Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2025 Aug 1.
Published in final edited form as: Train Educ Prof Psychol. 2024 Aug;18(3):221–229. doi: 10.1037/tep0000465

The development and current directions of a diversity specialty clinic: Implications for multicultural training in psychology

Patricia Rodriguez Espinosa 1, Yajaira Johnson-Esparza 2, Gabriela López 3, Jennifer Benson 4, Natalia C Moss 5, Rebecca Avila-Rieger 6, Kamilla Venner 7,8, Steven P Verney 7,9
PMCID: PMC11286226  NIHMSID: NIHMS1949763  PMID: 39081902

Abstract

Addressing systemic injustices and racism in training and clinical service provision are key next steps in clinical science. While the APA Multicultural Guidelines and accreditation standards have long emphasized this need, most graduate programs offer a single course on diversity, equity, and inclusion topics, which is inadequate to train and sustain culturally humble providers and redress systemic injustices and racism within psychology. Few “real-world” examples exist to guide the development of training models. We provide background on the development and components of a specialty clinic, the University of New Mexico’s Cultural Counseling Center, whose mission is providing culturally informed clinical services to diverse clientele, and to infuse multicultural training throughout the graduate program.

Informed by the racial-spatial framework for psychology and critical race theory, we describe our approach intended to: 1) offer applications for the operationalization and delivery of multicultural and antiracist training; 2) enhance supervisory models; and 3) increase awareness of structural competence. Our clinic, developed collaboratively among students and faculty, serves as a safe forum for dialogue around structural injustices and seeks to improve treatment for diverse clients and those underserved in mental health care. We discuss issues of student and faculty engagement and offer the perspectives of faculty and students of color, case examples illustrating our services, and current efforts to expand and formalize community collaborations. We offer a model that integrates coursework, informal activities, and multicultural supervision for comprehensive student training and that promotes a departmental culture of dialogue and support around equity, diversity, and justice.

Keywords: Multicultural counseling, multicultural training, diverse populations, anti-racist education, cultural humility

Introduction

Addressing systemic injustices and racism in training and service provision are key next steps in clinical science. While the American Psychological Association’s (APA) Multicultural Guidelines and accreditation standards have long emphasized the need for multicultural training (APA, 2017; Arredondo, 1994), its emphasis in many graduate psychology and counseling programs and curricula is lacking. Graduate programs are faced with the challenge of developing and implementing curriculums and formal training opportunities that can actualize the goal of producing culturally sensitive and humble providers and redress systemic injustices and racism within psychology. Yet, few “real-world” examples exist to guide the development of such training models. The purpose of this article is to describe the development of a specialty clinic, the Cultural Counseling Center (CCC) at the University of New Mexico (UNM), as an approach to address the gaps in multicultural training in graduate programs. We provide an overview of the development of the UNM CCC, review key elements of the center, training model, provide case examples, and offer insights into challenges and lessons learned.

Need for Continued Multicultural Graduate Training

During the last few decades, the United States (U.S.) has become increasingly diverse. In 2015, over 50% of children under the age of 1 were minority children (Pew Research Center, 2016). According to the U.S. Census in 2045 the US will officially become a minority-majority country (Vespa et al., 2020). Moreover, several states are already considered minority-majority states including Hawaii, California, Texas, New York, and New Mexico (U.S. Census, 2020).

This shift is also happening across the nation with 78 counties transitioning to minority-majority counties in 2013 (Pew Research Center, 2016). As clinicians and educators, these demographic changes carry implications for our clinical clientele, student demographics, and our teaching and supervision models (Gopalkrishnan 2018). In addition to increased diversity in our clientele, we are also seeing an increase in racial/ethnic diversity among our graduate students (APA, 2022) and faculty (APA, 2020). Yet, in 2018, the vast majority of the U.S. psychology workforce in 2018 were White (84%), with racial/ethnic minorities being woefully underrepresented, 6% Hispanic, 4% Black, 4% Asian, and 2% American Indian/Alaska Native, Native Hawaiian/Pacific Islander, and people of two or more races (APA, 2020). The diversification of our nation’s population also highlights the need for creating real change within our education and services, with the aim of preparing the next generation of multicultural mental health providers (Gregus et al., 2020; Woods-Jaeger et al., 2020).

