Multicultural psychotherapy: Applying the multicultural orientation framework in psychotherapy and clinical training with Dr. Jesse Owen

This week, Dan is joined by Dr. Jesse Owen,
Dan and Jesse peruse what multicultural psychotherapy really is and how to apply the multicultural orientation framework in psychotherapy and clinical training.

The conversation explores the concept of multicultural orientation (MCO) in psychotherapy/counseling. The MCO framework consists of three pillars: cultural humility, cultural opportunities, and cultural comfort. Cultural humility emphasizes the therapist's willingness to learn from the client's cultural experiences and not assume expertise. Cultural opportunities involve recognizing and exploring cultural aspects that arise in therapy sessions. Cultural comfort refers to the therapist's ability to navigate discomfort when discussing cultural topics. The conversation also touches on the importance of understanding clients' values and beliefs, even when they differ from the therapist's own. The MCO framework focuses on the salient identities, values, and beliefs of clients and how they influence the therapeutic process. It emphasizes the importance of understanding and acknowledging the cultural values and identities of both the therapist and the client. The framework is not intended to be a social justice framework, but rather a process-based model for psychotherapy. It aims to help therapists effectively connect with clients and address their individual needs, regardless of their cultural background. MCO training can also be applied to supervision, with a focus on understanding how the supervisor's and supervisee's identities influence the therapeutic process. Machine learning is being used to develop automated tools that provide real-time feedback and training on MCO skills.


Guest Starring:

Dr. Jesse Owen

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Transcript

Hello, listener, and welcome to episode number three of the Psychotherapy and Applied Psychology Podcast, where we talk to the world's foremost researchers with the aim of learning a few applicable things while peeling back the curtain and having some fun along the way. I'm your host, Dr. Dan Cox, a professor in Counseling Psychology at the University of British Columbia. And I would like to very humbly ask, if you wouldn't mind, if you could let one person who might be interested know about the show.
You could take out your phone right now, hit that share button and text it to someone, share it on social media, or whatever is easiest for you. If you have an iPhone, the share button is a box with an arrow coming out of the top of it. And if you're on Android, share button looks like a V, but instead of the opening of the V pointing up, the opening points to the right.
At least I think that's right. I don't have an Android, but based on the internet, that's the best I could come up with. I gotta tell you how much I would appreciate it if you shared the show.
One other update, after two whole episodes, I've changed the title of the show from the Applied Psychology Podcast to the Psychotherapy in Applied Psychology Podcast. I realized that when I searched for psychotherapy, the show was nowhere to be found, hence the change. There's absolutely nothing that you have to do on your end, but I'm letting you know, because that just seemed like the right thing to do.
On to today's show. I absolutely could not be more excited to have this conversation with my excellent guest, who has really shaken up the field of multicultural psychotherapy with his and his colleagues' development of the multicultural orientation framework. In our conversation, we discuss multicultural orientation and its three components, cultural humility, cultural opportunities, and cultural comfort.
We contrast multicultural orientation with competency-based and social justice approaches, what to do when therapists and clients have different values, and integrating multicultural orientation into clinical training. There's a little bit of jargon that we use in this conversation that I just want to clarify right at the outset. We use the acronym MCO, which stands for Multicultural Orientation, and the acronym EFT, which stands for Motion-Focused Therapy.
We also talk about dynamic sizing, which I say that I'll get back to so my guests can define, but of course I don't. So, what dynamic sizing is, because I had to look this up, is it's for the therapist, them knowing when to generalize cultural norms to a client, and when not to. We also talk about the miracle question.
Common example of the miracle question is when a therapist would say to a client, assume your problem has been solved. What's different? So let's get to it.
I am thrilled to have one of the world's foremost experts in multicultural psychotherapy, Professor of Counseling Psychology at the University of Denver, Dr. Jesse Owen.
But I'm super excited to talk to you. You know, when it came to like introducing multicultural related stuff into my teaching and training of students, I always really struggled with it because my experience of it was always that, like, it was kind of this tacked on thing at the end. And it was like, you know, it would present some model or something, but it didn't really resonate with me or give me anything really meaning.
It just sort of felt hollow. And I think, and I don't even remember, to be honest with you, Jesse, how I started learning about the work that you and your collaborators were doing with multicultural orientation stuff. But somehow, it coincided with everything during the pandemic.
And when lots of stuff was happening during the pandemic, I was like, all right, I'm committed to figuring out how to integrate multicultural stuff in my class in a meaningful way. And that's, coincidentally, that's when, and I don't remember how, I really became more familiar with your work. And I was like, and it just really resonated with me.
And so, and I have been. So, it's awesome getting to actually like chat with you about it. So, but one of the things that I'm curious about is sort of what your experience was in training when it came to multicultural counseling, multicultural psychotherapy, and that sort of thing.
I'm probably dating myself a little bit here, but you know, I came up, but I got my master's in like 1999 to 2001. I had my doctorate degree in around 2005. And so, like we were skirting around cultural issues at the time.
And the one thing I did appreciate, at least with my master's training, because I was down in Miami, it was impossible to avoid culture. It was like, it was all around us. It was right there in our face.
And so, like the nice thing, the sort of the models that I had in front of me were like Jose Sibotsnik's work on family systems work and doing it in a very culturally sensitive and culturally oriented way. When I got to my doctoral program, I had the, you know, basic class where like each week was like one, like this is how you treat black people, this is how you treat Hispanic people.
I had that same class.
And like it was, I mean, the intention of it was well-meaning. And like I've known of like Daryl Sue's work for decades. And like he even tried to make it just that way, but he wanted to give some justice.
And he actually, if you read deeper into the book, he talks about dynamic sizing and like this idea that we have to make sure that we understand that this is an imperfect level of knowledge, but we got to start somewhere. And I thought that was, I didn't get that to way later because I thought the class was taught in a way that was kind of stereotyping these different groups. And it didn't make any sense.
Like, I'm not sure what, like a reflection of feelings, is that really not useful for certain cultural groups? We don't have that level of knowledge. Like, we just, as a field, we don't.
And so then that's kind of what got me started down this route of like, how do I think about myself as a therapist of color in this space? What do I really want to like convey to folks? And so that's when myself and Karen Tao and others, Karen and I were really kind of at the forefront of like creating the multicultural orientation framework.
