Client-Centered Advocacy in Education and Clinical Training from the Supervisees’ Perspective

Abstract

As the field of marriage and family therapy has evolved along with managed care and the transition to a recovery-oriented approach to mental health, the concept of client-centered advocacy has become the focus of much conversation. As part of the discussion about professional competency, the American Association for Marriage and Family Therapy code of ethics proposes that marriage and family therapists (MFTs) should be committed to advocacy. Though there has been a push for client-centered advocacy in the field of marriage and family therapy, it is often difficult to operationalize the term: what, exactly, does client-centered advocacy mean, and how does it look in the various settings of clinical practice, particularly for student trainees and interns? Though there is substantial research about the social justice movement in psychotherapy and clinical counseling, and some research about client-centered advocacy in psychotherapy education and training, this research is solely from the perspective of the educator and/or supervisor. In this chapter, we present the results of a study that examined the experiences of client-centered advocacy of MFT trainees and interns that are currently engaged in clinical training. We identify the various aspects of training and supervision that are particularly helpful in terms of educating student trainees and interns about how to carry out client-centered advocacy in clinical practice. Additionally, we propose ways in which educators and supervisors can better meet the needs of students and supervisees who are engaged in client-centered advocacy throughout the training process.

Appendices

Appendix A

Case Presentation Outline (Adapted from Natrajan-Tyagi, 2017)

• 1. Genogram

• 2. Presenting problem, date of 1st contact, referral source, and why now?

  • (a) In the client’s words

  • (b) In the words of the referral source

  • (c) In your words

  • (d) Any co-created words

• 3. Assessments you will use (have used) consistent with theory

• 4. DSM/ICD diagnosis: Axis I ________________; Axis II _______________; Axis III _________________; Axis IV ___________________

• 5. Client’s contextual factors

___ Class issues? What? ______________________________.

___ Cultural/ethnic/immigration issues? ___________________.

___ Money issues (debt, gambling, unemployment) _______________.

___ Race issues _________________________________________________.

___ Gender/sexual orientation issues ______________________________.

___ Religious/spiritual issues ____________________________________.

___ Physical illness? What? _______________________________________.

___ Gender/power issues _____________________________________________.

___ Medication _____________________________________________________.

___ Other therapists/professionals involved?_______________________.

___ Other contextual issues _________________________________________.

• 6. Therapist’s Contextual Factors as they Relate to or Intersect with the client’s (Address most Relevant Factors)

___ Class issues? What? ______________________________

___ Cultural/ethnic/immigration issues? ___________________

___ Money issues (debt, gambling, unemployment) _______________

___ Race issues _________________________________________________

___ Gender/sexual orientation issues ______________________________

___ Religious/spiritual issues ____________________________________

___ Physical illness? What? _______________________________________

___ Gender/power issues _____________________________________________

___ Medication _____________________________________________________

___ Other therapists/professionals involved?_______________________

___ Other contextual issues _________________________________________

• 7. Crisis, legal, and ethical issues in the case and steps taken

• 8. Client-centered advocacy issues addressed/interventions used (see flowchart)

• 9. Systemic hypothesis for the case (Use language appropriate to your theory of choice. Please indicate your theory)

  • (a) Individual

  • (b) Relational

  • (c) Social

• 10. Therapy goals (short term, long term, for session)

• 11. Treatment plan (Based on selected theory, include theoretical terms; early, middle, and late phase treatment goals; and specific interventions for each goal)

• 12. Reflection of personal challenges, barriers, and conflicts in the therapeutic context (therapists’ own issues including positionality, family life cycle, gender, power, FOO, countertransferences)

  You will reflect on personal challenges, barriers, and conflicts that you may face in the therapeutic context. The goal is to explore these issues within our supervisory group and seek personal clarity.

• 13. Course of therapy and outcome

• 14. Questions for supervision

• 15. Supervisory feedback

Client-Centered Advocacy: Accessing Resources for Clients

Appendix B

Tips for Instructors and Supervisors on Addressing Their Own Positionality and Modeling Client-Centered Advocacy

Tips for Addressing One’s Own Positionality with Students and Supervisees

When giving examples of cases or discussing multicultural issues in class/supervision:

• 1. Talk about how you identify yourself (gender, race, nationality, sexual orientation, citizenship, religion, class, etc.). Talk about your multiple identities and their intersection. What identities of yours are most salient for you or have consequences for you? Then connect this to how it might look in regard to your students’/supervisees’ experiences and how they can use this lens to view their clients’ positionality and its impact in their lives.

• 2. Give examples of how both your privilege and lack thereof influence your everyday life. Bring it back to experiences of privilege and lack thereof in your student’s/supervisee’s everyday life. To make it more experience-near, you can talk about their privilege and lack thereof of as students/supervisees in your institution or agency and how it impacts them.

• 3. When you discuss issues of power, talk about some differences between you and your students/supervisees regarding race, gender, education, experience, status, etc. Discuss how some of these demographic identifiers lend you more/less power compared to your students/supervisees. Then discuss in what ways these differences matter. Then discuss how differences between your students/supervisees and their clients influence power dynamics between them and how that matters in the therapeutic context.

Tips for Modeling Client-Centered Advocacy

Besides helping students/supervisees find resources in the community for their clients and sharing examples of how you have done client-centered advocacy, it is important that instructors and supervisors model client-centered advocacy through the process of student−/supervisee-centered advocacy. Given below are some tips for carrying out student−/supervisee-centered advocacy.

• 1. Have regular check-ins with students/supervisees about barriers they may be facing in completing tasks or fulfilling their responsibilities in the program/agency. Refer them to appropriate resources in the university/agency that will help them overcome their barriers (e.g., counseling services, tutoring, financial aid, mentoring, training, etc.). Make sure you check-in about larger systemic issues that may be impacting their performance and consider advocating for them (e.g., if your student speaks English as a second language, advocate for the student to get more time during examinations).

• 2. Empower your students/supervisees to advocate for themselves and ask for services (e.g., change of course/supervision schedule, altering course/assignment requirements, seeking additional supervision, etc.). When students bring up these issues in class/supervision, deal with it in a nondefensive and democratic way. Open up the floor for discussion and be transparent about your decision-making process.

• 3. Encourage students/supervisees to become part of groups that advocate for them (e.g., university student organizations and regional or national units of their professional organization). Encourage them to advocate for themselves and others including influencing policies and procedures that pertain to them.