Introduction

Despite a history of working towards providing culturally competent and sensitive care, the field of marriage and family therapy (MFT) has long been criticized for its focus on the White, middle-class family. Additionally, MFT theories are arguably more centered on the dominant, White American cultural experience (McGoldrick & Hardy, 2019). In recent years, criticism has also focused on training White students to provide multicultural counseling to diverse populations and focusing less on the training needs around cultural competency and cultural humility for students of color (Pieterse et al., 2016; Pulliam et al., 2019). Many students of color have criticized their MFT training programs for lack of representation, as well as many programs’ reliance upon students of color to provide education to their White peers about issues of privilege and oppression (Erolin & Wieling, 2020). These training programs are at best not helpful to students of color and can be harmful (Erolin & Wieling, 2020).

Students who wish to be trained to provide marriage and family therapy should receive training that is useful and relevant. Programs should provide training that is not just focused on training White students, but also provides training that is applicable and prepares students of color to provide marriage and family therapy to diverse populations. Multicultural counseling courses are often focused on addressing issues of power and privilege with regard to students’ different social identities; however, when the majority of students in a class are White, the focus tends to be on owning the privilege of whiteness (Pieterse et al., 2016; Pulliam et al., 2019). In order for students of color to be trained equally and equitably, the focus needs to change to provide training and development for all students.

Unfortunately, there is little to no research to guide this transition. Research identifies that it’s important for clinicians of color to feel safe in their training environment (Pieterse et al., 2016; Pulliam et al., 2019). It is also apparent that a diverse faculty is important for the success of diverse students (Pieterse et al., 2016). However, there is no research that addresses how students of color develop the skills they need to provide multicultural counseling.

This study began the understanding of what would be helpful for students of color while they train as marriage and family therapists. This study utilized a phenomenological design to understand the experiences of the participants. Semi-structured interviews were conducted with eight conditionally licensed or fully licensed clinicians of color to discuss their experiences in their multicultural counseling courses as well as what they learned after their graduate program that would have been helpful for them to learn before they began practicing. The interviews were transcribed and analyzed, and emerging themes were identified. The resulting data will inform future studies and future training practices.

Theoretical Framework

The theoretical framework for this study was critical race theory (CRT) because of its focus on the impacts of racism on individuals and communities. CRT provides a structure for considering how clinical programs are impacted by racism and how clinicians of color view these macro and micro limitations within their training structure. Further, recent research utilizing this framework has also focused on the experiences of people of color in educational settings (Amiot et al., 2020). Since the focus of this research was around improving clinical training for MFT students of color, the theoretical framework fit nicely.

CRT asserts that racism is ordinary and can occur in obvious and subtle ways for the benefit of all white people (Delgado & Stefancic, 2017). It is embedded in our society’s laws, institutions, and everyday life. Academic institutions are not exempt from the influence of racism despite efforts to be so. CRT asserts that this is because the often-subtle policies and procedures put in place in institutions make racism hard to acknowledge and address. Further, because these policies benefit so many, it is even more challenging to remove them. Ultimately, CRT emphasizes the importance of dismantling institutional racism in order to heal the trauma that people of color have experienced for generations. One of the ways CRT believes institutional racism can be dismantled includes sharing counter-stories, the experiences and viewpoints of people of color. This study aimed to amplify the voices of MFT’s of color and share their experiences.

Literature Review

There have been several studies exploring students of color and their experience in their master’s training programs. Across these studies, students of color identified that the strategies used to develop self-awareness around issues of race and diversity in their master’s program were helpful in building their own self-awareness (Erolin & Wieling, 2020; Laszloffy & Habekost, 2010; McDowell et al., 2003). However, they also noted that they did not feel as though it helped them become more competent in providing therapy services to clients from a different background than their own (Erolin & Wieling, 2020). This lack of awareness of the clinical students’ background was exacerbated by a lack of marginalized voices throughout the curriculum. Some students felt as though discussions around diversity were present to simply meet the accreditation standard instead of being meaningful to therapist development (Erolin & Wieling, 2020; Pulliam et al., 2019). Overall, students of color rated their training around culture and diversity as poor (Erolin & Wieling, 2020).