While the APA Multicultural Guidelines, accreditation standards, and scholars have long called for and advocated for increased multicultural training and attention to both educational and service models (Altmaier, 2003; APA, 2017; Bernal & Castro, 1994; Bernal & Padilla, 1982), progress has been slow. While in recent years there has been an increase in graduate programs and internships acknowledging the importance of incorporating cultural diversity into their curriculum (Bidell et al., 2007; Newell et al., 2010), most graduate programs offer a single APA required diversity course and few electives or other opportunities for sustained and integrated training exist (Bernal & Castro, 1994; Frisby & Perez, 2018). Moreover, studies find that existing efforts center heavily on diversity narrowly defined as race or ethnicity, with fewer opportunities for training around religion, sexual orientation, gender identity, disability and other axes of multiculturalism and privilege (Green et al., 2009). Efforts have also centered on increasing and retaining diverse students and faculty (Bernal & Castro, 1994; Callahan et al., 2018; Hsueh et al., 2021; Renninger et al., 2015; Trent et al., 2021). Yet, systematic efforts are still needed to ensure curricula are not perpetuating racist and colonialist practices (APA, 2021).

Development of the University of New Mexico Cultural Counseling Center

The initial conception of the UNM CCC emerged as part of a student-led organization within the Psychology Department, the department’s Diversity Organization (DO!). The Diversity Organization’s mission was that of increasing diversity among graduate students in psychology, as well as creating awareness through forums for ongoing discussions and training around multicultural topics. A need was identified by the current clinic’s supervisors to sustain and enhance the diversity course’s efforts - a required course for clinical students - through an ongoing supervisory group to supervise students in providing culturally informed and equitable care to a diverse clientele, and to provide ongoing discussions and didactics around multicultural counseling theories and best practices. As part of the Diversity organization, students and faculty regularly met to plan activities and discuss student needs for additional multicultural resources. Out of this planning and strategic vision, the idea of the UNM CCC emerged.

While the department offered a course on multicultural training and the Diversity Organization often hosted workshops, lectures, and case conferences, a need was identified for additional infrastructure and support for training throughout the program. This included opportunities to integrate trainings, have small group discussions, integrate coursework learning with practicum experiences, expand current practicum sites, and receive mentorship from diverse faculty. This aligns with recommendations and training gaps identified in the literature (Green et al., 2009; Murphy et al., 2002, Daniel et al., 2004). In addition to support students, a need for consultations was also sorely needed. Many supervisors (internal and external to the department) were not formally trained in multicultural counseling techniques or assessment, or their training had become outdated, making consultation services valuable for both trainees and supervisors alike. Finally, students expressed an interest in non-classroom-based opportunities that allowed them to integrate newly acquired skills, as they see clients in a variety of settings.

Mission and Vision

Thus, the UNM CCC emerged as a specialty clinic within the Department of Psychology Clinic, where Clinical Psychology students can obtain clinical training. The UNM CCC is committed to providing culturally informed clinical services to clients from diverse backgrounds, clinical supervision to those serving clients from diverse backgrounds, and a weekly forum for open discussion of diversity-related issues and anti-racism in clinical training. The UNM CCC endorses an inclusive definition of diversity that encompasses race, ethnicity, nationality, age, gender, sexual orientation, socioeconomic status, religion, different abilities, and any other significant group with which a client may strongly identify.

Theoretical Foundations

Our Center’s services and training curricula are informed by the racial-spatial framework for psychology (Liu & Liu, forthcoming; Liu, Liu, & Shin, In Press), critical race theory with developments in law, education, and psychology (Crenshaw, 2011; Delgado & Stefancic, 2017; Salter & Adams, 2013; Taylor, 2009), and with key applications in challenging discrimination in educational practices and curriculum (Dávila, 2015; Delgado Bernal, Burciaga, & Flores Carmona, 2012), and by the socioecological framework (Stern et al., 2021).

