling, thought, or action toward social
objects. (implicit attitude)
• attributions of qualities to a member of a social category (implicit
stereotype)
-Greenwald and Banaji (1995)
Implicit biases are based on implicit attitudes or stereotypes and
produce behavior that diverges from a person’s avowed or
endorsed beliefs or principles

IMPLICIT BIAS AND THERAPISTS
 The presence of implicit bias and a strong
belief in personal competency when
working with diverse clients can occur
together. (Boysen & Vogel, 2008)
 Studies of implicit bias among mental
health providers have consistently
documented significant levels of bias
(Abreu, 1999; Boysen & Vogel, 2008; Castillo
et al., 2007)

INTENT AND IMPACT
 Important to NOT equate intent with impact
 Many microaggressions are not meant to be hurtful and may be
jokes or naïve curiosity
 If we only focus on intention, we continue to center and prioritize
the perspective of the dominant group member who commits the
microaggression and invalidate the experience of the targeted
group members
“Get over it”; “Didn’t mean anything by it”; “You’re making a big deal
out of nothing”; “You’re oversensitive”
 Dominant group members have broad societal support for
validation of their opinions and feelings with respect to gender,
race, sexual orientation
 We are socialized to believe people with social power.

ASSUMPTIONS OF NORMALITY
 Ideas of what is normal / good / “better”
Heteronormativity
White “Supremacy”
Male Dominance
 We are socialized to give more credibility to those from
high social power groups (e.g., whites, men, higher SES)
 How we deal with “exceptions”
 How does this impact our evaluations of client behavior?

IMPLICIT BIAS AND DYNAMICS
OF DIFFERENCE
The existence of difference and all that it means in social context is at
the root of implicit bias
We are simultaneously
-LIKE ALL OTHERS (common humanity)
-LIKE NO OTHERS (unique story and journey)
-LIKE SOME OTHERS (minority/majority group;
culture/community
The 5 Ds of Difference provides a framework for checking in with
ourselves on implicit bias
Developed over 20 years ago to conceptualize common “difference
dynamics” (Harrell, 1995)

AT THE INTERSECTION OF CULTURAL
DIVERSITY AND PSYCHOTHERAPY:
THE DYNAMICS OF DIFFERENCE (HARRELL, 1990)
People develop ways of managing the threat, anxiety, or
discomfort that difference experiences can create
Those in power can establish the norm and define differences
from that norm as deviant or unacceptable
Difference dynamics are associated with minority-majority
group status and with in-group/out-group dynamics
There is a social press towards conformity and fitting in
Being different is sometimes only acceptable in competitive
situations (being the “best”); difference is typically assigned value
(e.g., better than or worse than)
23

THE 5 DS OF DIFFERENCE (HARRELL, 1995)
Ways we attempt to resolve the anxiety and dissonance that
difference creates
There are 5 basic strategies that people
use in difference encounters
Distancing
Denial
Defensiveness
Devaluing
Discovery

ABOUT THE 5 Ds
We all manifest each of these dynamics
in a variety of everyday situations
The function of these strategies is
protective as they seek to reduce anxiety
We can’t eliminate discomfort with
difference (either our own or others), it is
a normal reaction
Self-awareness is the key

Denial
• Minimize the existence or significance of the difference
• Colorblindness, universality, invisibility
• Selective attention to similarities; need for conformity and sameness; low
tolerance for disagreement and conflict
Defensiveness
• Stance that "I" have no problem with differences
• Defensive declaration of strong values of equality and “proof” through close
relationships with the “different” group
• Threatens sense of self as not having “isms”
Distancing
• Create separation from the difference
• Physical, emotional (e.g., pity), cognitive (e.g., intellectualization)
Devaluing
• Difference is experienced as deviance, pathology, or “wrong”
• Maintain sense of superiority or being “right”
• Inflexibility and anger
Discovery
• Curiosity and active engagement with the difference
• Positive feelings about the different group
• Can be objectifying and boundaries may not be respected

