Harrell - Multicultural Supervision
- 1. 1/22/2014 1 “A MulticulturalApproachto ClinicalSupervision” Continuing Education Course Presented by Shelly P. Harrell, Ph.D. January 23, 2014 - CSULB 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.” –EthiopianProverb 2 Whatis ourultimatedestination? Effectiveandethical mental health servicedelivery Culturally-informedevidence basedpractice Multiculturally-competentmentalhealth practitioners How willwe get there? ProfessionalGuidelines EthicalPrinciples forPsychologists APA BenchmarksforProfessionalPsychology APA MulticulturalGuidelines Training and Practice PsychotherapySupervisionModels Multiculturally-competentsupervision Importance CoreIssues andChallenges Whatis ournavigation system? Cultureandcontextof client, therapist-trainee,andsupervisor Multiculturalawareness,knowledge,andskills MulticulturalPsychology101 Culturally-adapted,Culturally-centered,and Culturally-SpecificPractices Whatpowers the journey? DiversityPrinciples:InformedCompassion,Contextualized Understanding, EmpoweredHumility CoreGuidelines:CompassionateConfrontationand Empathic Exploration Whatspecificpathwillwe traverse today? Harrell’s MulticulturalNarrativeApproach 3
- 2. 1/22/2014 2 Professional Standards and Guidelines Modelsof Supervision UnderstandingCulture Multicultural Awareness,Knowledge,and Skillsand CompetencyBenchmarks Introductiontothe Multicultural Narratives Approach ApplyingtheMulticultural NarrativesApproach AGENDA WHAT IS MULTICULTURAL COMPETENCE FOR MENTAL HEALTH PRACTITIONERS? The demonstrated abilityto consistentlyand carefullyconsiderthecultural dimensionsof self, otherand context, and to engage in ethical and multiculturally-informed behaviorand interactionsthrough the applicationof multicultural awareness,knowledge,and skills in multipleprofessional roles (e.g., assessment, intervention,research, teaching, consultation, supervision,administration,advocacy, collaboration,etc.).(S.P.Harrell, 1997; revised 2002 & 2006) 5 TRAINEE COMPETENCE IS RELATED TO SUPERVISOR COMPETENCE An important goal for today: Contribute to the development of supervisor multicultural competence AWARENESS: Increase awareness of self as a multicultural being KNOWLEDGE: Increase understanding of the meaning of multiculturalcompetence SKILL: Learn a new approach for integrating multiculturalconsiderations into supervision 6
- 3. 1/22/2014 3 START HERE ETHICAL PRINCIPLES AND STANDARDS 7 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". 8 FROM PRINCIPLE D: RESPECT FOR PEOPLE'S RIGHTS AND DIGNITY "Psychologists are aware of cultural, individual and role differences, including those due to age, gender, race, ethnicity, national origin, religion, sexual orientation, disability, language, and socioeconomic status.” “Psychologists try to eliminate the effect on their work of biases based on those factors, and they do not knowingly participate in or condone discriminatory practices." 9
- 4. 1/22/2014 4 ETHICAL STANDARDS 1.04- Boundaries of Competence 1.08- Human Differences 1.09- Respecting Others 1.10- Nondiscrimination 1.11- Sexual Harassment 1.12- Other Harassment 1.15- Misuse of Psychologists Influence 2.04- Use of Assessment in General with Special Populations 10 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 11 OPERATIONALIZING AND APPLYING EVIDENCE-BASED PRACTICE What evidenceshould 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 existenceof ESTs for specific disorders The foundationof ESTsare the randomizedclinical trials (RCTs) conductedwith largely homogeneoussampleswith respecttodimensions of diversity (e.g., ethnicity, acculturation, socioeconomicstatus, religion, sexualorientation, 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 problemsare particularlyconcerning in regards to the trend towards thegenerationof listsof evidence-based treatments thatare inappropriatelyimposed upondiverse communities thatbearno resemblancetothe samples in the RCT studies thatestablished the interventionas “efficacious” What “evidence” is there for modifying ESTs in culturally diverse settings? There has been some progressexamining theapplicabilityof evidence- based psychological practice with culturallydiverse, underserved, and marginalized populations. Need foreffectivenessstudies! 12