Helpful Supports

Students of color have also reported some positive experiences in their counseling programs around different supports that have been beneficial to them. First, it is important for students of color to have access to diverse faculty (Erolin & Wieling, 2020; McDowell, 2004; Pieterse et al., 2016; Pulliam et al., 2019). Students reported negative experiences with White faculty and feeling dismissed, but when they had an interaction with a faculty member from a similar background as their own, they felt validated and empowered in their experience (Erolin & Wieling, 2020; McDowell, 2004; Pieterse et al., 2016). Second, students stressed the importance of a diverse peer group (Erolin & Wieling, 2020; McDowell et al., 2003; Pulliam et al., 2019). When a cohort is diverse, there are less experiences of tokenism and stereotyping throughout the training program as well as increased racial awareness (Erolin & Wieling, 2020).

Addressing Racism in Therapy

Therapists of color have the unique experience of having to manage instances of racism in session with White clients (Bayne & Branco, 2018). Based on the above reviews of students of colors’ experiences in their graduate programs, it appears that many programs do not adequately address experiences of racism students of color may experience in clinical settings. Bayne and Branco (2018) found that clinicians of color consistently experience micro-aggressions in therapy with White clients. The first theme to emphasize is that clinicians of color prepare for micro-aggressions and buffer them as they happen (Branco & Bayne, 2020). This preparation and buffering comes from the idea that clinicians of color are used to experiencing micro-aggressions, and they take it in stride with the rest of their life. Clinicians of color also noted that micro-aggressions are covert as well as overt. Some White clients will make blunt racist comments in front of them while others will make a vague comment about how they look or present. Sometimes, this includes questioning their competence as a therapist. Lastly, clinicians of color seemed split on how to respond to different instances of micro-aggression. Some clinicians did not respond at all, while others would ask follow-up questions and still, others would directly address the issue.

This study indicated a need for training around addressing instances of racism in session with clinicians of color. Branco and Jones (2021) proposed a method for responding to micro-aggressions in session with White clients, but there is no research on the effectiveness of this method. Therefore, further research is needed. Based on this information, it seems that learning how to address instances of racism in session is a needed skill set for clinicians of color to develop as a part of their multicultural counseling competencies.

The Evolution of Cultural Competence

There is a wealth of literature in clinical counseling fields around the importance of being able to provide appropriate therapeutic treatment to diverse populations through the lens of a White clinician (Haskins et al., 2013; McDowell & Hardy, 2019; Katafiasz & Patton, 2021). The first term to be largely researched and referenced is cultural competence. Cultural competence was initially largely focused on understanding different cultures and value differences can affect treatment (Sue et al., 1982). However, as the concept of cultural competence has been criticized for only focusing on other cultures, which tended to perpetuate stereotypes, and was challenged with the notion that competence implies an end to development, new terms started to surface that embraced a more comprehensive recognition of working with differences (Fisher-Borne et al., 2015; Kissil et al., 2013; Mosher et al., 2017; Niño et al., 2016).

Cultural sensitivity and cultural humility are the two most frequently used terms that emerged from the criticism of cultural competence (D’Aniello et al., 2016; Fisher-Borne et al., 2015; Mosher et al., 2017). Cultural sensitivity refers to the need for the therapist to be sensitive around the value and cultural differences between themselves and the client and family they are serving (D’Aniello et al., 2016). This is a notable criticism of cultural competence because it identifies that the therapist shouldn’t just be knowledgeable about other cultures, but they need to be open and thoughtful as to how the differences between clients’ values and their own can impact treatment, which was a big step into acknowledging that the self of the therapist affects the therapeutic relationship (Tohidian & Mui-Teng Qeck, 2017).

Cultural humility addresses the need to be knowledgeable about other cultures by being curious and asking the family for input around their values and beliefs instead of assuming a blanket cultural belief about a family based on their race or any other demographic factor (Fisher-Borne et al., 2015; Mosher et al., 2017). When demonstrating cultural humility, therapists should be open and humble and acknowledge that they do not know everything and will need to get clarity from the family about their needs.

Multicultural counseling competencies is a term that was adopted by the Commission on Accreditation for Marriage and Family Therapy (COAMFTE) in 2018 to address the training needs of students in MFT programs (COAMFTE, 2018). This term includes developing cultural sensitivity and humility and encouraging students to know about various cultures they may work with in their careers. By combining the idea of cultural competence with sensitivity and humility, COAMFTE may have been attempting to put an end to the great debate around cultural competence and move forward with specified skill sets for students to develop. For the purpose of this study, I used the term multicultural counseling competencies with the understanding that there remains continual evolution on the best language to apply to working with differences in clinical settings, and I have chosen to use the term provided to us by COAMFTE (2018).