These frameworks inform our conceptualization of systemic racism and race as a fundamental driver of inequities and help contextualize current racial struggles and political climate. They help us center our dialogue around prejudice, racism, color blindness, power, and intersectionality, and highlight the systems perspective we take when approaching education and clinical services. Informed by the socioecological model (Stern et al., 2021), we acknowledge systemic barriers and issues faced by clients and partners with local community-based organizations who address upstream determinants of health. Moreover, these frameworks acknowledge that those from minoritized backgrounds (e.g., faculty, students, and clients) are better able to articulate issues of race and intersectionality than others, enhancing the importance of listening and learning from their stories and experiences and creating spaces for bidirectional learning and dialogue. With these frameworks in mind, key components of the UNM CCC include: (1) a commitment to social justice; (2) intentionally holding regular space for discussions around race, power, and privilege; (3) critical examination of mainstream psychological curricula, educational, and other institutional practices; and (4) taking specific actions to improve multicultural and anti-racist education and improve access to quality mental health services for clients.

Faculty and Students

Faculty.

Supervisors of the UNM CCC include two Alaska Native clinical psychologists, Steven P. Verney, Ph.D. (Tsimshian) and Kamilla Venner, Ph.D. (Ahtna Athabascan). Both faculty supervisors and mentors teach undergraduate and graduate level courses focusing on diversity, multiculturalism, and cultural psychology and serve as advisors for the UNM Psychology Department’s Diversity Organization (DO!). Their research interests also center around health equity research and working with multicultural populations (e.g., American Indian Alaska Native communities) and are involved in other service and efforts at the University around similar issues.

Students.

The UNM CCC welcomes students from any year or level of experience within the Psychology Department. First and second year students who join may contribute to discussions, consultations and group supervision, and c other services such as translation, the resource library, and clinic screening and intakes. More advanced students and those seeing clients are able to sign up for UNM course credits for supervision and receive supervision directly from the CCC. Students’ clients include those from the Department’s training clinic or from designated practicums that have approved partnerships with the UNM CCC. Students outside of the CCC are also welcomed to join for consultation or didactic learning. The CCC has an open-door policy for students engaging in clinical work to maximize the department’s participation and utilization of services. As such, there are opportunities for students at various levels of experience and with varying levels of time commitment. Students who see clients as part of the CCC typically commit to one year of supervision with the CCC as part of their clinical rotation but often continue for years. On average, six to seven students commit to the CCC yearly and see clients regularly.

Services Offered

Services offered by the UNM CCC address several of the requirements posited by the APA Multicultural guidelines (APA, 2002) and include: 1) providing linguistic and culturally informed counseling services, including assessment; 2) providing a process and space for consultation and referrals; 3) discussing case conceptualization from a cultural and anti-racist perspective; 4) providing regular supervision to students seeing cases; 5) curating and maintain a resource library; 6) providing translation services; 7) providing a place for didactic learning including discussions around sociopolitical, historical, and economic contexts and their impact on client’s functioning; 8) providing a safe environment to discuss and increase awareness around personal bias, racism and prejudices; 9) assisting clients in naming issues based on a racism and social exclusion; and 10) leveraging community partnerships to address socioeconomic concerns such as access to other services such as housing and medical care (Gopalkrishnan, 2018).

The UNM CCC provides direct supervision to students seeing diverse clients (individuals, couples, and family services are offered) who are seen at the Psychology Department Training Clinic located on campus or seen as part of practicums at community-based clinics or other partnering organizations. For these cases, assessment, cultural case formulation, and regular treatment recommendations and follow-up are provided via weekly group and individual supervision. Consultation services around these topics are also offered to those seeing clients through the larger Psychology Training Clinic or in outside practicums. For instance, a popular consultation request involves recommendations for culturally and linguistically appropriate assessment. Consultations are done as a group, with consulting clinician attending the weekly meeting to present the case. Oftentimes a follow-up meeting is also scheduled to discuss implementation and follow-up of the consultation case. At times, we have also invited clinicians in the local area with certain expertise (e.g., working with Indigenous groups, refugees, Spanish-speaking supervisors) to attend our meetings and provide consultation or supervision advice.

