CROSS-CULTURAL SUPERVISION IN MARRIAGE AND FAMILY THERAPY

Transcription

1 CROSS-CULTURAL SUPERVISION IN MARRIAGE AND FAMILY THERAPY Elizabeth Wieling James P. Marshall ABSTRACT: The purpose of this study was to gain an understanding of the various cultural factors that influence the supervisor-trainee relationship when at least one of these individuals is a member of an ethnic minority group in the United States. Marriage and Family Therapy supervisors and students were asked to compare and contrast their experiences working with ethnic minority and white persons. Findings indicate that both supervisors and students express great value in cross-cultural supervisory experiences, but report that these opportunities are very limited. KEY WORDS: supervision; cross-cultural; multicultural; marriage and family therapy. Currently, literature describing cross-cultural supervision processes in Marriage and Family Therapy (MFT) as well as in other mental health fields is limited. Although there have been studies conducted on cross-cultural therapy, and methods for introducing cultural awareness and sensitivity into training programs (McGoldrick, Pearce, & Giordano, 1982; McGoldrick, Giordano, & Pearce, 1996; Hardy & Laszloffy, 1995; Preli & Bernard, 1993; Hardy, 1993; Falicov, 1988; Pedersen, 1985), little is known about the cross-cultural dynamics present in clinical supervision (Brown & Brown, 1995). Elizabeth Wieling, PhD, is an assistant professor, marriage and family therapy, Texas Tech University, PO Box 41162, Lubbock, TX ; James P. Marshall, MS, is a doctoral student, Marriage and Family Therapy, Texas Tech University, PO Box 41162, Lubbock, TX Reprint requests should be sent to the first author. Contemporary Family Therapy, 21(3), September 1999 H 1999 Human Sciences Press, Inc. 317

2 318 CONTEMPORARY FAMILY THERAPY Many disciplines (i.e., anthropology, sociology, human development, and family studies) have stressed the role that culture plays in setting the contexts for our lives and providing the lenses from which we view the world. Spradley and McCurdy (1987) defined culture as "the acquired knowledge that people use to interpret their world and generate social behavior." In other words, culture is an ethnocentric knowledge that one uses to construct and understand behavior. Furthermore, culture is a system of interrelated parts as well as a system of knowledge by which people design their actions and interpret the behavior of others (Spradley & McCurdy, 1987). Several authors in the field of MFT have made strong cases for the need to properly train therapists to become culturally aware and sensitive, not only to the therapist's culture of origin, but also to the culture of others. Hardy (1993) has emphasized the importance of cultural relativism and the necessity for one to consider attitudes, perceptions, and behavior within cultural contexts. However, the field has largely ignored a crucial element in the training of therapists, that of the cross-cultural supervisory relationship. Given the fact that ethnic minorities in family therapy training programs seem to be few, and the number of ethnic minority approved supervisors who work at training institutions are minimal, the nature of these cross-cultural relationships is crucial. As we enter the 21st Century, we are aware of the fact that demographic population trends in our country are changing, and of the fact that approximately half of the population in the United States will belong to ethnic minority groups. Therefore, mental health practitioners from various disciplines are called upon to take a leadership role in training professionals who not only represent various racial and ethnic groups, but that also understand, interact, and provide effective services to culturally diverse families. Brown and Brown (1995) emphasize the need to understand cross-cultural supervision dynamics and to incorporate them into current supervisory models because supervisors directly influence the attitudes, knowledge, and skills of a supervisee through their own attitudes, knowledge and skills. The worldview congruence model (Brown & Brown, 1995) is a helpful tool for understanding how people's worldviews are developed and sustained by their culture in several dimensions. For example, one's values, beliefs, epistemology, and ontology are all heavily influenced by their culture of origin. Several studies addressing clinical supervision (Kaiser, 1992; Figley & Nelson, 1990; Nichols, Nichols, & Hardy, 1990) have