And we started really, like she actually came up with the word orientation because we wanted to flip the script on competencies because competencies didn't make any sense to us. And now, granted, we're in a field where like competencies movement is, you know, it's the thing that we're trying to like do. But like, what is it, like if you really take that to task, what does it really mean to be multicultural competent?
And how would you ever know it? And I think that's the challenge that we have as a field, is to really think through like, that's maybe not the right framing. And I think words matter, and I think the frame matters.
And so like, when Karen and I came up with multicultural orientation, we're like, well, this is just like a lens around how people see the world. And we want people to like start seeing the world and their practice through a multicultural lens, from start to finish. And so I'm not going to give you more examples, but I'll stop there.
But I think that's kind of where my training left me with so many questions. And then Karen and I started just toying around with some of these concepts and this kind of framework. And it just all kind of made sense to us.
And when it made sense to both of us, I was like, okay, we got something here. Let's try to study it.
So, okay, so sort of a couple of pieces to pull out. And then I'm going to ask you to explain what dynamic sizing is because I have no idea. So the idea of competencies, it sort of implies here are the things you need to know.
Here are the things you need to be able to do in order to do this kind of work, right? It's sort of like a checklist-y kind of a framework, right? And where did that fall short for you?
So in my mind, one of the things that really fell short to me was when I started digging into literature, there's really no... I think knowledge is important, right? Let's start with that assumption.
But there's no studies that actually show that if you know more about any cultural group, you're going to be more effective with them. And so when you think about that, it kind of goes back to this idea of just because you know a lot of stuff doesn't mean you're good at doing it in the therapy of space. I think the closest thing along the competency route that we got behind was the awareness piece.
So knowledge, skills, and awareness. I'm not even sure what they mean by skills, because they don't really define it that well. But the awareness piece makes a lot of sense to me.
I mean, having more awareness of yourself, your blind spot, for example. That makes sense. How we operationalize that and understand it, different story, but yeah.
So that's where competencies got lost somewhere. There's really no great evidence that this matters. And if you actually look at some of the measures that we use to measure competencies, they're either therapist self-report, which I'm not sure all people that is, or it's client reported.
And one of the scales that we took the task and where we started down this measurement was one of these observer report measures that got converted to client report measure, which made no sense in the conversion. And so items like, my therapist used a variety of verbal and nonverbal interventions. I'm like, is there another kind?
What else are you measuring if it's not verbal or nonverbal? How would you, as a client, I was thinking, how would you even assess that? Or my therapist offered systematic interventions.
Like, maybe? But not likely, right? It's not likely that therapists are doing systematic interventions for every single client.
So these kind of measures got me confused, and I was like, as a therapist, if I got that feedback, like, oh, I'm not doing well because I didn't offer systematic interventions, but it wasn't even called for. Like, how would I understand myself as a therapist? So we started down the route of like, what are the actual, initially the three pillars of MCO came into the light was like, what is it that we actually want people to do from a process standpoint in therapy?
And so cultural humility, when we got paired up with Josh and Josh Hook and Donnie Davis, like, we started in on something that was kind of foundational to the MCO model, which was, you know, cultural humility as a way of being. We already were talking about this, but the cultural humility language actually worked out really well because it really spoke to what we were hitting at from the onset. And then, you know, cultural opportunities gave the what.
So since you're doing it, let me just sort of put a header on it so that way people, because what you're doing, because I think it's important, and I want folks to be able to get what you're saying, which is right now you're describing there are these sort of three facets, three pillars, three aspects of the multicultural orientation. So yeah, humility, opportunities, and comfort. So sorry I interrupted you, but I just wanted to make sure that folks knew that, because this sort of explanation is going to be the rest of, the majority of the rest of our conversation is going to come from this explanation of these three constructs right here.
Yeah, for sure. It's a culture of humility for us was the sense of like curiosity, not superiority, this kind of a non-assuming lens, but also knowing that you know something, right? So like it's not saying that you know absolutely nothing about culture, but it's about, I don't understand maybe what you have gone through based on your own identities, right?
So taking a step back and even like, hey, even if you identify with this culture, like you have the same identities, you still don't know what it looks like to walk through the days of that person's lives. And so having that sense of humility and connection and this kind of other orientedness of really, really being present for that person was a strong piece for us. Because like that's, in essence, like what we were saying with the MCO framework was it's a way of being.
And what I mean by that, if you ever read Carl Rogers' book on way of being, that was a big influence to me for this framework. Because what he was saying, he was breaking things out for his different principles of change in humanistic therapy. But like what he was really saying is like, if you get people and people get you, you will know it on a deeper level, where somebody really kind of understands you and really understands what you're going through, because you're there in a way where you're truly listening, truly connected, and that's what we wanted to convey.
And culture, humility, language, and that sense of being was really part of that. But at that point, when we came out with the three pillars, we actually started with cultural opportunities. Because cultural opportunities were the thing that people were missing.
And what we find in our research, in part, is cultural opportunities are those things that we're training people in programs, typically, to look for symptoms, to look for distress, to look for pathology. And we're not necessarily framing that through a cultural lens. Now, some programs do better than others, and some supervisors do better than others on framing that.
But if you just think about, let's take depression, for example. We train people to look for signs of loss of pleasure, sadness, changes in appetite, blah blah blah. But what we need to be doing is to say, how does depression show up differently based on gender ideology, based on racial ideology, based on political ideology?
How does this show up differently? Because depression isn't depression without the person. And I think that's the keys of really understanding how a cultural-orientating lens can really help us shape the ways in which we engage.
It's not just diagnosing depression. It's understanding what depression means for this person with this identity, with this lived experience. And I think that's the piece that we need to get back to.
Or get to, I'm not sure if back to is the right word, but get to these.
And then do you want to just real quickly, do you want to hit on comfort?
Yeah, so cultural comfort to us was the intangible, right? So the things that happen in those conversations that you could probably pick up, I mean, you know it as a person. And so when you're in that cultural conversation, are you feeling some level of distress?
Are you feeling some level of ease with the conversation? And people on the opposite side, we knew that people would pick up on this. If you ever had a cultural conversation with somebody and they're like, well, let's not talk about that.
Or like, hey, this is a little bit dicey. You can kind of get that sense, even if they don't say those words. And that's what we wanted to pick up on because it's that level of intangibleness that happens in conversations for, I mean, it could be cultural or not, but it happens all the time.
