Competence in Marriage and Family
Marriage and family therapists of all races and ethnic backgrounds will increasingly be called upon to assist individuals, couples, and families who possess markedly different cultural backgrounds and therefore often different worldviews. Clients’ worldviews will influence their understanding and willingness to access mental health services, their comfort level with self-disclosure, and their expectation of therapy and the therapist. Clearly, proficient marriage and family therapy requires an understanding of these different world views.
Successful marriage and family therapy with multicultural clients requires that the therapist spend time at the onset of treatment in assessing and addressing the client’s concerns, such as the client’s feelings of working with a therapist of the dominant culture who might not understand or relate to their experiences and perceptions. There might also be a concern that their problem will not be properly understood or dealt with. Additionally, there might be an uneasiness about the therapist’s ability to view them as unique individuals, as a social unit within a family, and as a member of a cultural group (Ponterotto & Casas, 1991). This is why marriage and family therapists need to be trained to provide multiculturally competent therapy that allows clients to grow and change and reach their full potential in a culturally sensitive therapy environment.
Classroom instruction in itself is not sufficient to prepare marriage and family therapy students for dealing with the changing nature of population demographics and learning to apply the classroom knowledge with their multicultural clientele. Multicultural graduate coursework generally covers a wide variety of topics (i.e. historical perspectives, theory and models of racial and ethnic identity development, and relevant information about different ethnocultural groups) but generally there are no opportunities for clinical application. Classroom instruction can be viewed as providing the foundation which will later serve as a springboard for further discussion, exploration, and application of multiculturally competent therapy.
Supervisors can start the process of promoting multicultural competency in supervisees by assessing their: (1) cultural awareness and biases of themselves and their families, (2) knowledge (including verbal and non-verbal communication), awareness, attitudes, and beliefs of different cultural groups distinct from their own, and (3) multicultural therapy competencies. The supervisor can help the supervisee assess their own and their family of origin’s cultural awareness and bias through the use of the cultural genogram (Hardy & Laszloffy, 1995). The cultural genogram, according to Hardy and Laszloffy (1995), involves two steps: (1) getting organized—meaning that supervisees gather multicultural information, including such issues as shame and guilt about their family of origin, and then selecting colors and symbols that help depict graphically the information gathered, and (2) designing the multicultural genogram and considering some of the questions developed by the author. The multicultural genogram can then be used to explore cultural transmission across generations in group and/or individual supervision. The purpose of this exercise is to help supervisees gain knowledge about "…cultural background, highlighting how it shapes his/her cultural identity and impacts his/her role as a therapist" (Hardy & Laszloffy, 1995, p. 233).
The supervisee’s cultural knowledge, awareness, attitudes, and beliefs about different cultural groups can be assessed with such instruments as the Multicultural Awareness-Knowledge-Skill Survey (MAKSS) (D’Andrea, Daniels, & Heck, 1991). This instrument consists of 60 items, containing three subscales (Awareness, Knowledge, Skills) of 20 items each, with a 4-point Likert scale. This self report measure can be used by the supervisor to assess the supervisee’s multicultural awareness, knowledge, and skills. Examples of MAKSS questions are:
• At this point in your life, how would you rate your understanding of the impact of the way you think and act when interacting with people of different cultural backgrounds?
• At this point how would you rate your own understanding of the following terms: Culture, Mainstreaming, Pluralism, and Cultural Encapsulation?
The instrument does not assess for right or wrong responses, but rather serves as a springboard for further discussion between the supervisor and supervisee. The MAKSS is only one of several multicultural competency assessment instruments. Others are the Multicultural Counseling Inventory (MCI) (Sodowsky, Taffe, Gutkin, & Wise, 1994), the Multicultural Counseling Awareness Scale (MCAS-B) (Ponterotto, Rieger, Barrett, &Sparks, 1994) and the Cross-Cultural Counseling Inventory, Revised (CCCI-R) (LaFromboise, Coleman, & Hernandez, 1991).
For example, a supervisee, after completing the MAKSS, disclosed to the supervisor that he had never thought about some of the issues raised by the instrument and reported that as much as he had learned and enjoyed the multicultural class he took, that he had not yet internalized some of these concepts and was unsure about how to implement this knowledge when working with clients. This self disclosure served as a springboard for further exploration and discussion with the supervisor.
Multicultural therapy competencies are the next step for supervisees in embarking on the process of developing a multicultural professional identity and becoming a multiculturally competent marriage and family therapist. The supervisor needs to assist the supervisee in adding to the already complex and interactive dynamics and process of marriage and family therapy by addressing potential client concerns, such as working with a therapist from the dominant culture who might not understand or relate to their experience, perception, and presentation of the problem. The supervisee needs to then assess the clients’ worldview (the ways that couples and families interpret their world), acculturation ("a multi-dimensional and psycho-social phenomenon that is reflected in psychological changes that occur in individuals as a result of their interaction with a new culture"[Casas & Casas, 1994]) and ethnic identity (intracultural variation), which can be assessed through circular questioning. Additionally, the supervisee needs to assess, through the guidance and direction of the supervisor, the clients’ (individual and the family as a whole) level of "marriage and family therapy mindedness". Seeking marriage and family therapy and asking for professional help might not be within the couple’s or family’s frame of reference. For example, in some cultures, a wife talking about her feelings might be interpreted by her family as self-indulgence and require attention from the supervisee, who might deal with the situation through education, reassurance, and processing of the clients’ world view.
Supervisors play an essential part in the supervisee’s development as a multiculturally competent therapist. The supervisor needs to be committed to being honest about their own multicultural competencies, both with themselves and with the supervisee. Jordan, Brinson & Peterson (In Press) wrote about the importance of supervisors and supervisees bringing their beliefs, value system, and experiences about multiculturalism to their relationship and the way that they relate to one another, and also how they relate to the supervisee’s multicultural clients. This will set the stage for the supervisee to engage in honest discussions about their feelings, values, and beliefs about different ethnicities without feeling judged or stonewalled by their supervisor. If they are very different, it will likely be more challenging for the supervisor and supervisee to work together; however, in a safe and respectful learning environment, these differences can be overcome. The importance of creating a safe and respectful learning environment goes beyond supervisor-supervisee differences. It is the foundation needed to allow the supervisee to take risks and to push him/herself past personal comfort to grow and become a multiculturally competent therapist.
Karin Jordan, Ph.D., LMFT is an AAMFT Approved Supervisor, and Assistant Professor of Marriage and Family in the Department of Counseling at the University of Nevada, Las Vegas. She will be participating in the "Supervision, Education, and Training Roundtable" at AAMFT’s 59th Annual Conference.