Clinical Supervision of International Supervisees: Suggestions for Multicultural Supervision

What matters in mental health care? A co-design approach to developing clinical supervision tools for practitioner competency development

Background

Specialised mental health (MH) care providers are often absent or scarcely available in low resource and humanitarian settings (LRHS), making MH training and supervision for general health care workers (using task-sharing approaches) essential to scaling up services and reducing the treatment gap for severe and common MH conditions. Yet, the diversity of settings, population types, and professional skills in crisis contexts complicate these efforts. A standardised, field tested instrument for clinical supervision would be a significant step towards attaining quality standards in MH care worldwide.

Methods

A competency-based clinical supervision tool was designed by Médecins Sans Frontières (MSF) for use in LRHS. A systematic literature review informed its design and assured its focus on key clinical competencies. An initial pool of behavioural indicators was identified through a rational theoretical scale construction approach, tested through waves of simulation and reviewed by 12 MH supervisors in seven projects where MSF provides care for severe and common MH conditions.

Results

Qualitative analysis yielded two sets of competency grids based on a supervisee's professional background: one for 'psychological/counselling' and another for 'psychiatric/mhGAP' practitioners. Each grid features 22-26 competencies, plus optional items for specific interventions. While the structure and content were assessed as logical by supervisors, there were concerns regarding the adequacy of the tool to field reality.

Conclusions

Humanitarian settings have specific needs that require careful consideration when developing capacity-building strategies. Clinical supervision of key competencies through a standardised instrument represents an important step towards ensuring progress of clinical skills among MH practitioners.

Career Barriers and Coping Efficacy with International Students in Counseling Psychology Programs

This study uses Lent et al.'s (1994) social cognitive career theory (SCCT) as a framework for understanding the career barriers and coping efficacy experienced by international master's of counseling psychology students. Grounded in SCCT, we described coping efficacy as international students' perceived capability to navigate career barriers. Using Braun and Clarke's (2006) thematic analysis, we explored the career barriers and coping efficacy of 12 international master's of counseling psychology students. The first focus area, International Journey with Multiple Barriers, included five themes: Interpersonal Stress, Language Barriers, Financial Pressures, Advising Concerns, and Visa and Immigration-Related Stress. The second focus area, Agents of Change in the Midst of Barriers, included five themes: Self-Regulating, Stepping into Discomfort, Cognitive Reappraising, Becoming a Change Agent, and Social Support Seeking. Findings demonstrated participants' coping efficacy and perceptions of themselves as agents of change. This study deepens the field's understanding of career development among international master's of counseling psychology students.

The Cross-Cultural Practicum Training Experiences of Asian International Counseling Students

Despite the call to internationalize counseling psychology and calls for improved mentoring to Asian international students enrolled in counseling psychology training programs, there is a dearth of literature to help trainers understand this population’s clinical training experiences. The present study explored the practicum experiences of Asian international students ( N = 10) in counseling psychology programs using the consensual qualitative research method. Data analysis yielded five domains: Learning Outcomes, Challenges, Resources, Behavioral Strategies, and Suggestions. Participants described how they navigated their cross-cultural practicum training in the face of unique challenges and how they adapted, as well as relied on support systems. As our participants reflected on their cross-cultural clinical training experiences, they shared the lessons they learned and provided suggestions for current and future international students, supervisors, and programs. Scholarly and practical implications for this population are discussed.

A Conceptual Framework for Incorporating Mentoring in the Clinical Supervision of International Counseling Students

There has been an increased number of international students attending universities in the United States, which has resulted in a growing number of international students in counseling programs. Cultural differences necessitate culturally appropriate supervision models for counselors and supervisors to utilize when working with international students. The authors identify and delineate the challenges and unique supervision needs of international counseling students and highlight the importance of mentoring as a culturally appropriate complementary supervision technique when supervising international counseling students. The authors propose the inclusion of mentoring with Bernard’s discrimination model of supervision as a strategy to enhance the counseling skills of international students.

Cross-Cultural Counselling Supervision in Ukraine

Counsellor educators face complex challenges in the advancement of the counselling profession internationally. One way the counselling profession in Ukraine has been developed is through the use of cross-cultural engagement between local supervisees and U.S.-trained international supervisors. This qualitative study examined the phenomenon of the cross-cultural supervisory experiences of twelve participants involved in transnational distance supervision among Ukrainian supervisees, and their U.S.-trained, non-Ukrainian supervisors. Semi-structured interviews were used to elicit participants’ descriptions of their supervisory experiences. Participants identified commitment to the supervisory relationship, the importance of felt supervisor support, shared resources to promote counsellor growth, and in-person meetings in the supervisee’s context prior to the start of the supervisory relationship as the most important aspects of supervision. The researchers highlight implications and propose recommendations for counsellor educators and supervisors desiring to implement cross-cultural or transnational supervision in different cultural contexts.