And that's what we wanted to pick up on that kind of more somatic level, that we have the observational stuff with the opportunities, we have the way of being with cultural humility, and then we have some sense of, emotionally, how you're doing. And at one time, we talked about, some people have used the word cultural countertransference and terms like that. And I mean, that's in the same ballpark, if you read the most recent literature on countertransference, they either call it reactions or countertransference.
So it's moved a little bit, even outside of psychodynamic sense. But we wanted to keep it kind of more theoretical, because we really wanted this MCO framework to be able to be applicable across different treatment modalities. And that's why it's not a theory, it's a framework.
So we're not trying to replace CBT, or psychodynamic theory, we're trying to enhance it. And that's kind of our focus.
I think it's interesting, because I didn't realize that the opportunities, cultural opportunities, is what came up first for you all. And I think, so just, so cultural opportunities, the way I think about it is like, just either when a client says something, so you know, a client talks about something related to, you know, in my family or, you know, at my church, or, you know, I don't think that men should, or whatever, right, that you sort of see that and say, like, you do, like, a follow-up. I mean, this is overly specific, but you do a follow-up with the client to say, like, oh, that's interesting.
And so you sort of just create an opportunity, or they created that opportunity, and you sort of seize it to see, like, is there a there or there? Is there something worth pursuing here? And then you let the client, with your own clinical experience, guide that, because it's possible, like, this could be a tremendously, could be tremendously important for them right now, or not at all important.
And the important thing that you do as a therapist is you follow up on it to see where it's going, or if there's a there or there.
Yeah, and you're exactly right. Like, it's that, you know, following the client, following kind of like what they're laying down and really explaining, like, what does that mean? Right, so, like, there could be some true values and beliefs connected to whatever identity that they have that will get you nowhere in therapy if you keep butting up against it, or you can work with it, right?
Like, go with where the client's at. The other piece that drove the cultural opportunities was, how do you start these conversations? Right, so, like, how do you create them, not just follow them, right?
And so when we were toying around with different terminology, you know, a lot of people use the word, like, culturally responsive therapy. And I, you know, we can part words and all this stuff, but, like, in my mind, it's not about just being responsive. It's about being oriented, that you're hearing everything through a cultural lens.
Right? So you're hearing this story, even if the client doesn't want to get into the weeds on their cultural identities, you have to know that they're living it, right? Like, you have to know that this is influencing their life in some way, shape, or form.
And so, like, they may not see, like, the forest from the trees, right? Like, I had this client who, session one, he was like, don't get me to cry. I'm not a crier, right?
So, like, and he was coming from a pretty traditional masculine lens of being, you know, kind of self-reliant, being tough. I can work through this. And, like, session six, he started to cry.
I was like, how are you feeling right now? Because I remember you mentioned that, that you don't want to be a crier. And helped me understand, he's like, I need this, I need this now, and I feel safe here.
And so, like, you know, different times, different places, you have to, like, understand where this stuff is coming from. And kind of work within it. And, you know, be supportive and understand that.
Like, if you don't see that through a cultural lens, you know, I could see a therapist pushing this guy to cry, which was not my intention at all. I was following him when where he was at, at that time, and where he needed to be. And so, like, that kind of stuff, it's important to understand, like, that's informing my way of interacting with him without even naming the masculine script that he was following, right?
So, like, it can inform your conceptualization, it can inform your interventions, but if you're not thinking of it in that way, you might do something that's just completely consistent with your theoretical orientation, which is fine, to a point, right?
Right, so what I'm hearing you say is, like, you're taking that information that you have about the client, in this case, his culture, identity, values, perception, and sort of bringing that into your conceptualization of the client, and then using that to feed your thinking. And then, so when that came up half-dozen sessions later, you're able to sort of bring that to, right, sort of bring that to him and see what's there.
Absolutely. And validate, like, you know, we all experience these emotions, right? Like, you know, do something that's encouraging, right?
Because that's what he needed at that time. But yeah, it's exactly what you're saying. Those are the moments, right?
But if you're not thinking through that lens, and let's say if you're, like, an EFT therapist, like, you might be digging into emotions that he's not ready for quite yet, right? Or, well, I could see it going a lot of different directions if not considering his masculine scripts that he was embodying.
Right. And so what, I mean, again, what I'm hearing you say is if you're an EFT therapist and in the first session when he said that, and you took it and integrated that, that that would influence, that you would sort of, you know, pull back on the reins, perhaps, of sort of some of your emotional experiencing or whatever with the client because you're aware of that. So, like, just again, it's not because this is a a-theoretical or trans-theoretical approach that, you know, you don't have to stop being a emotion-focused therapist, but you should still take that into your conceptualization of the client and then, of course, your work with the client in order to be more effective, obviously.
Absolutely. Yeah, 100%.
So, the-the-the humil- Yeah, yeah, the humility piece, which, um, if memory serves, in some of your writing and your colleagues, that y'all have sort of said, this is the more the foundational aspect of multicultural orientation framework, um, that, like, just-just, I think, to hit that. The way that I think about that is, yes, I'm the expert on mental health stuff and psychology stuff and psychotherapy stuff, but when it comes to my client's experience of life, of, you know, their-their culture, their identity, how they see the world, that, you know, I-it's, you know, I should let them be the expert on that and to learn from them to not make assumptions and to sort of, you know, when I give, how can I say this, like, yeah, to be willing to sort of value my client's experience of things, even if it's inconsistent with my expectations or perceptions of how things could, should, would be.
Yeah, absolutely. And, I mean, I think it's interesting to see, like, who gravitates to what pole in the framework. I mean, I think the culture of humility really does provide a glue to everything in terms of, like, yeah, this is how, like, take a step back.
And so, like, one of the things that influenced me a lot and why humility was a really big pillar here was I started my academic work in clinical judgment research. And reading this research, I mean, it's what you would assume, right? Like, it's just human nature.
Like, people make quick judgments about a lot of things. And as therapists, we have to make quick judgments, right? We don't have a ton of time to spend with any one client.
But the scary thing about some of this research, especially the early research, people make clinical judgments within one minute of meeting somebody. And then they do what we do as humans, which is try to confirm what we know. And don't look at disconfirmatory information all that well.
And that's where cultural humility comes in nicely, is that it should be that backstop to those kind of judgments, that we should say, what else could this be? What am I not seeing here? What's the cultural experience of this person?