- 5. 1/22/2014 5 APA MULTICULTURAL GUIDELINES Approvedaspolicy by the APA Council of Representativesin 2002 Emphasizesthe importanceof multicultural considerationsin our work Professional practice Research Educationand Training Organizational Change 13 FIRST SENTENCE OF APA MULTICULTURAL GUIDELINES “All individualsexist in social, political, historical and economic contexts and psychologistsare increasingly called upon to understand the influenceof these contexts on individuals’ behavior.” 14 APA POLICY GUIDELINES Guideline#1: Recognize that, as cultural beings, psychologistsmay hold attitudes and beliefs that can detrimentally influence their perceptions of and interactions with individuals whoare ethnically and racially different from themselves. Guideline#2: Recognize the importanceof multicultural sensitivity/responsiveness,knowledge, and understandingabout ethnically and racially different individuals Guideline#3: Employthe constructsof multiculturalismand diversity in psychologicaleducation. Guideline# 4: Recognize the importanceof conductingculture- centered and ethical psychological research among persons from ethnic, linguistic, and racial minority backgrounds. Guideline#5: Strive to applyculturally-appropriateskills in clinical and otherapplied psychological practices Guideline#6: Use organizational change processesto supportculturally informed organizational (policy) developmentand practices 15
- 6. 1/22/2014 6 GROUNDING PRINCIPLES FOR APA’S MULTICULTURAL GUIDELINES 1. Ethicalconductof psychologistsis enhancedby knowledgeof differencesin beliefsand practices that emerge from socialization through racial and ethnic group affiliationand membershipandhow those beliefsandpracticeswill necessarilyaffecttheeducation,training, researchandpracticeof psychology 2. Understandingandrecognizingthe interfacebetweenindividuals’socializationexperiences basedon ethnic and racial heritagecanenhance the quality ofeducation,training, practice, and research in the field of psychology 3. Recognitionof the ways in whichthe intersectionof racial and ethnic group membershipwith other dimensionsof identity (e.g.,gender,age, sexualorientation, disability,religion/spiritual orientation, educationalattainment/experiences,andsocioeconomicstatus) enhances the understandingand treatmentof all people 4. Knowledgeof historicallyderived approachesthat haveviewedculturaldifferencesas deficits and have not valued certain social identities helps psychologists tounderstandthe underrepresentationof ethnic minorities in the profession,andaffirms and values the roleof ethnicity and race in developingpersonalidentity 5. Psychologistsareuniquelyabletopromoteracialequityandsocial justice. This is aided by theirawarenessof their impactonothers and the influenceof their personal and professionalrolesinsociety (Comas-Díaz,2000). 6. Psychologists’knowledgeabouttheroles of organizations,including employersand professional psychological associationsare potential sourcesof behavioral practicesthat encouragediscourse,educationandtraining, institutional change,and researchand policy development,thatreflectrather than neglect, cultural differences.Psychologists recognizethatorganizations canbegatekeepersoragents of the status quoratherthan leaders in a changing societywithrespecttomulticulturalism. 16 WALKING THE TALK? Does what we do in practice match what we say about the importance of multicultural issues? Belief in importance of multicultural competence outpaces behavior • McKitrick, D.S., & Li, T.S. (2008). Multicultural treatment. In Handbook of Clinical Psychology, Vol. 1. Adults. 17 MULTICULTURAL EDUCATION AND TRAINING Academic Courses Diverse Clinical Opportunities SUPERVISION!!!!! 18
- 7. 1/22/2014 7 IMPORTANCE OF INTEGRATING MULTICULTURAL CONTENT AND PROCESS IN CLINICAL SUPERVISION Demographic Imperative Ethical Principles Policy Guidelines Evidence-based Practice APA Multicultural Guidelines Research Evidence Cultureand Human Behavior IntergroupRelations Supervision Research 19 APPROACHES TO SUPERVISION Compose an “elevator speech” description of your supervision style and approach. 20 MODELS OF SUPERVISION Developmental Models PsychotherapyBased Models Bernard’sDiscriminationModel Ladany et al’s Interpersonal Approach Falenderand Shafranske’s Competency-based Model Milne’s Evidence-basedSupervision Model 21
- 8. 1/22/2014 8 BERNARD’S DISCRIMINATION MODEL TEACHER “COUNSELOR” “CONSULTANT” PROCESS CONCEPTUALIZATION PERSONALIZATION 22 FALENDER AND SHAFRANSKE’S COMPETENCY-BASED SUPERVISION MODEL Competency-based supervision is an approach that explicitly identifies the knowledge, skills and values that are assembled to form a clinical competency and develops learning strategies and evaluation procedures to meetcriterion- referenced competence standards in keeping with evidence-based practices and the requirements of the local clinical setting Super-ordinate Values Integrity-in-Relationship Appreciation of Diversity Science-informed, Evidence-based Practice (Falender & Shafranske, 2004) 23 IMPORTANCE OF METACOMPETENCE Metacompetence Ability to assess whatone knows and whatone doesn’t know Introspectionaboutone’s personal cognitiveprocessesand products Dependent on self-awareness, self-reflection, and self- assessment. Supervisionguides development of metacompetencethrough encouragingand reinforcingsupervisee’s developmentof skills in self-assessment (Falender & Shafranske, 2007) 24
