Supervisor multicultural competence and its relation to supervisory process and outcome

This study investigated the direct and indirect effects of marriage and family therapy trainees' perceptions of their supervisors' multicultural competence in supervision on the supervisory working alliance, trainees' multicultural competence (case conceptualization abilities in etiology and treatment), and perceived supervision satisfaction. Path analyses revealed supervisor multicultural competence to be positively associated with supervisory working alliance and perceived supervision satisfaction. In addition, supervisor multicultural competence seemed to have a negative effect on trainee etiology conceptualization abilities. Finally, results suggested supervisory working alliance to be a significant mediator in the relationship between supervisor multicultural competence and supervision satisfaction. Findings are discussed within the context of theoretical, empirical, and practical implications for multicultural supervision.     

A Mexico City-based immersion education program: training mental health clinicians for practice with Latino communities

This article describes the philosophical foundations and educational methods of a Spanish language and cultural immersion program based in Mexico City, Mexico. The program is designed to assist U.S. graduate students in marriage and family therapy and clinical psychology programs to improve clinical service delivery with Latino clients. Utilizing critical pedagogy, the program works with future clinicians to develop multicultural and international competencies; acquire increased Spanish language skills; engage in self-of-the-therapist work; and expand their understanding of the historical and cultural influences shaping the mental healthcare needs of Latin American clients. A report of the themes from postimmersion surveys is provided and the implications for training are discussed.     

A Re-Conceptualization of the Working Alliance in Cross-Cultural Practice with Non-Western Clients: Integrating Relational Perspectives and Multicultural Theories

This article will addresses a gap in the literature regarding the working alliance in cross-cultural treatment. The paper draws on references from current relational theories and multicultural conceptual and empirical sources to re-conceptualize the definition of the working alliance to include cross-cultural dynamics between Asian clients and European-American therapists as a case in point. The paper includes an overview of the working alliance, and a proposal for the inclusion of specific relational domains that this author has found to be important for the definition of the working alliance. These domains are empathy, mutuality, the dynamics of power and authority, the use of self, and the process of communication. A case vignette is included to illustrate these discrete domains. The paper opens new directions for clinical practice and research in the area of the working alliance in cross-cultural counseling.     

Moving Up the Continuum of Hope: Developing a Theory of Hope and Understanding its Influence in Couples Therapy

For years therapists have suggested that hope is an important catalyst in the process of change. This study takes a grounded theory approach to address the need for a clearer conceptualization of hope, and to place interventions that increase hope within a therapeutic context so that therapists know how and when to use those interventions. Fifteen active and experienced marriage and family therapists from across the United States participated in hour-long phone interviews about hope in couples therapy. Moving Up the Continuum of Hope emerged as the core category from the grounded theory analysis of the data. This category represents a process, with general and specific conditions and consequences that increase a couple’s level of hope. This study serves as a foundation for future process research on couples therapy, as well as research on hope in other contexts (e.g., individual and family therapy) and with other perspectives (e.g., clients).     

Integrating a Multicultural Perspective Into Training for Career Counseling: Programmatic and Individual Interventions

Preparing students to provide competent career counseling to multicuturally diverse clients requires a systematic and integrated effort by training programs. This article discusses the essential components in a comprehensive, programmatic commitment to multiculturalism, and offers suggestions for enhancing multicultural sensitivity and competence in individual trainees. The definition of multicultural diversity used in this article includes issues in addition to race and ethnicity (e.g., gender, sexual orientation, age, socioeconomic status, and physical disability) and recognizes the diversity of counseling trainees.     

Counselor Trainees' Assessment and Diagnosis of Lesbian Clients with Dysthymic Disorder

SUMMARY

Graduate-level counselor trainees completed an Assessment and Diagnostic Inventory consisting of clinical vignettes and a series of questions pertaining to conceptualization of client problem, diagnosis, and assessment of overall level of psychopathology.We hypothesized that participants would assign different diagnoses to clients with lesbian versus heterosexual sexual orientation. Participants responded to vignettes in which clients were identified as either a lesbian or a heterosexual female, with all other content identical. Participants were significantly more likely to perceive lesbian clients' problems to be related to sexual orientation for the vignette corresponding to dysthymic disorder. However, they were not more likely to assign personality disorder diagnoses, nor did they attribute a greater degree of psychopathology to lesbian clients with dysthymic disorder.     