Beyond direct client services and consultation, the UNM CCC also curates resources that are available to the entire Psychology Clinic and Department. This includes an online library of key journal articles, printed treatment books including Culturally Responsive Cognitive Behavior Therapy (Iwamasa & Hays, 2009), Depression in Latinos (Aguilar-Gaxiola & Gullotta, 2009), Counseling the Culturally Diverse (Sue et al., 2019), articles, and assessment tools. Small funds offered through the University or in partnership with student organizations, such as DO!, have provided funds for this resource library. During weekly meetings, we offer a safe space for diversity awareness and anti-racism discussions around readings and new articles, and we foster an environment in which all UNM CCC members feel comfortable asking questions or bringing up relevant news to improve personal awareness and understanding and to enhance client care.

Translation services for documents or questionnaires are also offered free of charge. These have included translation of materials for research and documents for clinical use (e.g., flyers, intake forms, handouts). To ensure language equivalence, the UNM CCC employs forward and blind back-translation by bilingual students/clinicians until congruence of meaning is achieved (Brislin, 1970). Moreover, the UNM CCC organizes a yearly case conference featuring either a CCC case or a local expert such as Dr. Maria YellowHorse Brave Heart, as a training opportunity for the entire Psychology Department. These are attended by all clinical students and faculty. On occasion, we have also secured funding to bring in nationally renowned speakers, such as Dr. Patricia Arredondo in 2016, for departmental talks and workshops on multicultural issues.

Community Partnerships.

Creating meaningful partnerships with community-based clinics and organizations is an important way of: 1) addressing the service gap faced by many underserved and marginalized communities by extending the clinic services to local organizations in the community, 2) creating additional opportunities for practicum experiences, and 3) better integrating social needs services with mental health services (see Gopalkrishnan, 2018). The UNM CCC has developed partnerships with key community organizations that address social justice issues and serve medically underserved clients. One of the early partnerships involved Centro Sávila (The Sávila Collaborative, 2022), a non-profit community mental health clinic that provides services to Spanish-speaking clientele including documented and undocumented immigrants regardless of ability to pay. Centro Sávila also provides clients in need of social work services and connections to employment, low-cost childcare, classes in preparation for tests of General Educational Development (GED), housing navigation, and other social determinants of health. Moreover, they host an urban garden and with donations provide clients with healthy food boxes to address food insecurity. Partnership with the UNM CCC entailed a student clinician assigned to this practicum yearly who received supervision from the CCC, class visits, and volunteer opportunities in the garden. Centro Sávila’s Director was also often featured as a guest or seminar speaker in the Department. Other partnerships currently in progress include: 1) some local Pueblos or tribes, to serve Indigenous clients and partner with groups who often have long wait lists for behavioral health services; 2) cognitive assessments and diagnostic formulations for a program serving the unstably housed; 3) brief skills training and support groups for underserved individuals with psychological distress hosted at a community clinic; and 4) a culturally adapted Mindfulness Based Relapse Prevention group with Indigenous community members.

Although a practicum at the Central New Mexico Correctional Facility, a state-operated adult prison with minimum- and maximum-security prisons, was not exclusive to students from the UNM CCC, student clinicians often participated in the UNM CCC given the issues they faced when working with people incarcerated in the mental health unit. These clients’ lives were shaped by socio-political structures and other determinants, oftentimes requiring clinicians to identify best practices for addressing related mental health concerns within the constrictions of the prison system. Additionally, student clinicians of color at times experienced negative effects of racial tensions within the prison system; thus, requiring support from supervisors and fellow clinicians in processing these experiences.

These partnerships also provided a stable source of referrals to the UNM CCC and practicum opportunities that would not have been possible without supervision at the CCC. This mutually beneficial relationship was particularly evident among sites that did not have the capacity to offer direct clinical supervision but had a need for behavioral health services to meet the needs of the communities they serve.

Training in Action: Case Examples

The following case examples offer a glimpse into the types of cases seen at the UNM CCC, which include cases from the Psychology Training Clinic and from community practicums. A consultation example is also provided. Names and demographics in the following case examples have been changed to protect the confidentiality of clients.