- 9. 1/22/2014 9 SUPERVISION BEST PRACTICES THE CLINICAL SUPERVISOR: a) Examines his or her own clinical and supervision expertise and competency; (b) Delineates supervisory expectations, including standards, rules, and general practice; (c) Identifies setting-specific competencies the trainee must attain for successful completion of the supervised experience; (d) Collaborates with the trainee in developing a supervisory agreement or contract for informed consent, ensuring clear communication in establishing competencies and goals, tasks toachieve them, and logistics; and (e) Models and engages the trainee in self-assessment and development of metacompetence (i.e., self-awareness of competencies) from the onset of supervision and throughout. Falender& Shafranske, 2007, p. 238 25 TAKE-AWAYS FROM SUPERVISION MODELS Consider developmental level of the trainee in differentareas of competence Attend to thesupervisoryalliance Focus on content, process, and personalization Considertheoretical orientation Supervisepurposefullyforspecific professionalcompetencies Importanceof metacompetence 26 CULTURAL DIVERSITY AND SUPERVISION “Notwithstanding that it is a core component of psychology training, diversity is one of the most neglected areas in supervision training and research” (Falender & Shafranske, 2004,p. 115). 27
- 10. 1/22/2014 10 UNDERSTANDING AND INTEGRATING CULTURE 28 DEFINITIONS OF CULTURE “The patternsof behaviorand thinking that people living in social groups learn, create, and share.” (Bodley, 2002, MicrosoftEncarta) “The vast structureof language, behavior, customs, knowledge,symbols, ideas,and valueswhich providea people with a general design for living and patternsfor interpreting reality”(Nobles, 1978/2006, p. 71) “Attitudes,values, beliefs, norms,and behaviorsshared by a group but harboreddifferentlybyeach specific unit within the group, communicatedacross generations, relativelystable but with the potential to change across time” (Matsumoto, 2000, p.24) 29 HARRELL’S CONCEPTUALIZATION OF CULTURE The material, social, and ideological qualities of a group of people woven into the fabric of daily life, which: (1) have emerged, and are maintained, shared, and changed, in the service of collective adaptation to a particularsociohistorical context, and (2) are expressed through ways of thinking and viewing the world, values and behaviors, interpersonal interactions, and social structures. 30
- 11. 1/22/2014 11 ECOLOGICAL AND PSYCHOLOGICAL CULTURE EcologicalCulture (externalized) Reflects the expressionof culturein the multiplesocialization contexts withinwhichwe develop, live, and change The shared coreelements of cultural worldview, beliefs, customs, patterns of behavior, etc., those observable and commonlyexpressedculturalcharacteristics of a group The essential elements of a group’s wayof life passed down from generation togeneration PsychologicalCulture (internalized) Reflects the consciousand unconsciousinternal representations of our multiple culture-infused experiences The unique ways thatecological cultureis internalized and expressed by each individual The intentional choices that individuals makes regarding adopting and participating in particular culturalvalues, customs, behaviors, etc. The meaning of cultureto the individual 31 CULTURE IS… 32 Embedded in our Relational, Socialization, and Environmental Contexts Internalized into our Beliefs, Values, Thoughts, Motivations, and Identity Expressed through our Preferences, Sensibilities, Behaviors and Interactions Human behavior is multiply determined and culture is one of those determinants All behavior occurs in mulitple internal and external cultural contexts – we see, experience, and interpret the world through a cultural lens Culture provides the external socialization contexts where norms for behavior and for social and interpersonal interactions are learned Culture provides the internalized context for making meaning of the world and understanding one’s place in it Broadly defined, culture can be demographically-based (e.g., ethnic culture, gay culture) or experientially-based (e.g., occupational culture, 12-step culture) Narrowlydefined, culture is a reflection of racial-ethnic-worldview intersections Individuals are exposed to and internalize multiple cultural influences which intersect in particularways to create identity 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 33 The Integrativeand Foundational Role of Culture