How is this helpful in our understanding? And so to me, that was a great way of suggesting to therapists, you're not the expert. You don't need to be the expert, and you don't need the client to teach you anything, but you need to be a collaborator in this process and go down this journey of true curiosity and learning about this human being that's sitting in front of you and see where that gets you.
And I think most therapists think they're doing this, and I think a lot of therapists are doing it in a way. And there's times when we're not doing this, right? And we have all been there.
We've all been on autopilot some sessions. We've all been not fully present. We know that.
That's just the human experience. And yet let's think about what can we remind therapists to be and check in with themselves about how are they really orienting themselves to other people? And that's where cultural humility, I think, is a great reminder of all that.
So, okay, so now let's hit on the comfort thing. And this is the one I sort of struggle with the most of the three. The first two seem like, oh, this is great.
The comfort thing I struggle with a little bit more. Now, before I say this, I should say that, you know, I'm in the bag when it comes to MCO. Like, I'm like totally in.
And I don't know, for transparency, like me and one of my students have done some work on it. We just had a paper published. Like, you know, my student Olivia Fisher, I should give her a shout out that she has a couple more papers that are about ready to be out as well.
So I'm totally in the bag.
So my little pushback here is taken within that context.
So with the cultural comfort thing, one of the things I struggle with is that we would expect that therapists will be, when they're working with folks from different cultures, of their own, whatever that means, and who have different values and belief systems, that they're going to be a little uncomfortable talking about some of these things. But we still want to encourage them to have those conversations and to sort of push themselves in spite of and while experiencing that discomfort. So this is where I struggle a little bit, which is, are we sort of saying it's bad to feel uncomfortable or if you're feeling uncomfortable, that should be a red light not to go there because displaying discomfort is a bad thing for your client.
So I'm curious your thoughts about that.
No, that's a good question. Honestly, what we consider cultural discomfort, if you will, the other side of that coin, is really more of a sense of a signal. All of this is just a signal.
And so when you get down to the literature on information avoidance, I'll circle back around how this relates to comfort, information avoidance is this concept that's been around for decades. But basically, it's the ability to avoid information that makes you feel uncomfortable. And so one of the classic studies is they did the study on how many people came back after they got tested for HIV, how many people came back to get the results.
And you would think that the initial buy-in to even go to get tested would suggest that all of these folks are going to come back. But almost a half didn't come back to get the results, because it's uncomfortable to know the reality of certain things. And so the interesting thing about cultural comforts and how this loops back to information avoidance is that when you're in a privileged position, which I would suggest that most therapists are, by virtue of their role, maybe not societally, based on their identities, but at least in their role, you have the privilege of not going down the cultural angle if you don't want to.
You have the choice to not start that conversation, not follow that conversation. You can change topics. And unless the client is really insistent on going down that angle, you can avoid it.
And so that's the real issue for us. How do you lean into that? And it might not be lean into it in that session.
If you're really uncomfortable about it, maybe get some consultation. If you're a trainee, go to your supervisor and figure out how can you work this in, because it's meaningful information. It's something about the session or it's something about the person or something about the dynamic between you and the client that's meaningful.
And so use that as a way of understanding your client deeper, understand the therapeutic process deeper, and it can relate to a lot of different things. It really could be the cultural angle that you'll feel comfortable with. It could be your own personal beliefs and how that's coming into the room.
And so how do you use immediacy, how do you use these other techniques to help bring that to light and help you navigate that sense of discomfort? And I would say some level of discomfort is probably good. It's giving you a sense that like, okay, something's not fully aligning here, something's not quite going on.
And what we know with the alliance rupture repair literature, when there's those tensions, not even like a full rupture, but when there's those tensions in the relationship, that's where you need to process this. And that's what's helpful. And now to put it into a cultural lens is the more challenging piece, I think, for a lot of therapists, where they feel like they can't go there or they shouldn't go there.
And what we see in some of our research is that like things around political affiliations, religious affiliations, some of these deeper held beliefs are harder to talk about. And yet, we should. Rex, those are important.
So one of the classes I teach, and we have several sections of it here, is like a basic helping skills course for three other... We have a variety of students in there, so sometimes they're sort of advanced undergrads, sometimes they're kind of in between, and sometimes they're like first year or whatever, you know, early grad students, not in our program, but in like, you know, we have social work students in there, we have genetic counseling students in there. And so this is something that comes up in there that they're often concerned about, which is, so what do I do if my client has certain, let's say, values?
Because I think in a way that's kind of a more challenging construct than beliefs, even though obviously they overlap. But when they have values that are antagonistic to my own. So how do you think about that within the MCO?
Well, I think that's where life happens. And I think for a lot of us, it's easy to avoid those types of dilemmas. But what's missing in that is a true conversation.
And I feel like in some ways, maybe it's the politics here in the US or something along these lines around cancel culture. And if I say the wrong thing, I'm going to get fired, these types of really egregious things. But really, if you really boil it down, if you really want to understand somebody's values, that's great.
That's where joining really happens. And so to me, you don't have to agree with the client. There's beliefs all around that I don't agree with, but it's really interesting to know how you got there and what life lessons, who's attached to that story that gave you that value.
And that's the history that will help you understand who you're working with. Because if you think about, and this is maybe more a psychodynamic or systems-based way of thinking, but if you think about the values that we hold, they came from something. And typically, they came from an experience with people.
And so who are those people, and what do they experience? And so I think about it in that sense of a lens of like, there's a story to this. It's not just, I don't support abortion rights or whatever.
It's not just that. But there's a value and a belief in a whole system of people that are connected to that. And that's who you're working with.
It's not just the person in front of you. And so from an MCO framework, get to know that family. Get to know that value system and who's in that value system.
And is it really important for you to combat it, you know, as a therapist? I think that's a different question, but like, yeah. So that's the storyline.
And I think some people say, like, well, it's too hard for me to hear of stories when it's not consistent with my values, because I'm, you know, I have this identity, blah, blah, blah. And I frequently think, I'm like, well, that's a very me first kind of position. And as a therapist, and like deepening your way of understanding others, you're going to have to have some difficult conversation with people who don't believe the way you do.
And it's a valuable way to do this. And part of that is from my own upbringing, but like, I think some of it's just my way of thinking about the world.