3 319 ELIZABETH WIELING AND JAMES P. MARSHALL stressed the importance of the development of trust, respect, personal awareness, accountability, and the use of appropriate power and authority for a positive supervisory relationship. Therefore, it is crucial that one's cultural framework be taken into consideration and overtly discussed during the supervisory relationship. Culture is one of the most influential determinants of one's organizing principles/worldview and, therefore, cannot be ignored. Stone (1997) agrees that literature linking multiculturalism and supervision is rare. He also indicates that one of the biggest challenges we face is being able to take the work that has been done in multiculturalism and translating that into useful practice for the supervisory experience. McNeill, Horn, and Perez, (1995), Bernard and Goodyear (1992), Peterson (1991), Carney and Kahn (1984), Morgan (1984), and Vargas (1989) have all written theoretical articles and book chapters on this topic. However, only three empirical studies (Vander Kolk, 1974; Cook & Helms, 1988; Hilton, Russell, & Salmi, 1995) have been done that address clinical cross-cultural supervision. Leong and Wagner (1994) did an excellent job in reviewing and summarizing the clinical and theoretical literature as well as the empirical studies that have been done in the area of cross-cultural supervision. Although the three empirical studies that have been conducted on cross-cultural supervision serve as a base from which to begin, there is still much to be done in this area. There is not only a need for additional empirical studies to be conducted, but descriptive studies as well. The empirical studies that have been done so far focus a great deal on race, to the exclusion of other cultural and ethnic factors that may influence the supervisory relationship. There is still much that needs to be learned about what these other factors are, and how they might influence the supervision process. Stone (1997) points out the unfortunate fact that culture has been viewed as an obstacle to be overcome in clinical practice rather than as a source of strength. The same feelings may very well hold true for the supervisor-supervisee relationship. Discussions of cultural and ethnic differences between supervisor and supervisee should be looked at as an invaluable part of the supervision experience, and something to be sought after by both parties involved. Unfortunately though, many of us may experience cultural and ethnic diversity as threatening and we may respond with "self-preoccupation or self-protection" (Stone, 1997). However, this preoccupation should not be used as a barrier to avoid discussing cultural issues.

4 320 CONTEMPORARY FAMILY THERAPY A manifestation of how cultural and ethnic diversity may be thought of as threatening, or as an obstacle, in the supervision process may be seen in the work of McRoy, Freeman, Logan, and Blackmon (1986). In their study of the dynamics of race and power, they found that both trainees and supervisors identified more potential problems than benefits in cross-cultural supervisory relationships. They found that black and Hispanic supervisors experienced lack of acceptance of their authority and competence by their white trainees. Stone (1997) points out that it is all too easy to avoid cultural factors in supervision unless we actively seek to promote such discussions. Failure to discuss cultural issues simply because they are not readily apparent, or because we are uncomfortable addressing them, leaves a wide gap unfilled in the supervisory process. Leong and Wagner (1994) also identified over-interpreting the influence of culture, under-interpreting the influence of culture, avoiding cultural issues, and fear of being labeled a racist as some other common problems that need to be addressed in cross-cultural supervisory relationships. Martinez and Holloway (1997) say that the specific role of supervision in multicultural training models has not been fully described. They also assert that comprehensive multicultural training will require structural changes at the institutional, curriculum, and instructional levels. The purpose of this study is to expand the literature regarding clinical cross-cultural supervision with a population of MFTs. Specifically, the aim of the study is to gain an understanding of the various cultural factors that influence the supervisor-trainee relationship when at least one of these individuals is a member of an ethnic minority group in the United States. MFT supervisors and students were asked to compare and contrast their experiences working with ethnic minority and White persons. Because the terms race and ethnicity are often used interchangeably, we would like to clarify how we are using these concepts. Race refers to any of the different varieties of humankind, mainly the Caucasoid, Mongoloid, and Negroid groups, distinguished by phenotypic characteristics (i.e., texture of hair, color of skin). Ethnicity describes a sense of commonality transmitted over generations by the family and reinforced by the surrounding community (McGoldrick et al, 1996). Further, "ethnicity refers to a common ancestry through which individuals have evolved shared values and customs. Ethnicity is a powerful force in determining identity" (McGoldrick et al., 1996,