- 12. 1/22/2014 12 DIMENSIONS OF CULTURAL IDENTITY ! = a centralandorganizingaspectof how I thinkof myself + = a less importantaspectof my identity x = notatall significanttome ? = have notthoughtmuch aboutthisdimension ____ Age cohort/Generation _____ Gender ____ Ethnicityor NationalOrigin _____ Race ____ Sexual Orientation _____ Social Class ____ Religion _____ Disability ____ Rural/Urban/Suburban _____ Political Affiliation ____ Creative-ArtisticTalent _____ MilitaryAffiliation ____ LeisureActivity, Hobby _____ Profession 34 MULTIPLE DIMENSIONS OF DIVERSITY Intersectionality The overlapping and interactivedynamics of multiple dimensions of diversity The effects of one diversitydimension in our lives is, in part, dependenton one’s status on additional dimensions of diversity Being an African American Being an African American woman Being a highly educated African American woman Being a highly educated African American woman baby boomer Ecologicalniche(Falicov) the place wherea one’s multiplecontexts and cultural locations converge 35 INTERSECTIONALITY AND ECOLOGICAL NICHE 36
- 13. 1/22/2014 13 GROUPS OF 3 OR 4 SIMILARITIES AND DIFFERENCES HOW MIGHTTHESE IDEAS INFLUENCE PSYCHOTHERAPYAND CLINICAL SUPERVISION? 37 DIVERSITY DIMENSION ISSUES TO CONSIDER IN THERAPEUTIC AND SUPERVISORY RELATIONSHIPS Differences in Identity Salience Differences in Identity Development Intergroup Dynamics within Dimensions 38 CORE DIMENSIONS OF DIVERSITY FOR MULTICULTURAL COMPETENCE Gender Ethnicity/NationalOrigin Race Sexual Orientation SocioeconomicStatus Religion Disability Age Cohort/Generation 39
- 14. 1/22/2014 14 IMPLICATIONS FOR MULTICULTURAL PRACTICE We all live and develop in multiple cultural communities (communities of race/ethnicity, gender, religion, sexual orientation, social class, etc.) Our clinical work must incorporate attention to the cultureand context of these communities, as well as who we are in the context of the culturesof those with whom we work Application of these ideas requires a unique journey with each client and each community with whom we work 40 TERMINOLOGY AND APPROACHES FOR INCORPORATING CULTURE Culturally-Sensitive Culturally-Appropriate Culturally-Relevant Culturally-Intentional Culturally-Adaptive Culturally-Alert Culturally-Responsive Culturally-Infused Culturally-Congruent Culturally-Competent Cultural Resonance (Trimble) Culturally-Syntonic (Harrell, 2008) 41 WHY CULTURALLY “SYNTONIC”? Syn – with or together the Greek “suntonos”-- in harmony with – Collins English Dictionary Emotionally in harmony with one’s environment -CollinsEnglish Dictionary Normally responsive and adaptive to the social or interpersonal environment -Merriam Webster’sMedical Dictionary In emotional equilibrium and responsive to the environment –YourDictionary.com Describes somebody who is normally attuned to the environment; used to describe behavior that does not conflict with somebody’s basic attitudes and beliefs –Microsoft Encarta College Dictionary Characterized by a high degree of emotional responsiveness to the environment; Of or relating to two oscillating circuits having the same resonant frequency -American Heritage Dictionary 42
- 15. 1/22/2014 15 CULTURALLY-SYNTONIC PRACTICE (CSP; HARRELL, 2008/2011) In the context of psychologically-informed interventions, Culturally-Syntonic Practice involves: Understandings, processes, activities, and interpersonal interactions that reflect attunement, harmony, and resonance with relevant dimensions of collective cultural aspects (ecological culture) and their individual expressions (psychological culture), such that engagement with, and the effectiveness of, interventions is enhanced and optimized. 43 MORE ON A CULTURALLY-SYNTONIC APPROACH Characterized by • activities, interactions,and perspectives -that reflectconsistencywith and/or responsivenessto a person’s orgroup’s • relevantcultural contexts; • internalizedcultural meanings,beliefs,values;and • manifestedactionsand behaviors -such that there is a “fit” orresonancebetweenthe practice and the relevantperson-environment transactions, current and historical, for the client 44 DIVERSITY PRINCIPLES TO FACILITATE CULTURALLY-SYNTONIC PRACTICE (Harrellsnd 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 interactionsamong 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 45