Case Seen by a Student Clinician Being Supervised at the University of New Mexico CCC

Miriam was a 9-year-old, bilingual girl who presented to one of our community partners due to behavioral concerns and possible depression. Miriam’s mother noted that Miriam had been fighting more frequently with her younger sister and appeared to be down and to be having less fun than usual. Her mother was confused and concerned, as she struggled to explain the sudden change she had noticed in her daughter. As the student clinician and Miriam continued working together, Miriam confided that she did not like her physical appearance and that she wished she looked more like her younger sister, who had a lighter skin tone. Like many children raised in cultures that privilege lighter skin and stigmatize darker skin, Miriam associated lighter skin with beauty and often expressed feeling ugly and ashamed.

During supervision with UNM CCC faculty and peers, the student clinician and the team engaged in discussion about the impact of colorism on Latinx mental health. Colorism is “a form of discrimination based on phenotype and imposed upon Latino/as by members of their own ethnic group” (Organista, 2009), and it has been associated with negative mental health outcomes (Calzada et al., 2019). Understanding the impact of colorism on mental health and wellbeing among Latinx youth, the clinician engaged Miriam’s mother in a discussion on factors contributing to Miriam’s presentation. Although Miriam’s mother acknowledged being aware that her daughter was not content with her appearance, she was not aware of the extent to which this had been impacting her. The discussion focused on bringing awareness to the role of socialization in how children perceive themselves. Additionally, they discussed the impact of subtle messages that disparage darker skin and are prevalent in the Latino community with the goal of bringing awareness to instances in which these messages were conveyed to Miriam during day-to-day interactions.

Consultation Case

Among UNM CCC’s first consultation cases was one of an Iranian couple that had recently immigrated to the U.S., reporting marital distress and contemplating divorce. The student clinician working with the couple sought recommendations and advice on how to proceed with this case and in particular with cultural case conceptualization. The UNM CCC student clinicians and faculty supervisors were able to assist in the identification of factors possibly contributing to distress. For instance, after discussion it became evident that marital conflict was related to acculturative stress (Berry, 2006). In this case, one partner was focused on maintaining traditional cultural values while the other one was focused on assimilating to the mainstream American culture. Important discussions also emerged around examining Western and non-Western views of marriage and courtship or lack thereof, and the need for clinicians to examine personal view and bias. This case also brought forward discussions around traditional couples’ assessments and their shortcomings when examining romantic or marital relations from other cultures, especially those with arranged marriages.

Group Therapy Offered by the University of New Mexico CCC in the Community

Two graduate student clinicians (first and third author) led a resilience and stress management group focused entirely on the needs of Spanish speaking Latinx women held at Centro Sávila. When they asked women and case managers at a local community center about their needs for services, additional resources around stress and coping skills emerged as a priority. The student therapists developed a group therapy curriculum that included psychoeducation and taught clients the following skills: communication, mindfulness, self-care, and coping skills for negative and/or unhelpful thoughts. During the process of implementing this five-week group, we noticed that many women were not completing their assignments related to self-care, often citing their familial duties as an obstacle to taking care of themselves and their needs. As a group, we integrated discussions around familism and marianism as Latinx cultural values that may conflict with engaging in important health behaviors (D’Alonzo, 2012). We then reconceptualized taking care of one’s own needs as a fundamental step in improving one’s ability to meet familial duties. The women were unanimously receptive to this idea and considered how much more present they could be with their families if they also allowed themselves time to engage in self-care activities (e.g., exercising).

Implications and Recommendations for Development of Multicultural Training Clinics

Needs Assessment

An initial step in the development of a multicultural training clinic is assessing programmatic training needs (e.g., via student evaluations on diversity training and application of theory, surveying graduate students, tracking of diversity of clients served, faculty meeting discussions), particularly as it pertains to the provision of clinical services and supervision. Moreover, it is critical to determine the extent to which the behavioral needs of historically underserved communities are currently being met. This initial step also represents an opportunity to engage other students and faculty in the conversation about gaps in training and in delivery of culturally informed services to further promote buy-in from students and faculty supervisors. Once a need has been identified, it can be useful to seek examples of other programs that have successfully developed specialty clinics within a department’s training clinic for guidance on addressing gaps in training and service delivery. It is important to consider the option of reaching out to those involved in the development of specialty training clinics for additional information and guidance, as well as ideas for innovation and improvements of existing training programs, if possible.