5 321 ELIZABETH WIELING AND JAMES P. MARSHALL p. 1). Clearly, individuals belonging to any race can have a variety of ethnic backgrounds. Procedures METHODS A 36-item survey was mailed to 250 members of the American Association for Marriage and Family Therapy (AAMFT). One hundred and twenty-five of those surveys were mailed to clinical AAMFT members and the other 125 surveys were mailed to student members. Fifty surveys were returned (24 from clinical members, 22 from student members, and 4 from associate members). That is a return rate of 20%. The surveys were accompanied by postage paid envelopes to make it as easy as possible for participants to complete and return the survey. Due to financial constraints, no reminders were mailed to participants. Participants Demographic information obtained from the 50 members of AAMFT who completed and returned the survey is contained in Table 1. It is noteworthy that of the 50 respondents, women returned nearly twice as many surveys as men. However, it is not surprising that 86% of the surveys completed and returned came from Anglo Americans since that population represents the majority of AAMFT members. Instrumentation In reviewing the existing literature on cross-cultural supervision, we were unable to locate any existing instrument that adequately assessed the type of information we were hoping to gather. The primary questions of interest included: (a) how participants rated the quality of the training they received in their clinical program regarding racial, ethnic, and other diversity issues; (b) have participants been supervised by someone who belonged to the same (and to a different) racial and/or ethnic background as their own; (c) how did participants categorize the nature of these supervisory relationships; (d) do partic-

6 322 CONTEMPORARY FAMILY THERAPY TABLE 1 Participant Demographics Gender: Age: Ethnicity: Education Completed: Primary Field of Study: AAMFT Supervision Status: Years in Clinical Practice: Male = 17 Female = 33 Mean = 43 Min. = 24 Max. = 63 Anglo = 43 Latino(a)/Hispanic = 2 Mixed Heritage = 2 Jewish = 2 Other = 1 BA = 7 MA/MS = 32 Ph.D. = 11 MFT = 42 Psychology = 2 Counselor Education = 1 Social Work = 3 Pastoral Counseling = 2 None = 43 Supervisor-in-training = 6 Approved Supervisor = 1 Mean = 8.3 ipants believe that issues related to race and ethnicity influence the supervisory relationship; and (e) have participants had a particularly good or bad supervisory experience that they attribute partly to issues regarding differences in race and/or ethnicity? In order to gather information that would provide us with tentative answers to these questions, we developed a new 36-item survey. The survey was composed of demographic information, scaling questions, and open-ended questions. RESULTS The question of how AAMFT members would rate the quality of training they received in their clinical programs regarding issues of race, ethnicity, and other diversity topics was accompanied by a fivepoint Likert scale. Possible choices ranged from poor (equal to 1) to excellent (equal to 5). The mean score of the 49 respondents who answered this question was 3.35, with a s = This indicates that respondents perceived the quality of their training in this area to be slightly above average. The question we must ask ourselves is

7 323 ELIZABETH WIELING AND JAMES P. MARSHALL whether or not average training in issues related to race, ethnicity, and diversity is adequate for professionals who potentially will work with people from a variety of racial and ethnic backgrounds? Forty-four of 49 respondents (89.8%) said that they had received supervision by someone from the same racial and/or ethnic background as themselves. In contrast, only 15 of 49 (30%) respondents said they have been supervised by someone from a different racial and/or ethnic background. Of the 15 respondents who have been supervised by someone from a different racial/ethnic group, the modal number of supervisors is one. This indicates that on the rare occasion that a clinician in training has the opportunity to be supervised by someone from a different racial/ethnic background, that will most likely be the only opportunity they have during their training. The 15 persons who have received supervision by someone from a different racial and/or ethnic background rated those supervision experiences as being between good and excellent on the same five point Likert scale mentioned before. They had a mean of 4.29 with s =.73. Only 12 of these 15 respondents answered the question comparing their supervisory experience with someone from a different background to that of their supervisory experiences with supervisors from the same background. These results showed a mean of 3.73 with a s = 1.0. The respondents who had been supervised by someone from a different background than their own rated those supervisors as being quite competent (mean = 4.46 with s =.66 on a 5-point scale). When these respondents were asked if they attributed any aspect of their relationship with supervisors from a different race/ethnicity to racial and/or ethnicity issues, 73% (11 of 15) of the respondents said "no," but 64% (9 of 14) said that there were other aspects of their relationship that did contribute to either a positive or negative experience. Sixty-nine percent (34 of 49) of the respondents to the survey have never been supervised by someone from a different racial and/or ethnic background as themselves. These 34 respondents categorized the nature of their supervisory relationships with supervisors from the same race and/or ethnicity as above average (mean = 3.76 with s =.78 on a 5-point scale). This rating is substantially lower than the mean of 4.29 that was indicated for supervisory experiences with supervisors from different races and ethnicities. Another interesting finding provided by those persons who have never been supervised by someone from a different racial and/or ethnic background as themselves, is that 79% (26 of 33) of them thought