So, one of the things I'm taking away from what you're saying is, when a person, when you're sort of hearing a value that you are sort of inconsistent with your own, take that as an opportunity to explore, to understand, to see what's going on there. And like that's where, that's sort of a useful and therapeutic intuition to have.
Yes, absolutely.
So, even in this conversation, one of the things that students have difficulty wrapping their head around with multicultural orientation is like, what's the thing that we're talking about? Like, when we're talking about culture, and like in your writing, sometimes culture and identity get used, you know, kind of interchangeable. And this conversation has been used interchangeably in some ways.
So, how do you think about that? Like, what is the, when you're thinking about applying, let's just say, humility, for example, like, what is the thing that we're applying humility to?
Yeah, to me, it's, and this is where, like, intersectionality comes into play, where you really have to think about somebody's cultural identities, whatever's salient to them, not what you think is salient. And what values and beliefs are associated with those identities. And so, when you think about culture in that lens, there could be an identity that's important, sure, but then there's associated values and beliefs that go with that identity, right, for that person.
And it's going to vary from person to person. The intersectionality of identities, it's key to understand. And when we first started down this route of studying different cultural things in psychotherapy, we did what most people do, check the box if you're white, African American, check the box based on gender identity, blah, blah, blah, and all that.
And those demographics are fine. But when we started to really study this in a more meaningful way, we had an open-ended field that said, what's your most salient identity? And how important is it to you?
And we had to list your top three or more identities and how salient are they to you? And they didn't always match up to what we would assume. So for instance, we did a study here in the Denver Jails, and one of the most salient identities for a sizable number of clients was their gang affiliation.
And so that's what was important to them. And so to understand what that gang affiliation means is probably something different than what we would normally put down on a demographic form, right? And so I also think about, like, you know, I had this client, it was first session, there was an Alzemont postdoc, and we don't get to choose our clients on our postdoc.
We just get people to sign to you. And my name being Jesse, it could be a girl, it could be a boy, it could be somebody else. And so this client walks in, and she goes, you know, I really want to talk to a woman.
And so, like, my identity as a man influenced, like, her salient identity as a woman at that moment, right? But if I was a woman, I bet she would be just fine going on with the session, right? And so, like, even the saliency of identity can matter on who is sitting across from you, and, like, what is really, truly important to you at that moment.
And so, like, and I think that's an important lesson to learn for most therapists is to be like, think about yourself, how you're showing up influences how this therapy is going to go and this therapeutic process. And so, whatever cultural values and identities you hold, make sure you know them and understand them, and make sure you're checking in to make sure that it's working for the client, right? Like, how this is, how these are jelling or not jelling.
Because there's a lot of assumptions that go on, and...
So, to sort of see if I have this right, when you think about it, you think about it in terms of what's important, what's salient for this client regarding their identities, their values, those sorts of things. Those are sort of... I sort of think about, like, identities and values in some ways as like a manifestation of culture.
You know, because I don't know about you, but when I think about, like, culture, I sort of think about this nebulous background thing that we all experience, right? And it's, like, nearly impossible to define. And I think about when I'm with my client that that's, you know, what their identity and values and similar sorts of...
I mean, you could even bring in personality and that sort of thing as, like, the manifestation of their culture to some extent. I don't know. So I guess that it's the salient identity values and related things.
That's the thing that you're saying is what you're... That's the that. That's the thing that you're focusing on with the client.
Absolutely. And, you know, we get some critiques on this issue. But to me, like, the reason why this is...
We focused mainly on psychotherapy and now kind of onto supervision. But, like, the key piece for us is, like, everybody has some cultural values, right? And so, like, that's what's salient.
Even if you're dealing with somebody who's from, like, a majority culture, who has a lot of privileges, those identities are still important, right? Because it speaks to who the person is. And this is kind of where, like, some of my training on personality and really focusing deep dives on personality kind of influenced this space.
It's like, the person sitting across from you, who's privileged, you know, at all rights, might have it easier when they walk out the door, sure. But they still want to be heard. They still want to be valued.
They're still in distress for whatever reason. And how you connect with that person is going to be important, right? And so, like, there's pieces of that where, like, yeah, it's going to look different based on the client.
But, like, in that moment, that person's cultural identities and values and beliefs are really important to them. And so, how do you dive into understanding that?
Right, and I think what you're hitting on is a really useful example. So it doesn't have to be sort of a, I don't know what the right language here would be, but sort of a minoritized facet of that client's culture. That it could be, you know, that it certainly could be, but it doesn't have to be.
And so to sort of key on whatever those identity, for example, those identity sort of facets are, what they're saying, you know, is important to me, or, you know, I need to be this, or I should be that. That's the things, those are the things to key on, even if it has nothing to do with anything related to a minority culture. You probably have better language for this than I do.
No, you're absolutely right. And I think that's the key. Like, you know, in our society, as a field, should we be helping minoritize clients navigate this world?
Yes, absolutely. And I think we can and we should. And this model or this framework can help do that.
And it doesn't mean that you just turn this off if the person sitting in front of you is from a more parallel background.
Yeah, totally. Yeah. And I think this is one of those things that I think that when I teach it, I struggle to get across to students.
And I don't know if that's different in 2024 or 2023 than it would have been if we were teaching this in 2015. But to help students see, it doesn't just have to be about how we usually talk about culture in the media or something like that, that it's really keying on what's important to this client, what's in this client's background and experience that's influencing them today as it relates to whatever their actual concern is. Because my client might be, their identity as an African American woman could be relating to the stress and experience they're having at work or at school, which they're coming in with, which is what we're talking about.
But it could also have nothing to do with what we're talking about. So it does matter in this context, because I'm here to help them with what they came in for, to make sure that it relates.
Absolutely. That's 100%. And all this stuff is going to influence the client, what's happening in the larger society, for sure.
And this is partly the reason why we differentiated our framework from more social justice frameworks. And there's a lot of really good social justice frameworks out there. I love a lot of them.
That's my top 10 list, for sure. And they're trying to, you know, Suzette Spikes said this really eloquently, like social justice is about creating social change. And could, you know, helping a client, you know, navigate the world better create social change?
Sure. But if you really dig deep into the social justice frameworks, they're talking about larger systemic changes in society or groups or different kinds of facets that typically, like most psychotherapy sessions are not really focused on. And so like, do those models if that's what you want to do social change on, because they're great.