Gaining Institutional Support

Having identified the need for a specialty clinic, with a proposal for the development of a specialty clinic, it is critical to obtain departmental support. Depending on the program, it might be necessary to obtain support from the department training clinic, director of clinical training, and departmental chair. As part of this step, it is worth considering departmental and institutional needs, resources, and any permissions or approvals that may be required. It is possible that this might include discussions around funding, as there might be costs related to use of facilities (i.e., clinic space), reproduction of materials (e.g., intake forms, screeners), testing materials, promotion of services, and support staff, among others. The UNM CCC sought limited funding from the Psychology Clinic and from graduate and professional student associations on campus for the resource library and to offer honoraria to speakers. The UNM CCC is essentially a course in which students register for supervision credits with each of the supervisors. Having students register gains leverage with the institution and the clinic becomes officially recognized as a part of the clinical training program.

During implementation, it is also key to create a positive atmosphere. This positive learning environment has been found to predict increased multicultural skills, for example in assessment and treatment (Dickson & Jepsen, 2007). The UNM CCC and similar programs offer a different environment compared to classrooms that are inherently evaluative and involve a power differential. This learning space is less formal, more interactive, collective, with ongoing involvement, and with opportunities to be involved across a spectrum (from joining journal club discussions or consulting, to being a regular member and seeing cases). Motivational interviewing techniques used in this training context can also assist student clinicians in their self-awareness and changing perspectives necessary in striving toward cultural sensitivity and humility (Venner & Verney, 2015). Our group also encourages members to attend professional conferences and join listservs (e.g., National Multicultural Conference and Summit; APA Division 45: Society for the Psychological Study of Culture, Ethnicity and Race; Boston College’s Institute for the Study of “Race” and Social Justice’s Diversity Challenge; Hispanic Science Network; Society of Indian Psychologists; Association for Black Psychologists; Asian American Psychological Association; National Latinx Psychological Association) for additional opportunities to network and gain supportive training and mentorship.

Considerations are also needed to ensure supervisors examine areas of growth for cultural humility and effectiveness, personally and with their trainees, and to implement best practices outlined by multicultural supervision models (Fernandes & Lane, 2020; Fickling et al., 2019; Inman & Ladany, 2014). This includes examining client, student clinician, and supervisor relations, as well as dynamics in group supervision, small discussions, and other activities to ensure these spaces do not reproduce oppressive systems of power and marginalization. This is particularly important as specialty clinics such as this one, are likely to bring a diverse group of student clinicians and faculty, highlighting the need to understand everyone’s culture, worldview, and sociopolitical background (Fickling et al., 2019). Multicultural supervision also requires an in-depth understanding of how larger systemic issues (e.g., structural racism, political events, multicultural environment within the department) influence the client-trainee-supervisor triad. This also involves maintaining a social justice and intersectionality lens in all aspects of the clinic.

Bi-directional Community Partnerships

Developing and/or strengthening community partnerships and collaborations is another key step towards expanding services and practicum opportunities, increasing mentoring by diverse providers in the community, and enhancing sustainability. In this process, it is crucial to ensure these are mutually beneficial relationships, with opportunities for bi-directional learning and shared decision making. For example, beyond clinical services for their clients, partners may find it beneficial to have an affiliation with an academic institution, to be a featured speaker, or to have support with evaluation, research, events, and other programming at their organizations. If possible, the services may take place in those community organizations to reduce burden on clients in terms of transportation and potential unfamiliar settings such as a college or university campus. These partnerships also present an opportunity to infuse and model participatory approaches to collaborations into research and other domains beyond clinical services provision (Woods-Jaeger et al., 2020).

Sustainability

Identifying how a specialty training clinic will be sustained beyond its initial development phase is critical. Although there may be a desire, and need, to grow the program quickly through additional services and multiple community partnerships, it can be useful to take inventory of the clinic’s capacity and to slowly increase the clinic’s reach as capacity increases. As referrals and advertisement of services start, it is particularly important for clinics in their infancy to avoid having long waitlists or having to turn community members away. This will maintain trust from referring groups, community members, and avoid reproducing barriers to services that the specialty clinic may be trying to address in the first place. It is also critical to develop ways of connecting clients to other treatment options that can be readily accessible when services are not available or cannot be offered in a timely manner.