8 324 CONTEMPORARY FAMILY THERAPY that it would have benefited them in some way to have been supervised by someone from a different background. This seems to indicate a significant gap in MFT training programs. MFTs realize that crosscultural training is important, and they would like to have the opportunity to receive some of that training from supervisors from different backgrounds than themselves, but the opportunities simply are not available due to the lack of racial/ethnic minority supervisors in MFT training programs. Respondents' reasons for wishing they had been provided the opportunity to be supervised by someone from a racially or ethnically diverse background seem to boil down to a few simple themes. They felt this experience would have given them a greater sense of awareness, insight, and perspective into multicultural issues. It was also stated that this experience would help them be more sensitive to diversity issues. Only six of the 50 respondents are either approved supervisors or supervisors-in-training, and therefore, provide supervision to others. Four of the six supervisors have supervised someone who belongs to a racial and/or ethnic group that is different from their own. They categorized the nature of those supervisory experiences as good (mean = 4.0 with s = 0 on a 5-point scale). When comparing those experiences to supervising someone from their own racial/ethnic background, the supervisors indicated a slight decrease in the quality of the relationship (mean = 3.33 with s =.52 on a 5-point scale). Eighty-three percent (5 of 6) of the supervisors attribute some aspect of their relationship with supervisees from a different race to racial/ethnic issues. These supervisors reported that they were able to get some idea from their supervisees of what it is like to be a minority in the field of mental health and to be enrolled in an MFT training program. They also mentioned the fact that they had to address their own stereotypes and biases with their supervisees. By having that type of open, two-way discussion, supervisors and supervisees both realized how important it could be to discuss racial/ethnic differences with their clients. The survey concluded with three open-ended questions. The first of these questions asked whether or not participants believed that issues of race and ethnicity had an influence on the supervisory relationship. Of the 45 respondents who answered this question, 73% said "yes," 2% said "no," and 25% responded "maybe" or "it depends." Assuming that answers of maybe, or it depends, indicate that race/ethnicity do influence the supervisory relationship, then 98% of respon-

9 325 ELIZABETH WIELING AND JAMES P. MARSHALL dents believe that race and ethnicity do indeed play an influential role in the supervisory process. Some participants commented that it's absolutely impossible for racial/ethnic issues not to influence the supervisory relationship because they "influence every relationship." These ideas were best summarized by the words of one respondent who said, "race and ethnicity are lenses through which we view the world, ourselves, and others with whom we are in relationships, including supervisory relationships." Comments such as these seem to indicate strong relationships between race/ethnicity and the supervisory relationship, and these relationships seem to be thought of as a positive aspect of the relationship. Other respondents seemed to recognize that race and ethnicity certainly could influence the supervisory relationship, but stated that the degree of influence depends a great deal on the individuals involved in the relationship. One respondent who realized that race and ethnicity may influence the supervisory relationship said, "ideally, race and ethnicity, will not influence the supervisory relationship." Based on comments such as these, it may be the belief of some MFTs that if race and ethnicity do influence the supervisory relationship, then racism and/or prejudice are part of that relationship. The second open-ended question in the survey asked if participants had experienced a particularly good or bad supervisory relationship that they attributed partly to issues regarding differences in race and/or ethnicity. Eighty-eight percent of the respondents said "no" (36 of 41), and 12% said "yes" (5 of 41). The respondents that answered "yes" to this question were the only respondents to provide explanations for their answers, and all of the experiences that were shared were positive. Ethnic differences in the supervisory relationship were referred to as, "the icing on the cake" by one respondent. Other respondents concurred that diversity in the supervisory relationship had given them the opportunity to view issues from outside their own perspective, to broaden their scope, and to overcome their fears of addressing cultural differences in future relationships. The final open-ended question asked whether there was anything else regarding the nature of their cross-cultural supervisory experiences that they would like to share. Several respondents commented that their experiences working with people from culturally diverse populations had been nothing but positive. These relationships had given participants the opportunity not only to understand other people better, but also to better understand themselves and their own culture.