Method

Phenomenology is a qualitative study design that focuses on the lived experiences of the research participants and seeks to understand a phenomenon (Creswell, 2007). This study is a phenomenological exploration of how clinicians of color go about developing multicultural counseling skills when, often times, they are asked to teach their White peers about matters of privilege and oppression rather than focus on their own skill development or self-awareness (Pieterse et al., 2016; Pulliam et al., 2019). Semi-structured interviews were conducted until saturation of themes was reached and no further themes were brought forward (Guest et al., 2020). Interviews were recorded and transcribed for the purpose of data analysis. A thematic analysis was conducted on the interviews and main themes and sub-themes were developed as a result of the analysis.

Population and Sample

The criterion for the study included associate level MFTs who identify as clinicians of color and who have been post-master’s for 2–10 years. Participants needed to have graduated from a COAMFTE-accredited MFT program. Participants did not need to have any special training beyond attending a COAMFTE-accredited program because the study looked to explore what was and what was not useful in diverse training practices. Therefore, all styles of programs were accepted. The sample was chosen with the use of strategic sampling, which is a sampling method where researchers recruit participants that differ widely based on the scale they are evaluating (Farrugia, 2019: Willis, 2007). I utilized this sampling method because it helped me create a diverse sample of participants, which would hopefully yield a holistic view of participants’ experiences. It should be noted that recruiting a large enough sample for this project was challenging. Prospective participants demonstrated concern around the ability to remain anonymous due to lack of diversity in their cohort of the school they attended.

Interview Questions

Interview questions were comprised of questions around participants’ experiences in their graduate training programs as it pertains to their multicultural counseling skill development as well as their experiences in the field including what they wished they would have learned in their training. Some questions included: What was helpful in your multicultural counseling course? What was not helpful in your multicultural counseling course? What is something you learned in the field that you wish you would have learned in your training? Since this was a semi-structured interview process, follow up questions were asked by the interviewer to ensure clarity around answers.

Study Procedures

Interviews were conducted over teleconferencing due to the wide geographic diversity of the sample. The interviews were semi-structured with a list of 12–18 interview questions that were open-ended with follow up questions. A semi-structured method was used because it gave the participants more flexibility to offer their own thoughts, insights, and ideas about the development of their multicultural counseling skills and allowed for the researcher to ask follow-up questions to add more detail or clarify the participant’s response (Jacob & Furgerson, 2012; Merriam & Tisdell, 2016). While qualitative interviews generally reach saturation around 12–15 interviews, saturation can be found with as little as six interviews (Guest et al., 2020). For this study, saturation was reached at eight participant interviews.

Data Analysis

Once the interviews were completed, they were transcribed using 360 Transcription, a HIPAA compliant software, and a thematic analysis was conducted. Once themes were identified by the researcher, participants were contacted via email with prior approval from them, and they approved the themes and offered any clarification needed. This process ensured participant statements were not misrepresented in any way.

Results

The results of the qualitative study include eight participant interviews conducted over teleconferencing. Participants included Latino males (n = 2), Latina females (n = 2), a Black male (n = 1), and Black females (n = 3). Of these participants, two individuals were born outside the United States and 3 participants spoke a language other than English. Participants were spread across the continental United States and attended a wide variety of COMAFTE-accredited programs including programs in New England, the South (including Texas, Kentucky, Virginia, and Georgia), and California. Participant age and ethnicity are not disclosed due to the potential identifying nature of too many known demographics. The interviews were recorded and transcribed. After transcription, themes were developed. Themes have been broken down into four categories: Learning in a White Environment, Developing Multicultural Counseling Skills, Participating in Multicultural Supervision, and Integrating Diverse Voices.

Learning in a White Environment

Participants report they had to navigate learning through a lens that was mostly focused on training White, middle-class Americans to treat White, middle-class Americans. This included a lack of representation in faculty and training clinicians and aspects of their education that did not address their experiences. Some participants discussed that race, or diversity was rarely discussed except in their single cultural competency course, which was often solely focused on race with little attention being paid to other social identities.

Participants stated most faculty members were not racially diverse. Faculty were mostly White Americans and, for most participants, if there was a faculty member of color, there was only one faculty member of color. In response to reporting that there were no diverse faculty in this participant’s program, participants suggested the importance of representation to them. Participant 4 noted: “I think representation matters. Being able to have not only students of color but faculty of color as well, it really does matter.” Participant 5 said: “I can say I never saw myself reflected in any of the professors that I’ve had throughout my time in my graduate program.”