- 16. 1/22/2014 16 APA’s COMPETENCY BENCHMARKS FOR PROFESSIONAL PSYCHOLOGY Six clusters (Professionalism, Relational, Application, Science, Education, Systems) provide the overarching structure for the benchmarks. Within these clusters, there are 16 core competencies, one or more related competencies within each cluster Each core competency contains several essential components of that competency Developmental descriptors and behavioral anchors are delineated for each of the three stages in the education and training sequence (practicum, internship, practice). http://www.apa.org/ed/graduate/benchmarks-guide.aspx?item=2 46 BENCHMARKS CLUSTERS AND CORE COMPETENCIES PROFESSIONALISMCLUSTER: ProfessionalValues and Attitudes IndividualandCultural Diversity Ethical, Legal Standards and Policy Reflective Practice/Self-Assessment/Self-Care RELATIONALCLUSTER: Relationships SCIENCE CLUSTER: Scientific Knowledgeand Methods Research/Evaluation APPLICATION CLUSTER: Evidence-based Practice Assessment Intervention Consultation EDUCATIONCLUSTER: Teaching Supervision SYSTEMS CLUSTER: InterdisciplinarySystems Management/Administration Advocacy 4748
- 17. 1/22/2014 17 INDIVIDUAL AND CULTURALDIVERSITY (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 Demonstrates knowledge, awareness, and understanding of other individuals as cultural beings Applies knowledge of others as cultural beings in assessment, treatment, and consultation Independently monitors and applies 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 Demonstrates knowledge, awareness, and 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 Independently monitors and applies 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 49 EXAMPLE OF DIMENSION- SPECIFIC MULTICULTURAL COMPETENCIES: RACE 50 RACE-RELATEDMULTICULTURAL COMPETENCIESIN THERAPYAND SUPERVISION Awareness, Values, and Attitudes (AVA) • Competence Goals: • (1) the developmentof a strong personalawarenessof the role and meaning of race and racial content, and • (2) the cultivationof a set of professionalattitudesandvalues related to racial material • AVA Core Competencies • Racial self-awareness • Race-relatedempathy • Respectfor race-relatedexperiences • Race-related biasawareness • Additional AVA competencies • Self-awarenessof thoughts, needs,and internal processesduring interracialand intraracialencounters; self-awarenessof interpersonal behavior in both interracialand intraracial interactions;awarenessof power and privilege dynamics in one’sown relationships;awarenessof ways that onecolludes with the maintenanceof racismand white privilege; awarenessof attitudesandopinions on race-related topics; an attitudeof openness tolearningabout and discussing race-related issues;andvaluing the explorationof the relationshipof raceto psychologicalexperience. 51
- 18. 1/22/2014 18 RACE-RELATEDMULTICULTURAL COMPETENCIESIN THERAPYAND SUPERVISION Knowledgeof Theoryand Research (KTR) • CompetenceGoal: • Familiarity with empirical, conceptual, and applied literaturerelevant to raceand racial issues • CoreKTR 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, prejudicereduction 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) 52 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. The Lived Experience of People of Color 14. Stereotypes, Prejudice, Discrimination and Oppression 15. Racism-related Stress: episodic life events, chronic, microaggressions, vicarious, transgenerational 16. The Physical and Mental Health Effects of Racism 17. Internalized Racism and Colorism 18. White Privilege 19. Intergroup Relations and the Dynamics of Difference 20. Liberation Psychology and the role of Social Justice in Psychotherapeutic Interventions 21. Critical Consciousness 22. Multicultural Competence 23. EBPP and Cultural Diversity 24. Culture and Theoretical Orientation 25. Culturally-Adapted and Culturally-Centered Interventions 26. Language and Psychotherapy 53 RACE-RELATEDMULTICULTURAL COMPETENCIESIN THERAPYAND SUPERVISION Race-related Multicultural Competencies: Interpersonal and Professional Skills (IPS) • Competence Goals: • Demonstrationof theapplicationof AVAs and KTRs in the conductof the case and therapeutic/supervisory relationship • IPS Competencies • Authenticityandgenuinenessin interracial interactions • Demonstrationof empathywhenexperiencesof racismare reported • Ability to co-createa safeand open environment fordiscussionof race- relatedcontent • Recognizingandattending tothe specific impact of one’sown race-related issueson the contentand processof interactions • Recognizingand processing the influenceof theclient’s race-related experiencesandperceptionson thetherapeuticalliance • Ability to work throughand recoverfrom race-related ruptures in the therapeuticrelationship • Inclusionof race-related inquiriesduring the intake process • Integrating race-relatedconsiderationsintocase formulation • Incorporationof racial content intopsychotherapy interventions • Ability to processanyovert expressionsof racism 54