They're fantastic. I love them. And understand where this kind of MCO framework kind of fits into the psychotherapy space, because it was intended to be more of a process based model or framework, at least for psychotherapy, when we first started not to try to create social change.
So I think this is important. So I hadn't really thought about it in this way. So this is actually very helpful for me for thinking about it and sort of separating sort of a social justice framework from the work that you all are doing, which I think of as more as how can I optimally help this person who is sitting in front of me right now?
Yes, 100%. That's what we were focused on and what we continue to be focused on. Mainly because I think, you know, I think some therapists say, oh, well, I'm doing socially, you know, I'm doing NCO work, so therefore I'm doing social justice.
And I think that conflation is not accurate. I just don't think they're the same. I think social justice frameworks are a larger calling to like change environmental, political systems that are unjust and continue to be unjust.
So I hesitate to ask this question, but since you're here, I feel like I have to. And if it's no good, we can just delete it.
But I'm curious about, because I'm sure you've thought about this a lot in a lot more of a sophisticated way than I have, applying social justice frameworks in psychotherapy.
Yeah, there's been some writing on it. I'm just not convinced that... I don't know what would be...
If it's applicable, sure. If a client is facing social injustice, maybe in their workspace, maybe in society at large, sure, maybe you can work with a client to do some of that change. But my experience has been most clients aren't coming into therapy to be like, help me change society.
I want this law changed, and how can you help me get there? That's not been my experience for most of my clients. Most of it's relationship distress, depression, anxiety, some psychosis here and there.
That's been my experience in my practice, which has been not devoid of these societal pieces. But they're not asking for me to do something larger, more systematic change. And so it could be that you get inspired by a client to change, try to help child protective services do things differently or help this system do things differently.
That's great. If that's your personal calling, do it. But I doubt most clients are like, yeah, let's do this together.
That's not been my experience.
So all right, I'm going to ask you one more question, just because frankly, this is very much selfish, just because it's like, oh, somebody's really thought about this stuff a lot that I can pick his brain on. And again, this is again going to be maybe a little pushing it. So if this doesn't turn out well, we can always delete it.
But I guess I'm curious about your thoughts because our field, so you and I share a field of counseling psychology, that counseling psychology has become increasingly, over the years, I mean, it always has, but has been sort of increasingly social justice focused. And I would say that there's been, and there's been some writing on this, that it's moved from less counseling or psychotherapy focus to more social justice focused. I'm curious about your sort of high level thoughts about that.
I mean, I think whatever people want to do, whatever they want to focus on, like, that's great. Like, I mean, I think counseling psychology has so many different branches underneath it and different kinds of specialty pieces that it's a big tent. So there's a lot of space for a lot of people.
I think that's a good thing. I think that the focus on social justice and more multicultural oriented type of training, I think it's also a great piece. I think we need to not lose sight of who we're training to.
Some 90 plus percent of our graduates from doctoral programs are going to be seeing patients. They're going to be supervising folks, most likely. They're going to be seeing patients at some capacity.
And so what we need to also remember is what pays the bills. In academia, I'm sitting here in a color coded bookshelf, and it's really nice that I have this job where I can spend the time just thinking about these topics. But at the end of the day, if I wasn't sitting in this room, I would have to see patients to make a living.
And I think there's a reality to that that we must not forget as trainers. Yes, we can train people in social justice stuff, and we also need to train people to be really effective psychotherapists.
That's interesting you say, because that's been my experience as well, and my thinking about it as well, which is even the students who do go into research, many of them get into the program because they're interested in counseling psychotherapy, maybe assessment, but these very applied, in this counseling psychotherapy world, and that is what, I don't know, and I think a lot of times students, when there's opportunities to engage in research that's related to psychotherapy, they light up because it's like, oh, great, this is why I got into this. And so that's one of the things that I've thought about too, particularly as some programs become, would self-identify as social justice oriented.
That in the real world, there aren't many jobs for that. And so it becomes, you know, and it's not to say that those programs shouldn't do that. And in a way, it's actually really nice when those programs overtly stay, this is what we are, because then people know, right?
So people can make good, informed decisions. But that, yeah, I just think about that, like, in terms of why the students, why the graduate students are coming here and what they're wanting, and that a lot of it is based around doing psychotherapy.
And, you know, for a lot of those programs that I know of, at least, some of the faculty are doing research in communities, and so people can get kind of, not a specialization, but more in-depth training with certain communities. And I think that's fantastic. That's great.
Like, if that's your passion, do it. And find that program, find that professor or professors who are doing that work, and go train with them. That's your, I mean, in some ways, grad school is really hard, and it's also kind of a selfish time for trainees, right?
You get these four or five years, maybe six years, to like just focus on what you want to learn in learning. And like, you know, maybe this is old jaded professors talk, but like, I don't get that luxury anymore, right? Like I have to do what I do.
Yeah, totally. I often refer to graduate school sort of a choose your own adventure. All right, so just a couple more questions before you wrap up.
So one of the things that you had talked about doing work now with supervision, so just sort of a practical question, you know, what does MCO training look like? Or what could it look like?
Yeah, good question. So I think it starts with like, if you're a supervisor, it starts with the questions that you're asking. And so one of our studies that we did, Matt Wilcox led this study, and what we did was adapt to some of our measures, our MCO measures for supervision.
But we specifically asked, how is your supervisor doing with you and your identities versus asking about your client's identities? So basically, try to differentiate how much are you guys talking about your client's identities and how that relates, and how much are you talking about yourself? And it turns out that supervisors are more comfortable talking about client's identities and cultures than they are inquiring about their supervisor's identities and cultures, which kind of makes a little bit of sense.
You know, it's always easier to talk about people who are not in the room, and I think that's the hallmark of supervision in some ways. But I do think that there is something to be learned by that, right? What MCO supervision could look like is really making sure that you are putting a supervisor, putting yourself out there, and understanding how your identities are influencing this supervisee.
First off, second, to understand how that interaction is, and then thirdly, in the parallel process way, understand a little bit about how that interaction between you and your supervisee is interfacing with that client, right? And so having that lens and starting with that lens can help understand what the relational dynamic is. And obviously, this is going to look differently based on the supervisee's level of development and all of that.