Participant 3, who reported one diverse faculty in their program, said, “It (multicultural counseling skills) came more from the teachers because of their experiences.” He was highlighting how his diverse professor could discuss multicultural counseling differently because of their experiences working with diverse populations as a diverse therapist.

Participants also stressed that most of the literature and research they were exposed to were written by White authors. Participants noted very little if any exposure to literature written by racially diverse authors. If they wanted to read anything by a racially diverse or representative authors, they had to seek out the information themselves. Participant 2 said, “I was never exposed to academic materials that were actually written by scholars from different nationalities and different cultural backgrounds.” This participant discussed the homogeneity of academic materials in his graduate program. Participant 4 discussed how he didn’t learn about any diverse clinicians until he sought out the information after graduation: “I didn’t learn about any, people of color when it came to psychology in my program. I didn’t learn about Black psychologists and therapists who paved the way for social workers until after my program.” This participant further discussed the plethora of diverse authors that have made a significant impact and should be considered pioneers in the mental health field.

Participant 5 discussed one of the drawbacks of a lack of diversity, she stated, “When you’re talking about case studies (in class) it was typically white couples, families, individuals. There was no mention of culture or diversity. Everything was nuclear family.” Her sentiment here suggests that by only focusing on white middle-class families, participant 5 further acknowledged the field is ignoring a vast amount of the population needing services.

Developing Multicultural Counseling Skills

Participants noted that they felt they had to develop their own understanding of therapy theories and approaches as well as interventions that would work for them because many of the approaches taught in their programs were created by and for White men. As Participant 8 put it, “I don’t know how I can say these things and get away with it…without calling my safety into question.” Participant 4 asserted that “certain things just won’t work with certain populations,” noting that many MFT theories were developed for the middle-class white nuclear family, and the approaches used do not translate to other families with different structures and backgrounds. Because of this phenomenon, participants felt they had to find research on their own that was more representative of their experiences and those of diverse clients. Participant 6 said, “I think that has a lot to do with the fact that there’s not a specific skillset that anybody has been taught. It’s almost self-learned.” Through the self-learning process, participants reported they had to figure out for themselves what approaches worked for them. Participants identified five major skills they’ve developed in order to close the gaps in their education: developing curiosity, developing shared meaning, attuning the cultural lens, crafting the therapeutic alliance, and acknowledging the impact of physical appearance.

Developing Curiosity

Participants learned developing curiosity is a way to build a connection to clients with diverse backgrounds and stay attuned to the therapeutic process and progress. This skill aids participants in avoiding assumptions about clients and allows them to truly get to know the client and attempt to understand their experience.

Participant 5 summarized the idea of remaining curious:

We talk a lot about cultural humility and cultural competence, and I really think it’s just keeping our clients as the experts on their own lives and allowing us to remain curious. Even if we have similar cultural backgrounds, whether it is ethnicity, whether it is socioeconomic status, whether it is religion, we all have different experiences, even if we have commonalities.

This participant has developed an understanding through her own experience that being curious can lead to building connections with diverse clients. She also asserts that if the client remains in the expert role, the clinician can remain curious, which can prevent making assumptions about similarities or differences.

Participant 1 reported, in her experience, being curious about a client’s culture also allows the therapist to consider if treatment is helpful for them.

Be mindful of who (you’re) sitting with and being, of course, curious about their culture...but I feel...it’s missing a piece...Is the treatment helping them? Of course, we want to be competent in gathering that information, but I would say what I hear missing is the step further of thinking about is this particular treatment or modality useful and successful with this person?

Overall, participants focused on the idea that curiosity helped them, as therapists avoid assumptions and build a connection with their clients. Participants also felt like curiosity went further than being curious about their client’s culture. They also want to be curious about what’s happening in the therapy room as it pertains to the similarities and differences between their clients and themselves and how that can impact the therapeutic process. Lastly, curiosity helps participants think critically about whether their therapeutic approach is helpful for this particular client or not.

Developing Shared Meaning

Developing a shared meaning highlights the ways participants use language in their clinical skills to build connections with clients that are different than them. Participants found this to be an effective clinical tool missing from their education and expanded on how shared meaning helps them in therapy.

Participant 3 stressed the importance of location and how that can affect the meaning behind words or how words are spoken:

Probably speaking Spanish…It’s a little bit tricky because like Southern California Hispanics, our Spanish is different compared to other places in the state. I get a lot of that, like you’re from California, huh? And I’ll be like, why does that matter? Like we can tell by the way you talk.

This participant’s quote suggests that language can have different meanings depending on geographical location and how he pays special attention to these nuances to build a connection with clients.

