Statement on Culturally Responsive Training, Service Provision, and Clinical Supervision for Marriage and Family Therapists

California Association of Marriage and Family Therapists
June 6, 2021

The California Association of Marriage and Family Therapists (CAMFT) reaffirms its values of integrity, accountability, transparency, inclusiveness, and collaboration. We are committed to racial equity within our organization and the promotion of racial equity in training, mental health service provision, and clinical supervision.

The events of 2020 included a global pandemic which disproportionately, negatively affected the lives and livelihoods of Black, Indigenous, and People of Color (BIPOC), as well as widely publicized, violent killings of unarmed Black Americans. These events and social dynamics have forced us to reckon with the history and current context of cultural, interpersonal, systemic and institutional racism endured by BIPOC in the United States. We denounce racism and racialized violence in all forms, in the strongest possible terms. While we recognize that racialized violence and oppression in the United States is not new, we are more committed than ever to supporting BIPOC communities in the battle for justice through allyship and the promotion of equitable access to quality mental health services for BIPOC.

While diversity in the United States is growing, with BIPOC making up 42.1% of the United States’ population in 2019 (US Census Bureau, 2019), racial oppression and racial disparities in access to quality and effective health care and mental health care are growing in parallel. The Centers for Disease Control (CDC) have declared racism a serious public health issue (CDC, 2021). The stressors impacting communities of color loom large with BIPOC significantly less likely to seek professional mental health services, less likely to receive the minimum standard of care once engaged, and more likely to discontinue professional mental health services before the recommended treatment is completed (Fortuna, Alegria, Gao, 2010; Jackson, Neighbors, Torres, Martin, Williams, & Baser, 2007; Snowden, 2001). By and large, these racial disparities are the consequence of more than a century of mistreatment of BIPOC in medical and research settings in the United States. As a thought leader for mental health, CAMFT acknowledges the importance of adding our voice to illuminate these growing challenges associated with racial injustice and inequity in the field of mental health and to join the conversation regarding the need for culturally responsive training, service provision, and clinical supervision.

Given that cultural responsiveness and cultural humility are the benchmarks for ethical and effective clinical practice and lead to better therapy outcomes for BIPOC, we encourage marriage and family therapy training programs, therapists, and supervisors to consider the implementation of these practices throughout the different stages of the therapeutic process as well as the different stages of trainee development. Cultural responsiveness is characterized as a therapist's ongoing commitment to gaining awareness, knowledge, and skills that can promote optimal functioning in diverse clients with varied clinical presentations, with an understanding of the impact of societal and institutional systems (Sue & Sue, 2003). Cultural humility requires “having an interpersonal stance that is other-oriented rather than self-focused, characterized by respect and lack of superiority toward an individual's cultural background and experience" (Hook, Davis, Owen, Worthington, & Utsey, 2013; p. 353). The goal for any MFT or mental health clinician should not be expertise through factual knowledge, but a commitment to lifelong learning, engagement, and self-reflection throughout one’s personal life and career.

In this context, we encourage the CAMFT community to focus on three aspects of multicultural counseling competencies in training, clinical practice, and clinical supervision (Arrendondo et al., 1996; Sue & Sue, 2003):

1. Awareness of one’s assumptions, values, and biases and the ways these aspects of our own identities influence therapeutic and supervisory relationships. Therapists must attend to issues of power, privilege, and oppression in the context of clients’ environments outside of the therapy room in addition to the ways in which these constructs influence the therapy process in the room.

2. Knowledge and understanding of our own worldviews and values as well as the worldviews and values of diverse clients, trainees, and colleagues. It is important for MFTs to understand the shared experiences of BIPOC communities while also attending to the uniqueness each client and/or family brings to the therapy context.

3. Developing skills inclusive of relevant and values-based assessment, diagnostic, prevention, and intervention strategies and techniques that align with the values and worldviews of our clients. This includes ensuring access to culturally responsive, evidence-based practices for BIPOC clients.

The CAMFT website includes a number of important resources focused on culturally responsive mental health care. Visit https://www.camft.org/Resources/Anti-Racism-Educational-Resources to access these resources.

This statement was created in collaboration with BARE Mental Health and Wellness, LLC, for publication at www.camft.org. Individual contributors to the development of this statement include:

• Jessica Graham-LoPresti and Tahirah Abdullah-Swain, Directors of BARE Mental Health and Wellness, LLC
• Nabil El-Ghoroury and Holly Daniels, CAMFT Executive Staff
• Robin Andersen, Juan Gavidia, Maureen Houtz, and Lisa Romain; CAMFT’s Social Policy Task Force

Any correspondence or inquiries regarding CAMFT Social Policy Statements should be addressed to communications@camft.org.

The CAMFT Board of Directors has prioritized the publishing of Social Policy Statements to raise understanding and awareness about the impact of social and systemic issues on mental health and well-being, and to emphasize the importance of culturally responsive training for mental health clinicians.

CAMFT develops these positions and responds to social issues relevant to the practice of psychotherapy, mental health policy, and social concerns impacting the mental health of individuals, families, and communities in California in order to guide the profession, amplify the voices of marriage and family therapists, educate the public, and influence decision makers.

CAMFT is aware that social justice issues are dynamic developmental processes responsive to evolving social, political, economic, and other world circumstances, as well as clinical, ethical, and legal considerations. This statement is both a commitment on the part of CAMFT to address these issues and intended to provoke discourse and evolution in recognition of the realities of members of all communities.

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References

Arredondo, P., Toporek, R., Brown, S. P., Jones, L., Locke, D. C., Sanchez, J., & Stadler, H. (1996). Operationalization of the multicultural counseling competencies. Journal of Multicultural Counseling and Development, 24, 42-78. https://doi.org/10.1002/j.2161-

1912.1996.tb00288.x

Centers for Disease Control and Prevention. (2021, April 8). Media statement from CDC Director Rochelle P. Walensky, MD, MPH, on racism and health [Press release]. Retrieved from https://www.cdc.gov/media/releases/2021/s0408-racism-health.html.

Fortuna, L., Alegria, M., Gao, S. (2010). Retention in depression treatment among ethnic and racial minority groups in the United States. Depression and Anxiety, 27, 485-494. https://doi.org/10.1002/da.20685

Jackson, J. S., Neighbors, H. W., Torres, M., Martin, L. A., Williams, D. R., & Baser, R. (2007).

Use of mental health services and subjective satisfaction with treatment among Black Caribbean immigrants: Results from the National Survey of American Life. American Journal of Public Health, 97(1), 60-67. https://doi.org/10.2105/AJPH.2006.088500

Snowden, L. (2001). Barriers to effective mental health services for African Americans. Mental Health Services Research, 3, 181—187.  https://link.springer.com/article/10.1023/A:1013172913880  

Sue, D. W. & Sue, D. (2003). Counseling the culturally diverse: Theory and Practice (4th ed.). New York, NY: Houghton Mifflin.

U.S. Census Bureau. (2019). U.S. Census Bureau Quick Facts selected: United States. [Fact Sheet]. https://www.census.gov/quickfacts/fact/table/US/PST045219