So if you're seeing your first client and you're trying to process through all of that, that might be a lot to deal with when you're just trying to get through that first session and make it fluid. But as it starts to develop, you can start to think about how can you roll some of this in and how can you start the conversation even from day one about, hey, this is going to be influencing us, even though we may not talk about it super directly at first, this is, I'm aware of this, we should be aware of this, and we should be able to name things that are coming up for us, right? Because even if you think about it, one of the supervisees' major complaints about a supervisor is they don't align on their therapeutic orientation.
So the supervisor is suggesting, hey, go do homework assignment or ask the miracle question or blah, blah, blah, and the supervisor is like, I don't like that. But the subtle conversation about that truly is our values are not aligning about how change happens. And those values about how change happens is a cultural conversation.
Because how you believe change happens in this world is culturally based. It comes from however you grew up, whatever family you grew up in, however you understand that. And that is a different conversation than just saying, I don't like the miracle question.
I don't like doing the empty chair technique. There's something about those techniques, those theoretical orientations that are culturally based. And so why is that the case?
And that's where I think supervisors can align better, is by having the cultural conversation. Where do your beliefs come from about change? And going down that route.
So one of the things I'm hearing you say is to bring it, I always sort of say this, which is like bring it into the room. So for the supervisor to bring sort of that process that's occurring into the room there, will facilitate training, how to do it, will facilitate the trainee learning how to do it in the room with their client.
Yeah, and what we find is that their supervisors who are more culturally humble, for instance, have supervisees who disclose more stuff. And that seems simple and that seems obvious for sure. And it's a good reminder that this is a thing that I've been harping on recently, is that less than 1% of all sessions that a trainee goes through, unless it's a live supervision model, are ever seen by anybody besides the client.
And so if you think about that as a field, and it goes down even lower after licensure, I'm guessing close to 0%. And so what we're really doing as a field is that we're training people to talk really well about therapy. We don't necessarily know how well they're doing most of the time, but if they sound really smart in supervision, a supervisor is going to be like, oh, that's a great conceptualization.
They could have this whole thing, deep psychodynamic counter-transference relationship and all this other stuff they're talking about. They could have done this complete psycho-ed that whole session. You just don't know unless you watch.
And there's some tools out there to help people get a better understanding of psychotherapy now that we have before. But I do think that when it comes to some of these pieces about disclosure, we really need supervisees to be able and feel comfortable about disclosing what's happening in the session and also comfortable enough to say, this doesn't fit my values, or this is not aligning with how I see the world. And that's a hard thing to say, unless you have a really great relationship with your supervisor.
And I think supervisors need to figure out, what are you really evaluating people on? So in our program, and I think consistent with most programs, supervisors fill out an evaluation. What are they basing that evaluation on?
And if you think about it, it's probably maybe 10 minutes of a session every week, if at best, at best, I would say. And so now we're evaluating students on their cultural competencies based on maybe one or two clients' sessions that were reviewed. Like, literally, think about the ramifications of that.
That's a lot of judgment that we're making on very slim data.
So sort of towards the end of this here, what kind of pushback have you gotten? This model, this orientation is sort of, it does differ from traditionally how we started at the outset of this, how traditionally we've been taught to deal with culture in psychotherapy. I'm just kind of curious what the field's reaction or at least as much as they've told you, what the field's reaction has been.
Yeah, I mean, at first, one of the things that we got some feedback on was that it wasn't socially just as focused enough, and it wasn't intended to be. So that's, I mean, mission accomplished, I guess, in some ways. And I can still see how some of the tenets could be used in some of the social justice frameworks that are out there, right?
Especially cultural humility. How do you engage communities? How do you approach communities?
I think some of the same principles have been in the literature for a long time. I think the other piece is, you know, we sometimes get feedback that it's not prescriptive enough. And I was like, it can't be prescriptive.
So some of the folks from the culturally adapted treatments approaches, where, you know, you take CBT and then you adjust it for a specific cultural group, those are much more specific in terms of what to do in session. Kinda. But not really.
If you dig deep enough, it's basically cultural opportunities just written down. And I think the other criticism that we've gotten over the years is that we're diluting the competencies. So by not focusing on competencies, that we are somehow making white people comfortable now with culture because of this framework.
And I hear that feedback in a couple different ways. In my mind, I want people to be engaged with this material in any way they can.
And I used to rail against the competencies movement, but now I'm like, you know, if you're studying multicultural competencies, great, do that. Let's do more studies on this area. Like, there's no limitation to how much knowledge that we need to have in this space.
I mean, if you think about it, like the Working Alliance and its relationship to therapy outcomes, over 250 studies at this point, you know, that we haven't met analyses. Multicultural orientation and multicultural competencies, not even in the ballpark of that. And most of that research has been, you know, even a lot of my own, has been like cross sectional studies or retrospective studies, and very few perspective studies like the Working Alliance literature has.
And so we need to get to a space where researchers across the spectrum of psychotherapy are as comfortable as dropping in a cultural humility measure as they are an Alliance measure. And I think that's the piece where we need to get to. And if you're studying it from cultural humility lens, if you're studying it from a multicultural competency lens, like we have measures for you.
We have these new brief measures, like it's out there, and I'm willing to share any and all things, because I really want to see this field grow. Like I don't make money on this stuff. I'm willing to give it out, and this is why I'm here with you, Dan, and this is why I love this work.
So to wrap up, you and I were talking just briefly before we started about some of your current stuff that you're doing and what you're excited about, and you were talking about some of your machine learning projects that you're doing. So could you catch me up on that stuff?
Yeah, so after Tim Anderson did his work on facilitative interpersonal skills, which is basically, if you're familiar with this space, therapists see a client, and they say the client sells a brief statement, and then you respond as a therapist. So it's all really micro-based training. And so he developed some videos.
He did some great studies, and it predicts a lot of good things in therapy outcomes, as you would imagine. Therapists who are better at facilitative interpersonal skills, like empathy, warmth, persuasion, alliance building, those things then predicted their therapy outcomes. So I got inspired by that.
So we developed some videos where people respond to these, again, brief cases, but they're all culturally based. So Tim's original work, all the clients were whites, and a lot of the pieces within that, he's now developed some more clips, and there's other groups out there, like SkillCenter, if you're familiar with that, I can drop you a link on that. They have a ton of videos, over a thousand videos, I think, at this point.
So anyway, there's a lot of people using this kind of technology. And so what we did, one of my former students, Dr. Shakira Haywood Stewart, she developed this, we developed a coding manual. And so we coded like 800 videos, kind of a labor of love.
