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Section 20
Cultural Factors in Clinical Supervision

Question 20 | Test | Table of Contents

Openness to cultural factors
A key element in using supervision to facilitate the acquisition of multi-cultural counseling competence is the supervisor’s open­ness to examining the role of cultural factors in counseling on an on-going basis. This is not something that can be effectively achieved by assigning a particular week to considering cultural factors. Nor would it be effective if cultural factors come to dominate the discussion of the psychological issues facing the client and supervisee. The parallel issue in counseling is concerns about ethical behavior. Not every counseling interaction stimulates a concern about ethical behavior, but an understanding of ethical behavior should guide all counseling interactions. Competent supervisors listen to every counseling interaction to make sure ethical guidelines are followed and regularly require supervisees to consider the ethical implications of their attitudes, beliefs and behavior. To do so effectively, the supervisor must be open to ethical considerations. The same is true for multi-cultural counseling competence. Two issues need to be considered in a supervisor’s openness to multi-cultural counseling competence —experience and feelings.

Supervisor’s experience with cultural factors
One of the awkward moments in supervision comes when a supervisee presents a case that represents a problem with which I have little experience. One of the best moments comes when a case represents a problem with which I have worked repeatedly and about which I have immersed myself in the relevant literature on its etiology and treatment. My personal experience of work­ing with ethnic minorities and working within predominantly white institutions contributes to my ability to help supervisees of all races address cultural issues with their clients. It is a per­spective that I could not bring to work if my supervisees were working with thought-disordered clients. To be effective in this type of supervision, I would need to take certain steps. Initially, I would have to familiarize myself with the current thinking on thought disorders. I would then need to work with several such clients under supervision. At this point, I would be better qual­ified to supervise others in this work. For a supervisor to be effective in helping supervisees integrate multi-cultural counseling competence into their professional identity, it is useful for the supervisor to have done so. The most effective way to achieve this integration is through supervised practice.

Supervisor’s feelings about cultural factors
As important as knowledge and skills are in the practice of multi­cultural counseling, issues of trust tend to determine the differ­ence between being effective and ineffective with clients (Nickerson, Helms and Terrell, 1994). Many ethnic minorities enter counseling with personal and cultural issues concerning the degree to which the counselor will respect them as an individual and as a cultural being. The former is certainly shared by all cultures, but the latter gets exacerbated within both cross- and same-culture counseling relationships. These feelings are power­ful in the client and draw powerful feelings from the counselor. The more a counselor is aware of his or her cultural being, the better able he or she is to manage those feelings and use them to benefit the counseling relationship. Supervisors also need to understand how they define and feel about their cultural being in order to address those feelings effectively in the supervisory relationship. Whenever I work with African descended super­visees I need to be constantly aware and responsive to two aspects of my own internalized racism. On the one hand, I need to resist my urges to protect other African descendants from discrimina­tion and feelings of isolation. When I feel that urge to protect, I start working very hard at being accepting of the supervisee and emphasizing their strengths. In turn, this allows me not to con­front them around the areas in which they need to gain greater competence. I am afraid that they will feel bad, that it will have a negative effect on their racial self-esteem, or that they will think I am rejecting them because of their race. This urge seems to be dominated by my own feelings about being African descended in a predominantly white profession, and not about the professional needs of my supervisees.

On the other hand, my internalized racism can lead to a hyper­critical stance in evaluating the work of African descended stu­dents. This stance can lead me to be less perceptive concerning the quality of their work and more likely to devalue their work as coming from a stigmatized source. This gets expressed in expect­ing less of them and giving less feedback than I do with European descended students. In both these reactions, my feelings lead me to treat the supervisee as a member of a race rather than as an individual who has a race. When I act out of these feelings, I fail to create the positive working alliance that is based on mutual and accurate respect.

It is only through examining these uncomfortable feelings that I can gain control of them. It is when I can control them that they can become a useful part of my supervision. When I am in touch with those feelings, I am better able to respond to the positive and negative projections of my supervisees. I am also better able to work through these issues and concerns in my own life.