10 326 CONTEMPORARY FAMILY THERAPY Some other responses to this question had to do with the relatively small number of racial/ethnic minorities that are working/ studying in the field of MFT. One respondent commented that, "if you are of an ethnic minority, it is a luxury to get supervision with someone of your own ethnicity." Another respondent shared this concern about the lack of minority supervisors in the field when he said, "I believe that there is a definite need for supervisors in the MFT field from all ethnic backgrounds possible. Hopefully as the profession grows we will experience this." DISCUSSION It is interesting that respondents rated the quality of training they received in their clinical programs regarding issues of race and ethnicity as slightly above average, when only 30% of respondents have ever been supervised by someone from a different racial/ethnic background than their own. Clearly, the experience of having a crosscultural supervisory relationship in and of itself does not guarantee that students will have "better" cultural diversity training. However, based on the feedback provided in this survey, MFTs believe that there is greater potential for growth and self-awareness provided by cross-cultural supervisory relationships; and on the rare occasions that they do occur, these relationships are highly regarded and valued. The respondents who had been supervised by someone from a different racial and/or ethnic background from their own rated the nature of those supervisory experiences as being better than supervisory experiences with persons of the same background. However, no clear reasons seemed to be provided by respondents as to why the nature of the supervisory relationship was better with minority supervisors than with majority supervisors. Our findings seem to emphasize the need for greater cultural diversity in MFT training programs. Although MFTs realize the importance of multiculturalism and cross-cultural supervision in the field (82% of respondents), we are not frequently provided the opportunity to discuss multicultural issues in our training, or to be supervised by, or associate with colleagues that come from a different race and/or ethnicity than our own. This study is unique in the sense that it seems to be the first study to look at the occurrence (or lack thereof) of cross-cultural su-

11 327 ELIZABETH WIELING AND JAMES P. MARSHALL pervisory relationships in the mental health professions. It also provides some insight into the perceived quality of those relationships when they do occur. In addition, this study provides a qualitative look at how important practitioners perceive these cross-cultural supervisory experiences to be. One of the major limitations of this study has to do with sample size. Of the 250 surveys we sent out, only 50 were returned. Based on the relatively small sample size, the conclusions we have drawn must be considered somewhat cautiously. This holds especially true for the information we gathered from supervisors, since only six of the respondents currently provide MFT supervision. Another limitation has to do with the fact that nearly twice as many women returned the survey as men. Gender issues were not the focus of this study, and they were not controlled for, but it is possible that gender differences may have had an impact on the results. In addition, since the survey that was developed and used in this study was used for the first time, there is no established record of validity or reliability for this instrument. The next phase of this study will involve placing the survey that was used on the Internet. This form of collecting data may make the process of completing and returning the survey easier than it is with traditional methods. Our reason for placing the survey on the Internet is to reach a greater number of people from a variety of mental health fields. This may allow us to compare and contrast the experiences and perceptions of professionals from several mental health disciplines regarding their cross-cultural supervisory relationships during their training. The lack of opportunity to engage in cross-cultural supervisory experiences is probably not a phenomenon that is unique to the field of MFT. We believe that this study serves as a means to: (a) document the lack of cross-cultural supervisory experiences in the field of MFT; (b) to encourage future research on the effectiveness and relational processes of cross-cultural supervisory relationships; and (c) to underscore the need for more ethnic minority students to be recruited into MFT training programs. An increase in the number of ethnic minority MFTs may help to ensure that future MFT cohorts have an opportunity to work with a supervisor from a different racial and/or ethnic background than their own. It will also supply the field with therapists that are more representative of the population in the United States.