ETHNOCULTURAL
COUNTERTRANSFERENCE
Interethnic
o Denial of
ethnocultural
differences
o Clinical
Anthropologist
syndrome
o Guilt
o Pity
o Aggression
o Ambivalence
Intraethnic
o Overidentification
o Us and them
o Distancing
o Cultural Myopia
o Ambivalence
o Anger
o Survivor Guilt
o Hope and despair
Comas-Diaz and Jacobsen, 1989

ETHNOCULTURAL
TRANSFERENCE
Interethnic
o Overcompliance
and friendliness
o Denial of ethnicity
and culture
o Mistrust,
suspicion, hostility
o Ambivalence
Intraethnic
o Omnicient-
Omnipotent
therapist
o The traitor
o The autoracist
o Ambivalence
Comas-Diaz and Jacobsen, 1989

SO, WHAT SHOULD WE DO?
-DIGNITY (worth and value of all persons)
-DEEPENING (awareness)
-DIALECTIC (both/and – similarities and differences)
-DIALOGUE (meaningful relational connection)
-DYNAMIC (in process)

DIVERSITY PRINCIPLES TO FACILITATE CULTURALLY-SYNTONIC
PRACTICE (Harrell and Bond, 2006)
 INFORMED COMPASSION
 Balanced integration of head and heart
 Seeking knowledge and awareness from a place of openness, respect, and
caring
 Not distanced over-intellectualized position nor emotion-driven
overidentified position
 CONTEXTUALIZED UNDERSTANDING
 Multiple levels of analysis: Individual, Microsystem, Organizational, Locality,
Identity Group, Macrosystem
 Temporal context
 Person and interactions among persons are a function of variables at all levels
of analysis
 Decontextualized analysis risks oversimplified and superficial understanding
 EMPOWERED HUMILITY
 Proactive engagement grounded in awareness of our vulnerabilities and
limitations
 Acknowledgement of another’s right to self-determination
 Understanding that stronger connection and greater empowerment emerges
from healthy humility that frees us to be open to see, hear, and learn in
unanticipated ways– gives us confidence to walk in unfamiliar terrain and
meet the “other” where s/he stands
30

START HERE
ETHICAL
PRINCIPLES
AND STANDARDS
32

FROM PRINCIPLE A: COMPETENCE
“Psychologists...provide only those services and
use only those techniques for which they are
qualified by education, training, or experience.”
“Psychologists are cognizant of the fact that the
competencies required in serving, teaching, and/or
studying groups of people vary with the distinctive
characteristics of those groups".
33

CULTURE AND CONTEXT
IN PSYCHOTHERAPY AND SUPERVISION
THERAPIST SUPERVISOR
CLIENT
CULTURAL VARIABLES TO UNDERSTAND AS RELEVANT TO THERAPIST,
CLIENT, AND SUPERVISOR INDIVIDUALLY AND IN THEIR INTERACTIONS
-Culture of psychotherapy
-Dominant Societal Culture
-Culture(s) of identity
-Dynamics of status, power and privilege
-Environmental & sociopolitical context
34

THE FOUR WAYS THAT CULTURE AND CONTEXT
IMPACT HUMAN EXPERIENCE
Cultural Socialization and Identity
• Dimensions of Exposure
• Patterns of Being, Believing, Bonding, Belonging, Behaving, Becoming
• Sociocultural and Intersectional Identities
Macrocultural and Microcultural Belonging
• Composition of settings (e.g., minority/majority status)
• Opportunities for affirmation and validation
Dynamics of Difference
• In the client’s life
• In the practitioner’s life
Sociopolitical/Sociohistorical Considerations
• “Isms” / Collective/Historical trauma and memory
• Social location, power, and privilege
• Immigration/Refugee experience; Acculturation processes

