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Clinical Supervision: Models, Role, Legal & Ethical, & Transference
On the last track, we discussed the reflective approach to supervision, and methods to encourage the growth of the reflective process in supervisees and trainee supervisors. The three dimensions of the reflective approach are the intention to examine one’s own actions, maintaining openness to alternatives, and the ability to use theory and past experiences to refine clinical technique.
On this track, we will discuss the three common perspectives in multi-cultural counseling. We will also discuss techniques by which to encourage the growth of multi-cultural counseling skills within supervisees.
Three Common Perspectives in Multi-Cultural Counseling
Perspective #1 - Universalist Perspective
Clearly, under this perspective, treatment focuses on the particular disorder of the client and the particular skills required by the therapist to treat this disorder. Thus, the universalist does not consider cultural factors such as race, gender, and class to be relevant concerns, and if the topics come up in therapy, they are presented and interpreted by the client.
Perspective #2 - Particularist Perspective
The cultural, rather than the personal being, is the focus. I have found that therapy under the particularist perspective tends to lean heavily towards the psychoeducational; for example, Bass and Coleman, when conducting a school-based intervention for under-achieving African-American students, focused primarily on teaching cultural history to the participants, and discussing how this cultural history affects their lives.
Perspective #3 - Transcendentalist Perspective
For example, in the case of eating disorders, it is important to the transcendentalist to understand not only how cultural factors influence body image, but the nature of family relationships, and the individual’s innate need for control. Focus of treatment, logically, is to include the client’s interpretation of these elements as well as psychoeducational exercises on the role contextual factors have in the disorder.
Isaiah (I-za’-ah), 13, was an African-American client treated by David, one of my supervisees. Isaiah had been placed in foster care following reports of his sexually inappropriate behavior towards his nine year old sister. There were also indications that Isaiah had been sexually abused himself, and he had been removed from his home primarily because his mother would not comply with treatment recommendations. Alice, Isaiah’s mother, had been openly hostile towards the therapists and case-workers who worked with Isaiah.
Alice had stated, "I don’t know why you’re always calling me in when Isaiah has problems at school and other places where I have no control over him." Since Isaiah’s removal from the home, Alice had been insisting he be brought home where she could care for him. Isaiah exhibited oppositional-defiant behavior, and responded to feeling threatened by verbally attacking the perceived offender.
When challenged, Isaiah’s behavior would escalate, requiring him to be removed from the room. David told me that he had observed Isaiah using the race of the ‘offender’ as a reason they would want to hurt him. Isaiah clearly had no background of positive relationships with peers or adults of any race.
Comparing the Three Perspectives
--b. Particularist: The particularist perspective, in which the primary factor in a client’s worldview and sense of self is largely the result of a particular cultural factor, such as ethnicity or gender, would require specialized intervention for each of Isaiah’s difficulties, for example, sexual predation, cultural identity, and oppositional-defiance.
--c. Transcendentalist: From the transcendentalist perspective, however, the therapist would make use of an integrated system of care which could address Isaiah’s difficulties both from an intrapsychic perspective and a contextual one.
David decided to work from the transcendentalist perspective, and developing a treatment program involved assessing the relative importance of each of Isaiah’s difficulties, as well as the importance on focusing on cultural identity development, family dynamics, and school behavior. We also discussed who could provide the most effective care for Isaiah based on race and gender.
After assessing these items, David constructed a treatment program with my assistance that involved individual therapy for the oppositional defiant behavior, and a psycho-educational group experience that dealt with the development of African-American cultural identity.
Clearly, had Isaiah been David's first African-American client, he may have had much more difficulty approaching his case. As you have probably experienced, the best way for supervisees to develop a constructive multi-cultural perspective is to ensure that they have exposure to clients of a wide array of cultural and ethnic backgrounds. In my experience, this varied exposure allows supervisees to develop the ability to discriminate the relative effects of cultural and intrapsychic elements on the development of a disorder, the construction of a treatment program, and evaluation of the client’s behavior within the treatment.
On this track, we have discussed three common perspectives in multi-cultural counseling. We also discussed techniques by which to encourage the growth of multicultural counseling skills within supervisees.
On the next track, teaching self-appraisal to clinical supervisees. We will also discuss the six point supervisee self-assessment that I use regarding working and evaluating skills. The five points in this assessment are action steps, focusing, reframing, confronting, and pointing out endings.
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