- 19. 1/22/2014 19 DETERMINANTS OF MULTICULTURALLY- COMPETENT SERVICE DELIVERY FOR THERAPIST- TRAINEES Therapist-trainee multicultural competence Supervisormulticultural competence Program multiculturalcompetence Institutional multicultural competence 55 FOUNDATIONAL IDEAS FOR MULTICULTURALLY- COMPETENT SUPERVISION 56 CULTURE AND CONTEXT IN PSYCHOTHERAPY AND SUPERVISION THERAPIST SUPERVISOR CLIENT CULTURAL VARIABLES TO UNDERSTANDAS 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 57
- 20. 1/22/2014 20 CULTURE AND THE DYNAMICS OF DIFFERENCE We are all AT THE SAME TIME Like ALL others Like MANY others Like SOME others Like NO others (paraphrased from Murray & Kluckhohn) 58 ALL OTHERS Our CommonHumanity MANY OTHERS Majority contexts SOME OTHERS Identity Groupcontexts NO OTHERS Uniqueness of our Story 59 AT THE INTERSECTION OF CULTURAL DIVERSITY AND PSYCHOTHERAPY: THE DYNAMICS OF DIFFERENCE (HARRELL, 1990) Peopledevelop ways of managingthethreat,anxiety,or discomfortthatdifferenceexperiencescancreate Thosein powercan establishthenormand definedifferences from that normas deviantor unacceptable Differencedynamicsare associatedwith minority-majority groupstatus andwith in-group/out-groupdynamics There is a social presstowardsconformityand fittingin Beingdifferentis sometimesonlyacceptablein competitive situations(beingthe“best”); differenceis typicallyassignedvalue (e.g., betterthanorworsethan) 60
- 21. 1/22/2014 21 THE 5 DS OF DIFFERENCE (HARRELL, 1995) There are 5 basic strategies that people use in difference encounters Distancing Denial Defensiveness Devaluing Discovery THE 5 D’S OF DIFFERENCE: DISTANCING Strategy: Maintain separationfrom thedifference Manifestations: 1) Physical(avoidinginteraction;maintenanceof homogeneous environmentsand social networks) 2) Emotional("pity") 3) Cognitive(scientificfascination) PossibleResults: 1) Preventsauthenticinteractionandopen/honestcommunication 2) Increaseslikelihoodof perceiving and interactingwithothers based on stereotypes 3) Increasesfeelingsof being dehumanized,alienated,or misunderstood THE 5 D’S OF DIFFERENCE: DENIAL Strategy: Minimize the existence or significance of differences Manifestations: 1) Color-blind posture ("people are people") 2) Selective attention to similarities-- need for conformity and sameness 3) Disagreement and conflict are actively avoided Possible Results: 1) Increases feelings of invisibility 2) Reduces the perceived relevance of learning about diverse racial/ethnic groups 3) Increases the chance that the concerns and needs of diverse groups will be neglected or overlooked
- 22. 1/22/2014 22 THE 5 D’S OF DIFFERENCE: DEFENSIVENESS Strategy: Adoptstancethat"I" have no problemwithdifferences Manifestations: 1) Defensivedeclaration of nothaving prejudicesorstereotypes 2) Identification,overinvolvement,and blurredinterpersonal boundarieswithoppressedgroups 3) Central toone's senseof self is beingcaringand altruisticwith strongvaluesof equality PossibleResults: 1) Feelingsof rejection,hurt, confusion 2) Ignoresthe real problemsbecauseof idealizationof racial/ethnicgroups 3) "Underpathologizing"bias THE 5 D’S OF DIFFERENCE: DEVALUING Strategy: Maintainfeelingsof superiority Manifestations: 1) Differenceisexperiencedas deviant 2) "What's wrongwith thosepeople?" 3) "Blame the victim"orientation 4) "My struggle is worse thanyour struggle“ PossibleResults: 1) Intergroupinteractionsareoftenopenlyhostile 2) One's ownanger, rage, conflict,and confusionareprojectedonto the othergroup 3) "Overpathologizing"bias THE 5 D’S OF DIFFERENCE: DISCOVERY Strategy: Embraceandseek greaterfamiliaritywithdifferences Manifestations: 1) Differencesareexperiencedas challengesandopportunities forlearningandgrowth 2) Intergroupunderstanding isvalued 3) Conflictand disagreementareacceptedas a partof dealing withdifferences 4) Confrontingdifferenceis experiencedas empowering PossibleResults: 1) Non-defensiveintergroupinteractions 2) Resolution ofconflictsthatmay emerge 3) Personalgrowth
- 23. 1/22/2014 23 ABOUT THE 5 Ds We all manifest each of these dynamics at one time or another The purpose of these strategies is protective We can’t eliminate discomfortwith difference (either ourown or others), it is a normal reaction If we construct our lives to minimize difference experiences then we also minimize the possibilities of understanding others, understanding ourselves, and developing rich relationships BEYOND IDENTIFYING DESCRIPTIVE DIFFERENCES: SPECIFIC COMPETENCY BEHAVIORS 1. Includesculturaldiversityassessmentat intake(utilizing Cultural Formulation appendixin DSM) 2. Integratesmulticultural factorsin theoretically-groundedcase conceptualizationdemonstrating familiaritywith the multiculturalpsychologyliterature 3. Reviewsempiricaland