EVIDENCE-BASED PRACTICE
APA’s Definition of Evidence Based
Practice for Psychologists (EBPP)
An integration of…
The Best Available Research
Clinical Expertise
In the context of:
•Patient Characteristics
• Patient Culture
•Patient Preferences
36

WHEN A CLIENT DOESN’T
RESPOND TO TREATMENT…
Non-compliant
Resistance
Not psychologically-minded
Not “ready” for treatment
Not willing to do the work
WE NEED TO RE-THINK THESE CONCLUSIONS IN THE
CONTEXT OF CULTURE AND DIVERSITY

Three Cultural Infusion Strategies for
Psychological Practice
Culturally-Adapted - Start with presumably universal
constructs, strategies and methods and make cultural
adaptations to fit client values, preferences, and needs
Culturally-Centered - Start with theoretical frameworks
and empirical research from cultural psychology and
diversity science to inform conceptualization, treatment
planning, and service delivery; integrate culturally-
congruent contributions from multiple traditions as
appropriate
Culturally-Specific – Start with the specific culture and
design strategies that emerge from constructs relevant to
the target group
38

OPERATIONALIZING AND APPLYING
EVIDENCE-BASED PRACTICE
What evidence should be considered? What is meant by “best available”?
Frequent blurring of the distinction between evidence-based practice
and empirically-supported treatments such that acceptable practices are
are sometimes perceived as limited to the existence of ESTs for specific
disorders
 The foundation of ESTs are the randomized clinical trials (RCTs)
conducted with largely homogeneous samples with respect to dimensions
of diversity (e.g., ethnicity, acculturation, socioeconomic status, religion,
sexual orientation, disability status, etc)
What “evidence” is there that these ESTs are efficacious and effective in
particular cultural populations outside of those who participated in the
RCTs?
 These problems are particularly concerning in regards to the trend
towards the generation of lists of evidence-based treatments that are
inappropriately imposed upon diverse communities that bear no
resemblance to the samples in the RCT studies that established the
intervention as “efficacious”
What “evidence” is there for modifying ESTs in culturally diverse
settings?
 There has been some progress examining the applicability of evidence-
based psychological practice with culturally diverse, underserved, and
marginalized populations. Need for effectiveness studies!
39

CHALLENGES TO EVIDENCE-BASED
PRACTICE
There are problems in the operationalization and
application of evidence-based practice
What evidence is considered acceptable?
RCTs only?
Lack of distinction between evidence-based practice and
empirically-supported treatments such that the evidence is
limited to the existence of ESTs for specific disorders
EBPP is broader than ESTs
Outcome variables; should disorder-specific symptom
reduction be the only outcome studied?
Efficacy studies establish ESTs but continuing need for
effectiveness studies
Internal and external validity issues

BENEFITS OF THE EST APPROACH
(a) evidence-based treatments give guidance to better serve
patients or clients seeking care;
(b) using the scientific approach to evaluate treatment is the
best way to advance knowledge in order to provide the best
mental health services in the future;
(c) it is necessary to use limited mental health resources wisely;
(d) there are treatments that work that most practitioners do
not use; and
(e) there may be no better alternative than to use science as the
standard for practice.
Whaley & Davis, 2007

ARE ESTS APPROPRIATE FOR DIVERSE
CULTURAL GROUPS?
Treatments were not originally developed and tested with various
cultural and SES groups in mind.
RCT samples are quite homogeneous, largely white and educated
Few ESTs have been systematically studied with culturally diverse
populations
WE DON’T ACTUALLY HAVE THE “EVIDENCE” to use them with
diverse populations
• One other consideration regarding intervention efficacy and
effectiveness involves the criterion of effectiveness, as defined in
reference to a specific population or group. This criterion is that “A
statement of efficacy should be of the form that, ‘Program or policy
X is efficacious for producing Y outcomes for Z population.’” (Flay
et al. 2005, Castro et al, 2010).