Conclusion
From a transcendent perspective, there is no one way to view the effect of cultural factors in counseling or supervision, but there is an imperative to explore the ways in which these factors are part of the warp and woof of counseling and supervision. In this chapter, I have attempted to describe various ways in which cultural factors can be addressed within supervision to facilitate the acquisition of multi-cultural counseling competence among supervisees. It is important to recognize that this competence can most effectively be acquired if it is addressed at the institutional and process levels of counselor training and supervision. It is also important to recognize that this is a dynamic and ever changing process. It is the supervisor’s responsibility to develop a system­atic method for understanding the effect of cultural factors in his or her work and to communicate that method with supervisees and colleagues.

Issues in multicultural counseling competence
Learning Objectives for Multicultural Training (Ridley, Mendoza and Kanitz, 1994). Culturally competent counselors should demonstrate:
1.     Culturally responsive behaviors (i.e. appropriate cultural factors reflected in observable behaviors, that are beneficial to the client (or other persons in the professional setting)
2.     Ethical knowledge and practice pertaining to multicultural counseling and training issues
3.     Cultural empathy (reflected through (a) identification of culturally relevant applications of traditional counseling skills, (b) modification of traditional counseling skills/ techniques to make them culturally relevant, and (c) creating new skills/techniques when necessary to address the needs of culturally different clients)
4.     The ability to critique existing counseling theories for cul­tural relevance
5.     Development of an individualized theoretical orientation that is culturally relevant
6.     Knowledge of normative characteristics of cultural groups
7.     Cultural self-awareness (i.e. cultural heritage, values, assumptions, world view)
8.     Knowledge of within-group differences (i.e. level of accul­turation, age, individual expression of cultural values, cul­tural identity)
9.     Knowledge of multicultural counseling concepts and issues
10.    Respect for cultural differences

Questions to Guide the Exploration of Multi-Cultural Issues
The following questions may be used to raise your awareness of multicultural issues.
la.     What are the main demographic variables that make up my own cultural identity and that of my client (i.e. age, gender, sexual orientation, socioeconomic status, race/ethnicity)?
lb.     What worldviews (e.g. assumptions, values) do I bring to the counseling relationships based on my cultural identity?
2a.    What value systems, based on my demographic identities, are inherent in my approach to counseling?
2b.    What value systems, based on my demographic identities, underlie the strategies and techniques I use in counseling?
3a.    What knowledge do I possess about the worldview of my client (who may have different cultural identities from me)?
3b.    What skills do I possess for working with clients who have different cultural identities from me? What other skills would be helpful to learn?
4a.    What are some of my concerns and/or challenges in working with clients who are culturally different from me?
4b.    How are these issues best resolved?
5.      How might I improve my ability to work with culturally diverse clients?
- Holloway, Elizabeth & Michael Carroll, Training Counseling Supervisors, Sage Publications, London: 1999.

Personal Reflection Exercise #6
The preceding section contained information about cultural factors in clinical supervision. Write three case study examples regarding how you might use the content of this section in your practice.

Update
Methods of increasing cultural competence in nurses working
in clinical practice: A scoping review of literature 2011-2021

Červený, M., Kratochvílová, I., Hellerová, V., & Tóthová, V. (2022). Methods of increasing cultural competence in nurses working in clinical practice: A scoping review of literature 2011-2021. Frontiers in psychology, 13, 936181. https://doi.org/10.3389/fpsyg.2022.936181

Peer-Reviewed Journal Article References:
Patel, Z. S., Tarlow, N., & Tawfik, S. H. (2021). Assessment supervision during COVID-19 and beyond: Trainee perspectives on the supervision of teleassessment. Training and Education in Professional Psychology. Advance online publication.

Schatten, H. T., Gaudiano, B. A., Primack, J. M., Arias, S. A., Armey, M. F., Miller, I. W., Epstein-Lubow, G., & Weinstock, L. M. (2020). Monitoring, assessing, and responding to suicide risk in clinical research. Journal of Abnormal Psychology, 129(1), 64–69.

Thompson, S. M. (2020). Responding to inappropriate client sexual behaviors: Perspectives on effective supervision. Journal of Psychotherapy Integration, 30(1), 122–129.

QUESTION 20
According to Holloway, what two issues need to be considered in a supervisor’s openness to multi-cultural counseling competence? To select and enter your answer go to Test.


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