theoretical literaturerelevantto key dimensionsof diversity 4. Incorporatesmulticulturalconsiderationsin treatment planningand identifiesculturaladaptationgoals,culture- centeredgoals,and/orculturally-specificgoalsas indicated 5. Implementstreatmentstrategiesin a culturally-syntonic practicecontext 68 APPROACHES TO THE INTEGRATION OF CULTURE Threeapproachesto the conceptualization and integrationof culture into psychological researchand practice Culturally-Adapted - Start with presumably universal constructs, strategies and methods and then make cultural adaptations Culturally-Centered - Start with constructs, strategies and methods that emerge from multicultural considerations and then integrate culturally-syntonic contributions from multipletraditions as appropriate Culturally-Specific– Start with the specific ecological cultureand design strategies that emerge from constructsrelevantto the target group 69
- 24. 1/22/2014 24 SUPERVISOR CULTURAL COMPETENCIES (Falender AndShafranske, 2004, p.149) 1) A working knowledgeof the factorsthat affect worldview; 2) Self-identityawarenessand competence with respect to diversityin the contextof self,supervisee,and clientor family; 3) Competence in multimodalassessmentof the multiculturalcompetence of trainees; 4) Modelsdiversityand multiculturalconceptualizations throughoutthe supervision process; 5) Models respect, openness,and curiositytowardall aspects of diversityand its impact on behavior, interaction,and the therapy and supervision processes; 6) Initiatesdiscussionof diversityfactors in supervision. 70 INTEGRATING MULTICULTURAL ISSUES IN CLINICAL SUPERVISION The importanceof developinga clearandcomprehensive approachtomulticultural issuesinclinicalsupervisionis particularlycriticalgiven the almostinevitableexperienceof anxietywhen topicsrelatedtorace,ethnicity,andcultureare raised in opendiscussion(Trawalterand Richeson,2008). The developmentof multicultural competenceis facilitatedbya processthat is able to incorporateattentiontothe emotional, cognitive,and contextualissuesrelated tomanaging the dynamicsand issuesrelatedto multipledimensionsof cultural diversity 71 USING MULTICULTURAL NARRATIVESAS AN ORGANIZING FRAMEWORK Narrative theorysuggests thatourstoriesare notonlycreatedby our lives,but simultaneouslycontributetocreatingourlives (McAdams, 2006). Narrativesare related tocreating memory, identity,and relational behaviors. A narrativeapproach facilitatestheintegration of thecognitive, affective,and behavioralelementsthroughtheuseof story. A multiculturalnarrativeis a storythatwe have involvingoneor moredimensionsof culturaldiversity,attributesof cultural groups,intercultural and intraculturalinteractions,and/or “isms”connectedtodiversitydimensions. The approachcan beorganizedintofourgeneral phases:(1) Layingthe Groundwork;(2) Timingand Opportunity;(3) Implementation of theMulticultural NarrativesSupervision Strategy;and (4) Evaluation 72
- 25. 1/22/2014 25 CORE GUIDELINES: COMPASSIONATE CONFRONTATION AND EMPATHIC EXPLORATION Both supervisorand superviseeare tasked withconfrontingand exploringemotionally-chargedsubjectmatterwhile simultaneouslymaintaining anatmosphereof compassionand empathyfor theanxiety,pain,ambivalence,and angerthat can accompanythe multicultural conversations. Thesediscussions can triggerstrongaffectiveand defensivereactions. Successful multicultural dialoguesrequiretheabilitytotolerate (1) the processingof unacknowledgedorundiscoveredmaterial relatedtorace-relatedfeelingsand experiences,and (2) feelings of uncertaintyand unfamiliarityrelated to“the other” (Tummala-Narra,2009). The act of non-judgmentallygivingsuperviseesspace to share theirmulticultural narrativesprovidesan in-vivoopportunityto strengthenthesupervisoryrelationship. 73 IMPLEMENTATION PHASE I: LAYING THE GROUNDWORK Conditions necessary for effectivemulticultural narrative approach Preparationand competence of the supervisor, Establishmentof multiculturalcompetence as part of the supervisoryagreement Creationof an open and emotionallysafesupervision atmosphere Difference is the one of the fundamentaldynamics operating at the intersectionof diversity and psychotherapy Processingand normalizingthe “Five D’s of Difference” 74 SMALL GROUP DISCUSSION What are your thoughts and ideas about how you might more explicitly lay the groundwork and set expectationsregarding multicultural issues in clinical supervision? 75