IN THE MEANTIME…
Until we have a sufficient body of empirical literature to inform
the use of ESTs with culturally-diverse populations:
• (a) allow basic research, especially studies on the target
population of color, to guide the development of an intervention;
• (b) apply a standard intervention to the specific ethnic/racial
group without any cultural modifications to learn which
components are useful; and
• (c) systematically examine a particular intervention from a
cultural competence perspective and assess the potential cultural
match of the intervention’s components to the group under study.
(Whaley & Davis, 2007)

MULTICULTURAL PSYCHOLOGY 101
1.Terminology (Race, Ethnicity, and Culture)
2.The “Culture” of Psychology
3.Psychological Research and Cultural Diversity
4.Dynamics of Difference
5.Racial-Ethnic Socialization and Identity
6.The Sociopolitical and Sociohistorical Context
7.Immigration, Refugee, Colonization, Genocide, and Slavery Experiences
8.Acculturation, Assimilation, Biculturation, Alienation
9.Collectivism, Communalism, and the Interdependent Self
10.Worldview and Culture
11.Indigenous Psychologies
12.Intersectionality and Ecological Niche
13.Narrative “lived experience” of Culturally Diverse Groups
14.Stereotypes, Prejudice, Discrimination and Oppression
15.Stereotype Threat research
16.Racism-related Stress: episodic life events, chronic, microaggressions, vicarious, transgenerational
17.The Physical and Mental Health Effects of Racism
18.Internalized Racism and Colorism
19.White Privilege
20.Intergroup Relations and the Dynamics of Difference
21.Liberation Psychology and the role of Social Justice in Psychotherapeutic Interventions
44

CULTURE & PSYCHOLOGICAL PRACTICE
The inclusion of culture in the
analysis of human experience,
behavior, and transformation
facilitates the identification of
constructs, methods, and
strategies that may enhance the
effectiveness of applied work in
diverse cultural contexts

PRE-ADAPTATION ISSUES
o Increasing the acceptability of interventions may help to
increase treatment engagement
o Before a treatment can work, there must be engagement
o Research is needed on drop outs from ESTs
o In addition, more research needs to be conducted on
dropout rates AFTER initial engagement and just before
treatment starts.

o Castro et al (2010) suggest that the impact
of culture may occur in the process of
therapy rather than the outcome.
o High rates of treatment dropout among
ethnic minority patients so the outcome of
the treatment actually remains unknown.
o Culture may be particularly important
during the process of therapeutic
engagement.

Culturally adapted therapy approaches may
be more compatible with ethnic/racial
minority patients’ cultural experiences
compared with standard therapeutic
approaches and, therefore, may be better at
treating their psychological problems (Kohn,
Oden, Munoz, Robinson, & Leavitt, 2002;
Whaley and Davis, 2007; Ghosh Ippen, 2012).
***Encouraging support from meta-analyses
-Griner and Smith (2006)
-Hall et al (2016)

CULTURAL ADAPTATION
It is also important to attend to intergroup
and bias issues; interpersonal issues are
impacted more on some dimensions of
diversity where fundamental cultural ways of
being are strongly held

A CULTURAL ADAPTATION CHECKLIST
Review for bias and then replace elements as necessary
• Review Materials for Cultural Congruence
• Review Examples and Metaphors
• Explore Meanings, Values, Religious Beliefs
• Attend to the Complexity of Language (bilingual and
choice)
Attend to two dimensions (Castro et al):
• surface structure adaptations –(micro)
• deep structure adaptations. – (macro)

UNDERSTANDING
AND INTEGRATING
CULTURE
51

CULTURE IS…
The multiple organizing systems of meaning and living in
the world that
• consist of patterns of being, believing, bonding,
belonging, behaving, and becoming which provide the
foundational frames for developing worldviews, interpreting
reality, and acting in the world
• for a group of people who share common ancestry,
social location, group identity, or defining experiential
contexts; but for whom, as individuals or intersectional
subgroups, elements of a particular cultural system may
be embraced, internalized, and expressed differentially.
• emerge and transform through cumulative and adaptation-
oriented person-environment transactions over time
• are maintained and transmitted through collective memory,
narrative, and socialization processes