Two participants noted the importance of “getting it” and clients not having to explain any further when maybe they would to another clinician. Participants reflected on how this can be comforting for clients when they don’t need to explain something in detail for their therapist to get what they are saying because they share the same definition and connotation as the client. Participant 4 said, “Just one of the things is vernacular, being able to say certain things or when they say something to me, and I understand it. It’s like, oh wow, I don’t have to further explain.”

Participant 5 shared:

I have had clients who have told me that there are unspoken rules of our culture that don’t have to be laid out, and maybe they’ve had to do for past clinicians before. Whereas, for a clinician of color, they maybe don’t have to spell it out as specifically, which can be a little overwhelming for them.

Participants emphasized how they benefit from having shared meaning with clients of similar backgrounds to them. This is a unique skill that can help clients feel more comfortable and more connected to their therapist.

Attuning the Cultural Lens

Participants described an attuned cultural lens as a way of looking at the world and at our clients with the ability to look at the wide picture of a client’s community, culture, and social locations, but also zoom it in really close to the unique, individual qualities of a person. Participants discussed ways they have developed a cultural lens is to pay close attention to the importance of exposure to diverse populations, checking their own biases, and letting their own experiences provide them knowledge.

Participant 2 noted the importance he felt in his own work to be really being informed about others who are different from himself:

Cultural humility doesn’t just go to the process of being exposed to the right experience. It’s talking to and reading about people who are different from you. That’s what I try to do. I try to locate myself on that angle.

This participant has observed that in his own work, locating external information and identifying personal location is a skill to aid in creating an open cultural lens.

Participant 4 reported that one skill he has learned is how they can join with clients based on their commonalities and understand what it’s like to be marginalized:

I’ve always been one who knows what it’s like to be out, you know, marginalized in that regard. I know what it feels like to do so. So then, because I know what it feels like, it helps me connect with another person that is also from a marginalized population.

By being transparent about his experiences, he feels clients can relate to him, and this can lead to a deeper comfort for clients who feel different from the therapist.

Participant 5 stressed the importance she places on being flexible in her therapeutic work and understanding her experience is not the only experience: “If we lead with our own cultural expectations, then we end up hindering the work that can be done.” This quote speaks to how she feels her values, beliefs, and biases can get in the way of the work she’s doing. If we are expecting others, even if we share the same race, to have the same experiences we do, then we will likely be making assumptions that can negatively impact treatment.

Crafting the Therapeutic Alliance

While skills in building a therapeutic alliance are taught in all therapy programs as an important part of building the therapeutic relationship, participants did not always feel these addressed needs of diverse therapists and clients. The participants emphasized the importance of embracing similarities and differences to form a strong therapeutic alliance. They delve deep into who their clients are as unique people, who they are as members of their community, and what they need.

When describing how she speaks with clients about their culture, their needs, and what they’re hoping to get out of therapy, participant 1 communicated this important sentiment: “I care very much to get to know you, and I care very much that you get the help you deserve.” Her statement takes initial therapeutic alliance building skills and adds a cultural awareness perspective of really building in the context of a person’s experience. For participants, alliance building is not just about getting to know the client, it is about getting to know their context.

Participant 7 noted how the therapeutic alliance affects the therapeutic relationship by building trust with diverse clients:

I’m learning people’s behaviors, what their needs are, what they’re missing, what they need. I build relationships. I believe that once you build a relationship with people…they’re more willing to open up to you.

Understanding culture seems to be a large component of crafting the therapeutic relationship. Participants have highlighted the phenomenon of making a person feel seen and understood leads to them feeling more comfortable with their therapist, which would allow them to share even more.

Acknowledging the Impact of Physical Appearance

Many participants have had to navigate client comments on their physical appearance. Participants believed these comments were, at times forms of microaggressions and at other times, just simple curiosities, especially when working with children. Clients may be curious about their race or background based on how they look. Some participants shared their inner dialog about these thoughts and experiences, others discussed ways they may address these moments.

Participant 1 processed her experiences being a lighter skinned clinician. She noted clients seem very comfortable sharing things with her that she thinks they might not share with therapists who have a darker complexion: “A lot of people won’t even question my background and just think, the white woman I’m talking to, which in some ways, can be helpful to me because they can say whatever they want." Other participants discussed elements of their visual appearance with regards to being “fair skinned” and how they felt this influenced therapy with clients who were not from their ethnic background. Participant 4 reported: “Even though I’m a 6′5” man, I’m also fair skinned, so it’s a little bit less intimidating…if I was a darker complexion, I’m pretty sure that it would be very different.”