12 328 CONTEMPORARY FAMILY THERAPY REFERENCES Bernard, J. M., & Goodyear, R. K. (1992). Fundamentals of clinical supervision. Boston, MA: Allyn and Bacon. Brown, M. & Brown, J. (1995). Counselor supervision: Cross-cultural perspectives. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (pp ). Thousand Oaks, CA: Sage Publications. Carney, C. G., & Kahn, K. B. (1984). Building competencies for effective cross-cultural counseling: A developmental view. The Counseling Psychologist, 12, Cook, D. A., & Helms, J. E. (1988). Visible racial/ethnic group supervisees' satisfaction with cross-cultural supervision as predicted by relationship characteristics. Journal of Counseling Psychology, 35(3), Falicov, C. J. (1988). Learning to think culturally. In Liddle, D. Breulin, & D. Schwartz (Eds.), Handbook of family therapy training and supervision (pp ). New York: Guilford Press. Figley, C., & Nelson, T. (1990). Basic family therapy skills, II: Structural family therapy. Journal of Marital and Family Therapy, 16, Hardy, K., & Laszloffy, T. (1995). The cultural genogram: Key to training culturally competent family therapists. Journal of Marital and Family Therapy, 21, Hardy, K. V. (1993). Live supervision in the postmodern era of family therapy: Issues, reflections, and questions. Contemporary Family Therapy, 15(1), Hilton, D. B., Russell, R. K., & Salmi, S. W. (1995). The effects of supervisor's race and level of support on perceptions of supervision. Journal of Counseling and Development, 73, Kaiser, T. (1992). The supervisory relationship: An identification of the primary elements in the relationship and an application of two theories of ethical relationships. Journal of Marital and Family Therapy, 18, Leong, F. T. L., & Wagner, N. M. (1994). Cross-cultural factors in counseling supervision: What do we know? What do we need to know? Counselor Education and Supervision, 34, Martinez, R. P., & Holloway, E. L. (1997). The supervision relationship in multicultural training. In D. B. Pope-Davis & H. L. K. Coleman (Eds.), Multicultural counseling competencies (pp ). Thousand Oaks, CA: Sage Publications. McGoldrick, M., Giordano, J. & Pearce, J. (Eds.). (1996). Ethnicity and family therapy. (2nd ed.). New York: Guilford Press. McGoldrick, M., Pearce, J., & Giordano (Eds.). (1982). Ethnicity and family therapy. New York: Guilford Press. McNeill, B. W., Hom, K. L., & Perez, A. (1995). The training and supervisory needs of racial and ethnic minority students. Journal of Multicultural Counseling and Development, 23(4), McRoy, R. G., Freeman, E. M., Logan, S. L., & Blackmon, B. (1986). Cross-cultural field supervision: Implications for social work education. Journal of Social Work Education, 22, Morgan, D. W. (1984). Cross-cultural factors in the supervision of psychotherapy. Psychiatric Forum, 12(2), Nichols, W, Nichols, D., Hardy, K. (1990). Supervision in family therapy: A decade restudy. Journal of Marital and Family Therapy, 16, Pedersen, P. (Ed.). (1985). Handbook of cross-cultural counseling and therapy. Westport, Conn.: Greenwood Press. Peterson, F. K. (1991). Race and ethnicity. New York: Haworth. Preli, R., & Bernard, J. M. (1993). Making multiculturalism relevant for majority culture graduate students. Journal of Marital and Family Therapy, 19, Spradley, J. & McCurdy, D. (1987). Culture and the contemporary world. In J.

13 329 ELIZABETH WIELING AND JAMES P. MARSHALL Spradley & M. McCurdy (Eds.), Conformity and conflict: Readings in cultural anthropology. (6th ed. pp. 1-10). Boston: Little, Brown, and Company. Stone, G. L. (1997). Multiculturalism as a context for supervision: Perspectives, limitations, and implications. In D. B. Pope-Davis & H. L. K. Coleman (Eds.), Multicultural counseling competencies (pp ). Thousand Oaks, CA: Sage Publications. Vander Kolk, C. J. (1974). The relationship of personality, values and race to anticipation of the supervisory relationship. Rehabilitation Counseling Bulletin, 18(1), Vargas, L. A. (1989). Training psychologists to be culturally responsive: Issues in supervision. Paper presented at a symposium at the 97th Annual Convention of the American Psychological Association, New Orleans, LA.

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