CULTURE IS…
The patterns, rhythms, and ways of:
• Being (identity, self, and experiential processes)
• Believing (values, meanings, and worldview)
• Bonding (attachment and relational processes)
• Belonging (community and group processes)
• Behaving (actions, agency, daily living)
• Becoming (transformation and healing)
53

CULTURE IS…
• embedded in social and institutional contexts,
• internalized as patterns of meaning and
identity,
• expressed through actions and relationships in
the context of power dynamics, and
• interactive with co-existing and intersecting
cultural systems through multiple dimensions of
human diversity that reflect shared identity and
experience
54

CULTURE, POWER, & PRIVILEGE
Some ways of being, believing, bonding,
belonging, behaving, and becoming are more
valued than others
We need to be aware of the internalization of
dominant cultural narratives of what is
acceptable, desirable, healthy, “normal”
• Impact on members of non-dominant groups
• Impact on members of dominant group
55

IMPORTANCE OF ECOLOGICAL AND
CONTEXTUAL VARIABLES
Context affects conditions of living and access to societal
resources
Context determines exposure to particular societal, sociocultural,
and community narratives that define self, acceptable roles, as
well as appropriate thoughts, feelings, and behaviors
Context impacts options for support and coping
Context influences opportunities for affirmation and validation
of self and community
Unhealthy contexts can impede functioning and well-being,
compromise or confuse personal and collective identity, and
suppress or misdirect health-promoting behaviors.

CENTERING CULTURE
Consideration of culture as an “add-
on” inevitably privileges the dominant
status quo and existing structures of
power and inequality that maintain
asymmetries in health and wellness
Collusion with the dynamics of
oppression in contemporary
psychological theory and practice
occurs primarily through omission

 Primary Macrocultural Collective Entities
 Deeply embedded in the functioning of persons and contexts
 Transmitted within family and community socialization processes
 Cultural elements of privileged macrocultural entities are woven
into the dominant cultural narratives of society (e.g., generational
trends, heteronormativity, ideology of white supremacy)
 EXAMPLES: Nationality, Ethnicity, Religion
 Microcultural Collective Entities
 Function within particular sociocultural communities
 Exposure typically occurs after childhood and outside of the family
socialization context
 Immersion in these entities may be voluntary
 EXAMPLES: Military culture, Alcoholics Anonymous, Gay male
culture
61
Culture-Carrying Entities:
Where culture is learned and transmitted

DIMENSIONS OF CULTURAL DIVERSITY
! = a central and organizing aspect of how I think of myself
+ = a less important aspect of my identity
x = not at all significant to me
? = have not thought much about this dimension
____ Age cohort/Generation _____ Gender
____ Ethnicity or National Origin _____ Race
____ Sexual Orientation _____ Social Class
____ Religious-Spiritual Identif _____ Disability
____ Rural/Urban/Suburban _____ Political Affiliation
____ Generation/Immigration _____ Military Affiliation
____ Profession/Occupation _____ Salient Physical Charac
62

DIVERSITY DIMENSION ISSUES TO CONSIDER IN
THERAPEUTIC AND SUPERVISORY RELATIONSHIPS
Differences in Identity Salience
Differences in Identity Development
Intragroup Dynamics within
Dimensions
Intergroup Dynamics across
Dimensions
63