Other participants discussed how they think clients, from all different ethnic backgrounds, might react to them based on their appearance. Participant 3 shared that he feels a negative reaction at times: “Be ready to get push back not all kids want it or adults, because I’ve had both, they look at you, and they’re like, you’re gonna help me?” His words suggest that he feels there is a likely bias or reaction based on his race. Participant 3 further elaborated that clients will be very curious about his ethnicity and background, often asking “what are you?” Clients will especially focus on his tattoos as well, “Like with my tattoos, that’s the first thing they notice, then my height. So, then they’ll start. I know they’re gonna get curious about my tattoos.” This participant discussed the sense that clients make assumptions about him based on his outer appearance. He illustrated that he often responds in two different ways. He will either let them guess what it means and allow the client to make an assumption, which was echoed by Participant 1, or he will use the opportunity to insert some humor into the relationship such as:

If they’re like teenagers, I’ll tell them well, I got a tattoo for every time I made a client cry and they’ll just look at me. Then it’s like, just joking. But then that’s usually the good ice breaker because then they’re like okay, this is not super serious, and teenagers need that.

Participant 3 demonstrated his unique style that allows him to not only address comments on physical appearance, but also use it as a chance to build the therapeutic alliance.

Participating in Multicultural Supervision

Participants discussed how supervision was important to their own reflections on diversity. While some participants lamented that they never felt like they had a supervisor that they could really open up to about their own social identities, as well as their experiences with clients around those identities. Other participants felt they had an impactful supervision experience that helped shape the therapist they are.

Some participants noted negative experiences with supervision, one participant shared, “I only had white supervisors, race and culture were never brought up in my supervision.”

Another participant echoed similar experiences:

I get frustrated because I don’t get a lot of constructive criticism. I know that I’m not perfect…I know that there’s things that I need to learn, but I feel like when I go into supervision, because my supervisor is a White male, and I am a Black woman, he’s too sensitive. I feel like he’s walking on eggshells.

Both of these participants reported that experiences with supervisors did not allow for conversations based on diverse backgrounds. They express how they were not challenged enough to develop their skills and struggled to feel like it was a topic that could be discussed.

Participant 1 reflected on a positive experience in supervision related to her ability talk openly about diverse experiences and getting feedback around how to navigate working with diverse clients, “Just having good supervision, around having the conversation: how do you feel about how old I am, or how do you feel that I look the way I look?” This participant discussed the importance of her supervision relationship in helping her develop her language around addressing diversity while building the therapeutic alliance.

Participant 6 identified that she had a very successful supervisory relationship with a White supervisor:

One of the first people that I encountered who I believe had a pretty good grasp on it was actually a supervisor who was an older, White man. He was very cognizant and very comfortable in his ability to articulate that here is a difference that we don’t often talk about, but it’s something we should pay attention to. And we both have to recognize how we are going to operate with each other in the context of this difference.

Participants asserted the importance of being able to discuss issues of race and cultural identity in supervision and openly evaluate the complexity of working with diverse populations as a therapist of color.

Integrating Inclusive Training: Recommendations

Participants highlighted the lack of attention given to diverse voices within their coursework and training. For example, one participant recalled only discussing “nuclear families” when learning about structural family therapy. This lack of focus on diverse family structures was memorable to this participant. It was critical to many participants that there needs to be greater content within their educational experiences to improve their work with diverse families and communities.

Participant 2 reported programs need to have more representation from marginalized communities. “We need to be exposed to other marginalized epistemologies that are taking place in Latin America, or in Asia.” Here, participant 2 is focusing on an international understanding of culture, not just an American understanding. This is vital in developing flexible theories and approaches to work with populations from communities outside the US.

Participant 4 said: “Bring in their (researchers of color) research. There is a whole plethora of people of color that have contributed to this field, and the field of psychology, mental health, in just umbrella terms, and they’re not recognized.” Here, participant 4 also acknowledges that the content being presented in graduate programs lacks diverse voices despite the fact that there are many diverse scholars that have published quality literature around providing therapy to diverse populations.

Participants advocated that they did not feel that one course in multicultural counseling is enough, which is currently all that is required by COMAFTE (COAMFTE, 2018). Some participants noted that this course was only able to cover race, and therefore, ignored other social identities that likely have large impacts on identity development of themselves and their clients. Other participants thought that the course felt as if it were an afterthought. Participant 2 called their experience in a multicultural course as “performative cultural humility.”