A Contextual Therapy Framework for MFT Educators: Facilitating Trustworthy Asymmetrical Training Relationships

This article provides a conceptual framework for asymmetrical relationships between family therapy educators and trainees. Our framework is based on contextual family therapy, and we apply the concepts of trust, entitlement, self‐validation, and loyalty to training relationships. We highlight the value of educators modeling responsible uses of power in addition to teaching trainees clinical concepts and skills. We propose that training can be a process where trainers earn constructive entitlement through their interactions with trainees, who then give to future clients, supervisees, and trainees to continue the cycle of intergenerational trustworthiness. We also provide examples that illustrate the application of contextual therapy skills such as multidirected partiality, I‐Thou relating, acknowledgment, validation, and accountability to family therapy training.     

Clients as Teachers: Reciprocal Influences in Therapy Relationships

The value of the continuing education industry for therapists is questioned, as is the usefulness of therapy books and journal articles, as a means of engaging therapists in life‐long learning. Instead, it is argued that our clients are our best teachers and that therapists learn most effectively from their clients. Drawing on research studies with prominent theoreticians and therapists, and on case studies from clinical work, a number of important themes are identified as ways in which therapists are influenced by their therapeutic encounters with their clients. The themes explored in this article include: (1) intimacy and high emotional arousal with clients as we witness profound change; (2) being challenged by clients; and (3) allowing for boundary ‘crossings’ in order to develop more flexible ways of working with clients. The implications for professional development are discussed.     

Addressing Concerns with Lesbian Couples Experiencing Fertility Treatment: Using Relational Cultural Theory

Legal changes and increasing research surrounding the positive influence of lesbian parenting have spurred a resulting increase in lesbian couples pursuing parenting through various fertility measures. Increasing counselors' multicultural competence regarding the experiences unique to the lesbian population with fertility will strengthen the counseling process when working with lesbian couples interested in adding children to their family. Through the lens of relational cultural theory, this article uses the constructs of mutuality, empathy, and reciprocity to provide counseling implications for work with lesbian couples during the decision making and stressful process of fertility treatment, while focusing on strengthening the relationship.     

Unique Characteristics of Cohabiters Seeking Therapy

There is limited information on cohabiters presenting for therapy. The authors examined the characteristics of 143 married and 54 cohabiting, young (m = 30.39), Caucasian, couples presenting for therapy. We hypothesized that cohabiters presenting for therapy would be more satisfied and committed than married couples and that they would be similarly emotionally differentiated. We conducted a repeated‐measures MANOVA to test the hypothesis. Significant effects between partners and between dyads were found, indicating a difference between clients based on relationship status. Cohabiting clients presented earlier in their relationship and were more satisfied and committed. Cohabiting male partners were less emotionally reactive. Without the institutionalized rules of marriage, cohabiting couples may perceive threats to their relationship earlier than married couples.     

Crisis management during "live" supervision: clinical and instructional matters

In this article, we illustrate two examples of "live" supervision with marriage and family therapy trainees whose clients presented in the therapy room in immediate crisis. The case examples, one a client with suicidal thoughts and the other a parent who had struck her child, demonstrate how the university-based therapy team managed the recursive clinical and supervision processes that unfolded during the sessions. We present the case examples from the perspective of both supervisees and supervisor, discussing how our different experiences of the supervision unfolded in real time. Case discussion and reflections later in the article illustrate the need for an open, transparent, dialogical process throughout supervision. A case is made for supervisory participants to create alternative formats in which multiple supervisory voices can be heard.     

The border pedagogy revisited

Border pedagogy is a multicultural educational approach utilized in multicultural settings to help students understand their histories and experiences and how it affects their identities and cultures. The approach seeks to produce intellectuals that transcend physical and metaphysical boundaries. The goal of border pedagogy is to remove cultural and political barriers to attain a greater conceptualization of the human experience. This paper will discuss border pedagogy in the contemporary Mexican/American border region.     

Working with African American clients: considering the "homeplace" in marriage and family therapy practices

In this article, we discuss perspectives on the "homeplace" that are important to consider in marriage and family therapy involving African American clients. The homeplace comprises individual and family processes that are anchored in a defined physical space that elicits feelings of empowerment, rootedness, ownership, safety, and renewal. Critical elements of the homeplace include social relationships that shape individuals' and families' sense of social and cultural identity. We draw on our ethnographic and clinical research with African American families in urban and rural settings to describe typical schisms between therapists and African American clients when communicating about the homeplace. We also explore the impact of homeplace disruptions on experiences of "yearning." Recommendations for integrating a homeplace perspective into therapy practices are provided.     