INDIVIDUAL AND CULTURAL DIVERSITY (ICD):
Awareness, sensitivity and skills in working professionally with diverse individuals, groups and communities who
represent various cultural and personal background and characteristics defined broadly and consistent with APA policy.
READINESS FOR PRACTICUM READINESS FOR INTERNSHIP READINESS FOR ENTRY TO
PRACTICE
2A. Self as Shaped by Individual and Cultural Diversity (e.g., cultural, individual, and role differences, including those
based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability,
language, and socioeconomic status ) and Context
Demonstrates knowledge, awareness, and
understanding of one’s own dimensions of
diversity and attitudes towards diverse others
Monitors and applies knowledge of self as a
cultural being in assessment, treatment, and
consultation
Independently monitors and applies
knowledge of self as a cultural being in
assessment, treatment, and consultation
2B. Others as Shaped by Individual and Cultural Diversity and Context
understanding of other individuals as cultural
beings
Applies knowledge of others as cultural
beings in assessment, treatment, and
consultation
knowledge of others as cultural beings in
assessment, treatment, and consultation
2C. Interaction of Self and Others as Shaped by Individual and Cultural Diversity and Context
understanding of interactions between self and
diverse others
Applies knowledge of the role of culture in
interactions in assessment, treatment, and
consultation of diverse others
knowledge of diversity in others as cultural
beings in assessment, treatment, and
consultation
2D. Applications based on Individual and Cultural Context
Demonstrates basic knowledge of and
sensitivity to the scientific, theoretical, and
contextual issues related to ICD (as defined by
APA policy) as they apply to professional
psychology. Understands the need to consider
ICD issues in all aspects of professional
psychology work (e.g., assessment, treatment,
research, relationships with colleagues)
Applies knowledge, sensitivity, and
understanding regarding ICD issues to work
effectively with diverse others in assessment,
treatment, and consultation
Applies knowledge, skills, and attitudes
regarding dimensions of diversity to
professional work
64

CULTURAL COMPETENCE SKILLS
A set of problem-solving skills that includes
• (a) the ability to recognize and understand the dynamic
interplay between the heritage and adaptation
dimensions of culture in shaping human behavior;
• (b) the ability to use the knowledge acquired about an
individual’s heritage and adaptational challenges to
maximize the effectiveness of assessment, diagnosis, and
treatment;
• (c) internalization (i.e., incorporation into one’s clinical
problem-solving repertoire) of this process of
recognition, acquisition, and use of cultural dynamics so
that it can be routinely applied to diverse groups.
(Whaley and Davis, 2006)

BEYOND IDENTIFYING DESCRIPTIVE DIFFERENCES:
SPECIFIC COMPETENCY BEHAVIORS
1. Includes cultural diversity assessment at intake (utilizing
Cultural Formulation appendix in DSM)
2. Integrates multicultural factors in theoretically-grounded case
conceptualization demonstrating familiarity with the
multicultural psychology literature
3. Reviews empirical and theoretical literature relevant to key
dimensions of diversity
4. Incorporates multicultural considerations in treatment
planning and identifies cultural adaptation goals, culture-
centered goals, and/or culturally-specific goals as indicated
5. Implements treatment strategies in a culturally-syntonic
practice context
67

USING MULTICULTURAL NARRATIVES AS AN ORGANIZING
FRAMEWORK
 Narrative theory suggests that our stories are not only created by
our lives, but simultaneously contribute to creating our lives
(McAdams, 2006). Narratives are related to creating memory,
identity, and relational behaviors.
 A narrative approach facilitates the integration of the cognitive,
affective, and behavioral elements through the use of story.
 A multicultural narrative is a story that we have involving one or
more dimensions of cultural diversity, attributes of cultural
groups, intercultural and intracultural interactions, and/or
“isms” connected to diversity dimensions.
 The approach can be organized into four general phases: (1)
Laying the Groundwork; (2) Timing and Opportunity; (3)
Implementation of the Multicultural Narratives Supervision
Strategy; and (4) Evaluation
68