Operationally, ensuring that sufficient supervision is available is key. We recommend the involvement of at least two supervisors, as well as other rotating or consulting supervisors (internal or external to the department). This ensures that students will always have oversight and limits any gaps in the provision of services. Creating relationships with supervisors in the community also presents an opportunity to bring in additional expertise (e.g., working with transgender clients, conducting assessments with refugees or asylum seekers), and dissemination of services. Within the communities in which we practice, there is a wealth of knowledge and expertise that can enhance the collective skills of the specialty clinic, as well as the provision of services to clients.

Recruitment and retention of students must also be an ongoing effort. We recommend inviting first year students to join the specialty training clinic to learn about multicultural counseling before they see clients, accumulate supervision hours, and be better prepared for the APA required diversity and multicultural perspectives course. For more advanced students, as another engagement opportunity, consider vertical supervision models where these advanced students directly supervise a less experienced student under the guidance of clinical faculty.

Conclusions

With the UNM CCC, we present a model for a diversity specialty clinic to infuse multicultural training throughout graduate student training to better serve diverse clients who often evidence significant health inequities and barriers in accessing mental health services. At UNM, we were in the unique position of a clinical psychology program to collectively develop and sustain the UNM CCC for nine years. We had capacity to do so with two faculty of color and a cadre of graduate students of color and other diverse identities and with support from the director of clinical training, the clinic director, and the departmental chair. Our clinic integrates coursework, literature, informal activities, direct service provision, community practicums, and multicultural supervision and consultation for comprehensive student training. Establishing similar training models in other departments is a key step towards addressing systemic injustices and racism in training and clinical service provision.

Figure 1.

Figure 1

Open in a new tab

Summary of Services and Resources Offered by the Cultural Counseling Center

Public Significance Statement:

  • We provide background on the development of a specialty clinic, the University of New Mexico CCC, as a training model and “real-world” example of operationalization and delivery of multicultural and antiracist training and clinical services. Program description and recommendations based on our experience can inform the development and implementation of similar Centers in other departments and aid in the training of the next generation of clinicians equipped to provide culturally informed care.

Acknowledgements:

None of the authors have any conflicts of interest. This work was supported by Transdisciplinary Research, Equity, and Engagement Center, 2 U54 MD004811-06 (MPIs: Cacari Stone, Verney, Sanchez, & Brave Heart) and by the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR003142. We would also like to thank our prominent community partner, William Wagner, Ph.D., Director, Centro Sávila, for his dedication to underserved communities, and to Dan Matthews, Ph.D., former Director of the UNM Psychology Training Clinic for his inspiration in establishing the UNM Cultural Counseling Center, and undying support to maintain and grow the center.

Biographies

PATRICIA RODRIGUEZ ESPINOSA, PhD, MPH is the associate director of research for the Office of Community Engagement at Stanford Medicine and Instructor in the Department of Epidemiology and Population Health. She received her doctorate from the University of New Mexico and completed a clinical internship at the Palo Alto VA. The ultimate goal of her research is to decrease health inequities among racial/ethnic minority populations, particularly Latinxs and immigrant communities, through transdisciplinary and community-engaged scholarship.

YAJAIRA JOHNSON-ESPARZA, PhD is a licensed clinical psychologist and Assistant Professor in the Department of Family and Community Medicine at UT Health San Antonio. She serves as Behavioral Health Consultant (BHC) at Robert B. Green Family Health Center, a family medicine residency clinic. She earned her doctorate in clinical psychology from the University of New Mexico and completed pre- and post-doctoral training in integrated primary care. As Assistant Professor/Clinical and BHC, she provides integrated primary care behavioral health (PCBH) consultation services to a primary care population, as well as behavioral science education, training, and supervision of family medicine and psychology residents.

GABRIELA LÓPEZ, PHD is a licensed clinical psychologist and Investigator in the School of Public Health at Brown University. She received her doctorate from the University of New Mexico and completed predoctoral clinical internship at the Warren Alpert Brown Medical School of Brown University. She then completed postdoctoral training at the Center for Alcohol and Addiction Studies at Brown University’s School of Public Health where she focused on further understanding mental health and alcohol use disparities among bisexual+ women with histories of sexual assault. Her research and professional interest include decreasing alcohol use and mental health disparities among sexual minority women particularly racial/ethnic sexual minority women.