And we validated this assessment tool, and then we sent it over to our friends over at Listen, who's a company that does a lot of machine learning, a lot of cool stuff.
So just sorry to stop you real fast, but you developed an assessment tool that assesses what?
It assesses MCO. So in these clips, how much the therapists are applying, manifesting multicultural orientation in their work?
Our three pillars, humility, comfort, opportunities. And then we thought, I wonder if machine learning can actually predict this as well. And it turns out the answer is yes.
And so a lot of people thought, how do you predict something like this? And so it turns out we just published this paper looking at machine learning predicting the MCO framework. And it does pretty well.
It's not perfect, right? It's not anywhere close to humans, and this is just one sample. So anybody out there who knows machine learning knows that your models are only as good as the samples that you train the data on.
And so we're now currently looking at expanding them. We developed some new tools and some more videos. We've got them professionally done.
And they look great. We have a whole training module, five modules. It runs you all through the MCO framework, and you get to practice on these mock clients.
And so what we're going to do with that is train some new models for machine learning to see if we can provide, in real time, feedback to folks to see how well they're doing with MCO. Because as you know, as any educator knows, you don't have enough time to watch every single video, every single response for all your students. It's impossible.
So it's about scalability, and that's what we're shooting for, is how can we train people in MCO, provide them real time feedback based on machine learning models, give them some encouragement, give them some more async stuff. And it's getting good reception at this point. We're starting to get some more responses on it.
And that's kind of where we're going in this next couple of years. We're going to get this work done in a place where it's scalable for folks.
So this is the... And tell me if I'm wrong here, but to sort of summarize here, what you're developing is... The idea is a person, a trainee or a professional doing continuing education or something like that.
The idea is that they can log on to some platform, they'll get some training, and then they'll be shown sort of mock video clips of a client sort of saying something having to do with culture or identity. And then based on the training, the idea is then the therapist or whoever is the actual person in this interaction will respond to the video, and then the system, the algorithm, the whatever, will then watch their response and give them feedback within seconds or a couple of minutes that will say, hey, this is, you know, here are your scores on, you know, cultural opportunities or cultural comfort or whatever. And then, and perhaps even, you know, here's your score based on this response you gave here or that response you gave there.
So the idea being it's an automated system so that me as trainee or me as therapist who actually wants to get better at this, I can access this training and actually get feedback on what I'm doing in a convenient way, because I can do whatever I want because I don't have to, I'm not reliant on anybody else, but also theoretically on a cost-effective way, because I don't need, you know, Dr. Owen there giving me feedback and he's going to charge $150 an hour because he should. But it's just, so it's all automated, so I can get this training and get feedback on what I'm actually doing and then work to improve what I'm doing through this automated system. Is that a reasonable encapsulation of what it sounds like you're doing?
Yeah, 100%. And we're also developing some videos to show MCO-focused responses. So getting feedbacks won't they?
But if you don't know how to change it, that's, I mean, you can keep going and going and going and be like, what do I need to say? And so we're also providing some model responses as well.
So I've thought about this a lot in terms of like, you know, like in the class that I teach in terms of training basic skills that, you know, we have a couple of assignments where we go through and actually go through the transcripts and give feedback. But it's similar to what you were saying earlier, where, you know, if they have, if this, you know, the students done 10, 20, 30, 40 hours, whatever, of practice in this class, and in total, we're giving them feedback on, you know, we're giving them really good systematic coded feedback on a half an hour of these, you know, dozens of hours that they've done. And that it's like, you know, wouldn't it be great to have tools like this?
So that way, you know, whether it's just out of their own keenness to get better, or as part of assignments, that they could be getting this feedback. And even if it's only, you know, kind of 80% right, that that's hugely helpful, and they can learn a lot from that, because they can just get so much more feedback.
Yeah, absolutely. And what we've seen, at least, you know, our prelim kind of findings for like the usability, accessibility. People like it because of exactly what you're mentioning.
Like, they can do it on their own. You know, the feedback, we don't have the feedback yet, you know, built into the system. But like the notion of just practicing and, you know, we do it in the same way we practice and share.
So like we have partners. So like I always talk about like, do you have an MCO buddy? Like, and what would that mean?
So like what an MCO buddy to me means is somebody who's able to be like giving you the real feedback, right? Because a lot of students, when they give feedback to each other, they're very kind, which is nice, which is very, very nice and very appropriate. And you also need somebody to be like, yo, you didn't say that really well.
You could come in across a little arrogant, like you need somebody in your space that's able to say that, or like, hey, that sounded a little misogynistic. Like you need to tone it down. You need somebody in your world that can give you that real feedback.
And it's sometimes not always the instructor, because they may not be always saying to your point, all those hours of training. And so, again, like this is a tool to kind of help build in an MCO buddy, and that's kind of what we're shooting for.
I mean, I think it's fantastic. And I think that this is such a useful use of this sort of technology, and it's so available now, and it's becoming increasingly accessible to folks. And, you know, I mean, it's one of the advantages of being a faculty member in 2024 instead of in 1984, because you've spent a decade or two sort of really developing with your collaborators this theory that's really very practical.
And so people can have access to it and learn from it in ways other than reading a chapter in an edited book or an article or seeing you in an academic talk. But they can actually, you know, this allows the actual clinician who's working nine to five and who, you know, frankly, they're not going to read the article. They probably don't even have access to the article.
Then they can actually like learn from, you know, the countless hours you and your collaborators have put into this and actually be like, you know, where the rubber meets the road, they can learn how to apply it in their work with their clients. Yes, absolutely.
And that's our hope.
That's wonderful. Well, Jesse, I can't thank you enough. And we're going to do a real quick fake sign off here.
And then we'll just, you know, catch up for a minute afterwards. But this has been wonderful. We went down some, you know, some rabbit holes I didn't expect to, which was I think was great.
So I really appreciated Jesse.
Yeah, of course. Thanks for having me.
First, a big thank you to Dr. Jesse Owen for sharing his invaluable insights. I feel incredibly fortunate that he joined us. I also want to give a quick reminder that if you enjoyed today's episode, please consider sharing it with others.
Stay tuned for some extraordinarily impressive guests that are lined up for the upcoming episodes. I honestly have to pinch myself. I'm so excited that I get to talk to these folks.
But until then...