CORE GUIDELINES:
COMPASSIONATE CONFRONTATION AND EMPATHIC
EXPLORATION
 Both supervisor and supervisee are tasked with confronting and
exploring emotionally-charged subject matter while
simultaneously maintaining an atmosphere of compassion and
empathy for the anxiety, pain, ambivalence, and anger that can
accompany the multicultural conversations. These discussions
can trigger strong affective and defensive reactions.
 Successful multicultural dialogues require the ability to tolerate
(1) the processing of unacknowledged or undiscovered material
related to race-related feelings and experiences, and (2) feelings
of uncertainty and unfamiliarity related to “the other”
(Tummala-Narra, 2009).
 The act of non-judgmentally giving supervisees space to share
their multicultural narratives provides an in-vivo opportunity to
strengthen the supervisory relationship.
69

IMPLEMENTATION PHASE I: LAYING THE GROUNDWORK
 Conditions necessary for effective multicultural
narrative approach
Preparation and competence of the supervisor,
Establishment of multicultural competence as part of the
supervisory agreement
Creation of an open and emotionally safe supervision
atmosphere
 Difference is the one of the fundamental dynamics
operating at the intersection of diversity and
psychotherapy
Processing and normalizing the “Five D’s of Difference”
70

What are your thoughts and ideas
about how you might more explicitly
lay the groundwork and set
expectations regarding multicultural
issues in clinical supervision?
71

IMPLEMENTATION PHASE II: TIMING AND OPPORTUNITY
When should a supervisor pay particular attention to multicultural
issues and dynamics?
Ten indicators of potential need to pay specific attention to racial
dynamics
• 1. Gaps in self-awareness
• 2. Reactivity
• 3. Minimization or devaluing the significance of culture
• 4. Interpersonal dynamics
• 5. Unfamiliarity, inexperience and lack of knowledge
• 6. Oversimplification or superficiality
• 7. Invisibility of culture and multicultural issues
• 8. Guilt, shame, or internalized “isms”
• 9. Context minimization error (“blaming the victim”)
• 10. Naïve, idealizing
72

Consider a supervision experience
where there was an opportunity to
process multicultural material. How
did or how might have you proceeded
with the trainee?
73

IMPLEMENTATION PHASE III:
PROCESSING CLINICAL MATERIAL USING
THE MULTICULTURAL NARRATIVES
APPROACH
74

BASIC STEPS OF THE MULTICULTURAL NARRATIVES
APPROACH FOR WORKING WITH CLINICAL
MATERIAL
Step 1: Elicitation/Disclosure
• The first step in the process involves eliciting relevant narratives by inviting the
supervisee to process the stimulus issue more deeply
• Compassionate Confrontation operates strongly here
Step 2: Deconstruction/Analysis
• The second step involves a process of deconstructing the narrative by facilitating
connections to the supervisee’s internal experience and exploring multicultural issues
embedded in the narrative (e.g., identity, stigma, privilege, etc.)
• Empathic Exploration can provide grounding in the Deconstruction process
Step 3: Reconstruction /Integration
• Guided by the idea that intentional meaning-making of multicultural narratives can
reduce cultural anxiety and result in therapist behaviors that are productive in the
management and incorporation of multicultural content and dynamics
• (1) incorporates a reflective normalization of multicultural issues
• (2) integrates insights from the deconstruction process
• (3) is consistent with values and self-image and can contribute to both personal and
professional growth and development
• Integrates multicultural awareness, knowledge, and skill development
75

INTEGRATED
SUPERVISION
EXAMPLE
76

IMPLEMENTATION PHASE III: STEP ONE
Elicitation and
Disclosure
Invitation to share personal,
family, cultural, or dominant
social narratives related
to the relevant dimension of
diversity; supervisee (and
sometimes supervisor)
disclosure and description of
narratives associated with the
stimulus issue or event
“I’m thinking it would be
a good idea to pause for a
moment and focus in on
what happened in the
session when_______.”
“I’d like to invite you to
take a moment and try to
connect any personal
experiences involving race
that are associated with
_______.”
77