Participant 6 reported they had two courses and felt they were more prepared than their counterparts from other programs:

We had a diverse family course as well as a class, gender, and ethnicities course that both allowed us the opportunity to highlight and address some of the challenges that I don’t think other programs did. And I’m saying that from the perspective of when I compared myself and my cohort with other clinicians who emerged at the same time in work settings. I felt like our preparation was better. There was an awareness that I didn’t see in my colleagues.

Participants emphasized the importance of having enough time to cover a multitude of identities in their coursework and having one course that was mainly spent on race was neither enough nor effective. The lack of focus on intersectionality and all aspects of identity were areas of concern and challenge for the participants as well.

Participants stressed the need for more representation in faculty but also understood that it may take time to have more representation in faculty, so they opted for creative answers to increase access and representation. Participant 1 and Participant 6 discussed respectively:

There should be room for clinicians of color to be able to talk with other clinicians of color, even if it means branching out into other departments like social work or even other universities.

I think there needs to be more incorporation of graduates of color who are actively practicing onto things like advisory councils to speak about recommendations and to just get the feedback from practicing clinicians.

Participants have noted that despite barriers, there are creative ways to ensure students have access to diverse voices. While it is important that the faculty at an MFT program be diverse for all students to feel welcome, there are other ways to ensure that students of color see themselves represented in the field.

Limitations

One of the biggest challenges with phenomenological research is the subjectivity of the data (Dahl & Boss, 2005). When data are in word form, they are open for interpretation and misunderstandings can occur. Another challenge with this design includes researcher bias (Dahl & Boss, 2005). The interviewer can steer conversation a particular way and can interpret the data biasedly. There were several steps put into place in this study in an effort to mitigate this issue. First, interview questions were prepared ahead of time and used consistently across interviews. Second, bracketing occurred during data collection and analysis. Third, the themes were returned to the participants to ensure accuracy.

Further studies are encouraged to replicate and expand the data as there are many diverse races and backgrounds that were not included in this study. Programs in the Midwest or Pacific Northwest were also not included. While this study has been highlighted as a starting point to understand how MFT’s of color develop their multicultural counseling skills, a subsequent study should address the gaps in diversity of the sample.

Discussion

The results of this study echo the importance of creating a more inclusive and extensive training environment for MFT students. Institutional racism has a significant impact on training as evidenced by a focus on training White students and leaving students of color to speak for their race in an attempt to education their White peers (Erolin & Wieling, 2020), Institutional racism also contributes to the lack of material dedicated to diverse populations focusing mainly on the traditional nuclear family (Erolin & Wieling, 2020; Pieterse et al., 2016; Pulliam et al., 2019). Participants discussed specific skills they have fostered throughout their practice that they believe have a significant impact on their ability to work with diverse clients. Further, participants reported what they felt were the significant barriers to their training and how to improve training practices as a result of those barriers.

Skills that Lead to a Positive Therapeutic Outcome

Participants focused on the phenomena that culture is in everything they do. As clinicians of color, they cannot escape culture, and they are always looking at the world through a cultural lens. Through this lens, participants described five multicultural counseling skills that help them provide effective therapeutic services to diverse clients. Participants reported these skills were largely self-developed, noting another phenomenon that MFT’s of color need to seek out additional information in order to meet their clients where they are and provide culturally competent care. These are the skills that MFT students should be developing in their training. While this list may not be exhaustive, it is a good start to understanding the particular skills the MFT’s of color are using in their routine practice. These skills have been highlighted in different ways across literature and curriculum (Aponte, 2021; D’Aniello et al., 2016; DuPree et al., 2013; Fisher-Borne et al., 2015; Foronda et al., 2016; McGoldrick & Hardy, 2019; Mosher et al., 2017). However, it seems that participants overlaid a cultural lens to everything they do, which emphasizes that participants utilize these skills in a different way than originally intended. Further, participants always keep the end in mind and utilize these skills to result in a positive therapeutic outcome.

These five multicultural counseling skills all point in a similar direction with participants focusing on how the therapeutic alliance affects therapeutic outcome. Common factors research has indicated that the therapeutic relationship is the biggest indicator of a positive therapeutic outcome (D’Aniello et al., 2016). Even the way participants respond to comments on physical appearance keeps the therapeutic relationship in mind ensuring that clients feel comfortable and safe to express themselves in the therapy room. The results demonstrate the phenomena that culture cannot be removed from the therapeutic process, and MFT’s of color and White MFT’s need to be able to utilize a cultural lens for all clients and in all aspects of the work.