- 26. 1/22/2014 26 IMPLEMENTATION PHASE II: TIMING AND OPPORTUNITY Whenshoulda supervisorpay particularattentiontomulticultural issuesand dynamics? Ten indicatorsof potential need topay specificattentiontoracial dynamics • 1. Gaps in self-awareness • 2. Reactivity • 3. Minimization or devaluing the significance of culture • 4. Interpersonaldynamics • 5. Unfamiliarity, inexperience and lack of knowledge • 6. Oversimplification orsuperficiality • 7. Invisibilityof cultureand multicultural issues • 8. Guilt, shame, or internalized “isms” • 9. Contextminimization error (“blaming the victim”) • 10. Naïve, idealizing 76 SMALL GROUP DISCUSSION Share a supervision experience where there was an opportunity to process multicultural material. Discuss how you did or might have proceeded with the trainee. 77 IMPLEMENTATION PHASE III: PROCESSING CLINICAL MATERIAL USING THE MULTICULTURAL NARRATIVES APPROACH 78
- 27. 1/22/2014 27 BASIC STEPS OF THE MULTICULTURAL NARRATIVES APPROACH FOR WORKING WITH CLINICAL MATERIAL Step1: Elicitation/Disclosure • The firststep in the processinvolveselicitingrelevantnarratives byinviting the superviseeto processthestimulusissuemoredeeply • CompassionateConfrontationoperatesstronglyhere Step 2: Deconstruction/Analysis • Thesecondstepinvolvesaprocessofdeconstructingthenarrativebyfacilitating connections tothe supervisee’sinternal experienceandexploring multicultural issues embedded in the narrative(e.g.,identity, stigma,privilege,etc.) • EmpathicExplorationcanprovide grounding inthe Deconstructionprocess Step 3: Reconstruction/Integration • Guided by the ideathat intentional meaning-making of multiculturalnarrativescan reducecultural anxietyandresultin therapistbehaviorsthatare productiveinthe managementandincorporationof multiculturalcontentanddynamics • (1) incorporates a reflective normalizationof multicultural issues • (2) integrates insights from the deconstruction process • (3) is consistent with values and self-image andcan contribute to both personal and professional growthand development • Integrates multiculturalawareness,knowledge,andskilldevelopment 79 INTEGRATED SUPERVISION EXAMPLE 80 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) disclosureand descriptionof narratives associated with the stimulus issueor event “I’m thinking it would be a good idea to pause for a momentand focus in on what happenedin the session when_______.” “I’d like to invite you to take a momentand try to connectany personal experiences involvingrace that are associated with _______.” 81
- 28. 1/22/2014 28 IMPLEMENTATION PHASE III: STEP TWO Deconstruction and Analysis Explorationof the narrative with respectto the supervisee’s internal experience, multiculturalissues such as powerand privilege, identity, bias, etc., and impactof these on the therapyand/or supervisoryprocess “I’m wonderingif you notice any similarities between your thoughts and feelings associated with your experience andwhat happened in the session”. “Let’s explore a bit more about your experiencewith respectto the role of race in your sense of self and identity as it may have been reflected in your work with this client.” 82 IMPLEMENTATION PHASE III: STEP THREE Reconstruction and Integration Facilitation of the supervisee’s processof integrating self, client, and contextto form a coherentnarrative of the therapyor supervisoryevent or issueand the supervisee’s developmental process; Connectionto relevant MulticulturalAVAs, 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”? 83 DEMONSTRATION 84
- 29. 1/22/2014 29 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 multiculturaldynamics 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. 85 PARTING THOUGHTS The central purposeof integratingmulticulturalnarratives intosupervisionis to facilitatethemeaningful consideration of multiculturalmaterial in theprocessof therapy,supervision,and professional relationshipsmore generally It is suggestedthatsupervisorsseek consultationfrom colleagueswhohave expertisein multiculturalissuesin orderto processways to deal withchallenging multicultural dynamicswith trainees,as well as appropriatesupervisorystrategieswith respecttoculture in caseconceptualization,treatmentplanning,and treatmentimplementation. 86 PARTING THOUGHTS (CONTINUED) Oneof the biggestbarriers to facilitatingsupervisee multicultural competenceis the reluctanceand/orinabilityof supervisorsto identifyimportantmaterialandbringthe issues to the supervisee’sattention Processingmulticulturalnarratives maytrigger unanticipated reactions and potentially exposethe supervisor’s ownvulnerability The quantity and quality of the supervisor’s previousexperience discussingraceis also an importantfactor influencing the implementationof the supervisionapproachdescribed Effectivesupervisionandevaluationof traineemulticultural competenceis notpossiblewithouttheongoingreflective practiceand self-assessmentof the supervisor 87
- 30. 1/22/2014 30 THANK YOU! Shelly Harrell, Ph.D. (310) 701-3171 Shelly.Harrell@pepperdine.edu 88