IMPLEMENTATION PHASE III: STEP TWO
Deconstruction
and Analysis
Exploration of the
narrative
with respect to the
supervisee’s internal
experience,
multicultural issues such as
power and privilege,
identity, bias, etc., and
impact of
these on the therapy and/or
supervisory process
“I’m wondering if you notice
any similarities between your
thoughts and feelings
associated with your
experience and what happened
in the session”.
“Let’s explore a bit more about
your experience with respect to
the role of race in your sense of
self and identity as it may have
been reflected in your work
with this client.”
78

IMPLEMENTATION PHASE III: STEP THREE
Reconstruction
and Integration
Facilitation of the
supervisee’s process of
integrating self, client,
and context to form a
coherent narrative of
the therapy or
supervisory event or
issue and the supervisee’s
developmental process;
Connection to relevant
Multicultural AVAs, KTRs;
and IPSs
“Let’s take a step back now and
look at what happened in session
in the context of some of what we
just processed”.
“How might you describe your
experience and understanding
from the session until now with
respect to the multicultural
issues we have identified”?
79

IMPLEMENTATION PHASE IV: EVALUATION
 Evaluation should be guided by observation of
indicators of professional behaviors, expressed
attitudes, and demonstrated knowledge of the
supervisee relevant to multicultural competencies
 A variety of multicultural dynamics may interfere
with the identification and remediation of
multicultural competencies that need further
development. Supervisors and trainees may
collude to avoid multiculturally-related meta-
competence conversations.
80

INTEGRATING MULTICULTURAL ISSUES IN CLINICAL
SUPERVISION - INTENTIONALITY
 The importance of developing a clear and comprehensive
approach to multicultural issues in clinical supervision is
particularly critical given the almost inevitable experience of
anxiety when topics related to race, ethnicity, and culture are
raised in open discussion (Trawalter and Richeson, 2008).
 The development of multicultural competence is facilitated by a
process that is able to incorporate attention to the emotional,
cognitive, and contextual issues related to managing the
dynamics and issues related to multiple dimensions of cultural
diversity
81

PARTING THOUGHTS
 The central purpose of integrating multicultural narratives
into supervision is to facilitate the meaningful
consideration of multicultural material in the process of
therapy, supervision, and professional relationships more
generally
 It is suggested that supervisors seek consultation from
colleagues who have expertise in multicultural issues in
order to process ways to deal with challenging
multicultural dynamics with trainees, as well as
appropriate supervisory strategies with respect to culture
in case conceptualization, treatment planning, and
treatment implementation.
82

PARTING THOUGHTS (CONTINUED)
 One of the biggest barriers to facilitating supervisee
multicultural competence is the reluctance and/or inability of
supervisors to identify important material and bring the issues
to the supervisee’s attention
Processing multicultural narratives may trigger unanticipated
reactions and potentially expose the supervisor’s own vulnerability
The quantity and quality of the supervisor’s previous experience
discussing cultural and sociopolitical dynamics is also an important
factor influencing the implementation of the supervision approach
described
 Effective supervision and evaluation of trainee multicultural
competence is not possible without the ongoing reflective
practice and self-assessment of the supervisor
83

MAIN TAKE-AWAYS
Cultural Competence is ultimately a way of THINKING about
culture and translating that into practice
Normalize consideration of culture and context; they must be
central in the clinical conversation
LEARN the theory and research of cultural and multicultural
psychology
Our work as psychologists should be informed not only by RCTs but
by basic science research
• Implicit bias and stereotype threat research are examples
Explore the role of implicit bias and non-conscious enactment of
privilege
84

THANK YOU!
Shelly Harrell, Ph.D.
(310) 701-3171
Shelly.Harrell@pepperdine.edu
85

Competencies and Strategies for Multicultural Supervision

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Competencies and Strategies for Multicultural Supervision

Similar to Competencies and Strategies for Multicultural Supervision (20)

More from Shelly Harrell

More from Shelly Harrell (20)

Recently uploaded

Recently uploaded (20)

Competencies and Strategies for Multicultural Supervision