VIOLENCE OR DISCIPLINE? WORKING WITH MULTICULTURAL COURT-ORDERED CLIENTS

Therapists working with court-ordered clients from cultures differing from the mainstream face challenging issues of compulsory therapy in the context of cultural diversity. This article reviews the literature on court-ordered and multicultural counseling, highlighting central elements of both. It then suggests guidelines that blend these elements. The author illustrates how using these guidelines can enable therapists to engage these clients in the therapeutic process and focus on culture as the context for change.     

The Daily Events and Emotions of Master’s‐level Family Therapy Trainees in Off‐campus Practicum Settings

The Day Reconstruction Method (DRM) was used to assess the daily events and emotions of one program’s master’s‐level family therapy trainees in off‐campus practicum settings. This study examines the DRM reports of 35 family therapy trainees in the second year of their master’s program in marriage and family therapy. Four themes emerged from the results: (i) Personal contact with peers‐in‐training engenders the most positive emotions during practicum; (ii) Trainees experience more positive emotions during therapy with families and couples in comparison with therapy with individuals; (iii) Positive affect increases over the course of a student’s practicum year; and (iv) Trainees experience less positive affect in individual supervision in comparison with most other training activities. Flow theory offers guidance for supervisors helping trainees face developmental challenges of clinical training.     

Indecision regarding a couple relationship A working model for ambivalence

Clients entering therapy with indecision regarding their couple relationship can present a difficult clinical situation for the therapist. These clients vacillate between staying in and leaving the relationship and many resist moves towards a resolution. It is proposed that such indecisive clients fall into two distinct categories, namely, ambivalence and dilemma, with each having a different therapeutic focus. The aim of this paper is to outline a working model for therapists to use with clients experiencing ambivalence in their relationship. A case study based on a composite of actual cases is used to demonstrate the applicability of the model.     

A perfect fit: connecting family therapy skills to family business needs

The purpose of this article is to encourage family therapists to become more interested in family business practice. It does so in three ways: (a) highlighting the number of therapists already involved in family business issues; (b) showing the parallels between family business and family therapy by applying family business research findings to couples therapy; (c) discussing how family therapists already have the practice wisdom to be effective in working with family business clients. Limitations of this practice are also discussed along with suggestions for overcoming them.     

Student-faculty perceptions of multicultural training in accredited marriage and family therapy programs in relation to students' self-reported competence

Although the marriage and family therapy field's recent attention to multicultural issues is laudable, there appears to be little clarity on what constitutes an effective multicultural training program and the impact of the effects of such training on trainee multicultural competence. The field continues to be challenged at different levels-training, practice, research, the setting of the standards and the work of the Commission on Accreditation for Marriage and Family Therapy Education, and the goals and strategic plan of the American Association for Marriage and Family Therapy Board. This study focused on assessing the extent of multicultural integration at different levels of training and the relationship between such training and students' perception of their own multicultural competence.     

Therapist Ratings of Frequency and Severity of Marital Problems: Implications for Research*

In order to ascertain fruitful directions for marital therapy research, practicing marital therapists were asked to provide information regarding the clinical relevance of potential research topics. A structured questionnaire was mailed to 250 members of the American Association of Marriage and Family Therapists. Therapists treating at least five couples were asked to rate the frequency, severity, and treatment difficulty for 29 problems commonly experienced by distressed couples. Therapists' responses indicated the clinical relevance of a number of potential directions for research. Communication and alcoholism were most strongly endorsed as priority areas for future marital therapy research.     

A FAMILY THERAPY INTERNSHIP IN A MULTIDISCIPLINARY HEALTHCARE SETTING: TRAINEES' AND SUPERVISOR'S REFLECTIONS

Family therapy doctoral students from American Association for Marriage and Family Therapy-accredited programs are required to complete a full-time clinical internship. The literature provides little information about these internship experiences. Two doctoral-level marriage and family therapists summarize their professional and personal experiences in their internships located within a multidisciplinary healthcare setting. In addition, their supervisor reports on her experiences working with marriage and family therapy doctoral interns. We hope that this case report will stimulate all interns and their supervisors to provide feedback to their internship sites and graduate programs about their clinical training and the extent to which the programs prepared them for their marriage and family therapy careers in the larger health and mental health community.