Institutional Racism is the Barrier

According to CRT, racism is ordinary and designed to benefit the dominant culture, meaning middle-class to upper-class, White Americans (Delgado & Stefancic, 2017). Institutional racism is one way that the dominant culture can maintain their power and academic institutions like MFT training programs cannot are not excluded from the impact of systemic racism (Amiot et al., 2020; Delgado & Stefancic, 2017). According to participants, MFT training programs are focused on educating students around theories that have historically been utilized for White, middle-class, nuclear families. MFT programs are also sharing literature and research written by mainly White authors. In practice, this training approach results in little to no understanding for how therapists can work with diverse families and cultures. Participants reported that many of the skills they learned in their graduate program did not translate to working with non-White families. Further, participants felt that these strategies would be harmful if utilized with non-White families. This approach to training left participants feeling that their needs as clinicians of color were not attended to by their training programs. There was no focus given to how clinicians of color cannot utilize certain therapeutic approaches because of how they would be seen by the clients and families they served if they were to use those approaches.

Recommendations for Practice

Recommendations made by participants were in direct response to the challenges they faced as students in their programs and denoted a notion of more. The participants want more cultural discussions, more access to diverse literature and therapeutic approaches, more access to diverse faculty, current practitioners, and peers, and more coursework around multicultural counseling. Programs could spend more time focusing on intersectionality and looking at the complexity of identity versus focusing on identities in a vacuum. Another main concept from the results is the phenomena that culture should be a lens through which all things are viewed. MFT curriculum could shift to assessing family structures, races and backgrounds throughout coursework and dedicate more time to multicultural counseling specific courses.

A good way of incorporating culture into all aspects of training would be incorporating the multicultural counseling skills the participants described. Each skill has its basis in current MFT training. However, the participants took the skills to a different level that allowed them to view the client and family holistically. These multicultural counseling skills could be incorporated throughout coursework. For example, some participants discussed how they reworked traditional family therapy theories to ensure they were culturally responsive, like McGoldrick and Hardy’s (2019) textbook, Revisioning Family Therapy. Using this textbook alongside traditional textbooks would be an interesting way to incorporate culture across the curriculum.

Supervision practices were another area that had a great impact on participants. Participants reported that they felt more supported by supervisors who were willing to engage with them around issues of culture and other social identities. This engagement allowed participants to open up and explore their beliefs around culture and values, which allowed them to grow their skills as a therapist. Participants who noted less support from supervisors were more likely to examine their need to seek out information and training independently. Based on these results, all supervisors should utilize a multicultural supervision approach as outlined in Tohidian and Mui-Teng Qeck (2017), who stress the importance of engaging in cultural conversations in supervision.

Recommendations for Future Research

This research study was a phenomenological design that explored the lived experiences of MFT’s of color in their training programs. Therefore, there are several aspects of the study that need to be looked at in greater detail. Additional research on the five multicultural counseling skills should be considered to explore if there are more skills that MFT’s of color are utilizing and if these identified skills can be replicated in different research designs as this design was qualitative and the sample size small. This is especially important of MFT programs are looking to incorporate these skills into the curriculum.

Based on participant response, further research is needed on family therapy models and how to apply them to diverse populations. Since participants reported they needed to pinpoint ways they could make the therapy models more culturally sensitive, their methods should be explored and researched regarding their effectiveness. Anecdotally, most therapists make theories their own and adapt them as needed. However, research should focus on closing this gap with some standard approaches for culturally sensitive care. Lastly, this study only focused on MFT’s of color and their experiences. Due to the complexity of intersectionality, further research should be completed looking at either different social identities or focusing more on a holistic presentation of individuals and how MFT training impacts them.

Conclusion

Every person has a culture. They may share some aspects with the larger culture, and they will have differences from the larger culture. When providing therapy to clients, therapists need to be able to assess all aspects of a person’s culture and how that shapes the therapeutic process, and MFT training programs needs to be preparing students to be able to do this in curriculum and in supervision. The participants in this study demonstrated the importance of attuning to a client’s culture, being curious about their client, creating a strong therapeutic relationship, and developing shared meaning. By using these skills and finding ways to manage difficult conversations, like comments of physical appearance, participants were able to show the amazing work they are doing with their clients and families. Unfortunately, these skills were learned independently and with little support from MFT programs. This enunciates the lack of space given to treating diverse families and training diverse clinicians. The MFT field continues to become more diverse, and our training practices must reflect that change.