JENNIFER BENSON, PhD, is a licensed clinical psychologist in Primary Care Mental Health Integration (PCMHI) at VA Puget Sound Healthcare System. She provides integrated behavioral health services to a rural primary care population in the Seattle area. Dr. Benson completed her doctorate at the University of New Mexico and her predoctoral clinical internship at the VA San Diego Healthcare System in PCMHI and SUD treatment. She then completed postdoctoral training in residential SUD/PTSD treatment at VA Puget Sound – American Lake before returning to PCMHI in her current position.

NATALIA MOSS, PhD, is a licensed clinical neuropsychologist. She provides neuropsychological assessments to children and young adults with a range of cognitive, learning, and social-emotional challenges in private practice. Dr. Moss received her Ph.D. in clinical psychology from the University of New Mexico (UNM). She completed an APA accredited predoctoral internship in pediatric neuropsychology at UNM’s Health Sciences Center where pursued additional training in conducting culturally informed assessments for Spanish speaking and bilingual youth. She completed a two-year postdoctoral fellowship program in pediatric neuropsychology through The Help Group/UCLA Semel Institute for Neuroscience & Human Behavior within the David Geffen School of Medicine.

REBECCA AVILA-RIEGER, PhD, is a licensed clinical neuropsychologist. She provides neuropsychological assessments to individuals across the lifespan with a range of neurodevelopmental, medical, and psychiatric presentations in private practice. Dr. Avila-Rieger received her Ph.D. in clinical psychology from the University of New Mexico (UNM). She completed an APA accredited pre-doctoral internship in pediatric neuropsychology at the Children’s Hospital of Philadelphia (CHOP) and a two-year postdoctoral fellowship program in lifespan neuropsychology at Montefiore Medical Center. She currently serves as a member of the Ethnic and Minority Affairs (EMA) Subcommittee of Division 40.

KAMILLA L. VENNER, PhD, is an Alaska Native (Ahtna Athabascan, Chitina Village) associate professor of psychology at the University of New Mexico and research associate professor at the Center on Alcohol, Substance use & Addiction (CASAA). She co-leads the Cultural Counseling Center to provide supervision for graduate students. She received her doctorate from UNM and completed a clinical internship at VASDHS/UCSD Psychology Internship Program. Her research and professional interests seek to reduce health inequities and include culturally tailoring implementation models and processes and evidence-based treatments for addiction in partnership with Native American communities. She is interested in broadening models to include social factors as well as spirituality as we move toward more holistic and culturally appropriate models and theories.

STEVEN P. VERNEY, PhD, is an Alaska Native (Tsimshian) Professor in the Department of Psychology at the University of New Mexico. He received his doctoral degree from the SDSU/UCSD Joint Doctoral Program in Psychology and completed his clinical internship at the Palo Alto VA Healthcare System. He is one of the Principal Investigators of the UNM Transdisciplinary Research Equity and Engagement (TREE) Center for Advancing Behavioral Health, an NIH Center of Excellence in Health Disparities. He co-leads the Cultural Counseling Center, which provides a multicultural counseling framework to doctoral students’ supervisory experience. His research and professional interests include cultural factors in cognitive assessment, cognitive aging, cultural psychology, and health inequities in underserved populations, especially American Indians and Alaska Natives.

References

  1. Aguilar-Gaxiola SA, & Gullotta TP (Eds.). (2009). Depression in Latinos: Assessment, treatment, and prevention (Vol. 8). Springer Science & Business Media. [Google Scholar]
  2. Altmaier EM (2003). Multicultural competence and accreditation in the professional psychology. In Pope-Davis DB, Coleman HLK, Liu WM, & Toporek RL (Eds.), Handbook of multicultural competencies: In counseling & psychology (pp. 303–312). Sage Publications, Inc. 10.4135/9781452231693.n19 [DOI] [Google Scholar]
  3. American Psychological Association. (2002). Guidelines on multi- cultural education, training, research, practice, and organizational change for psychologists. https://www.apa.org/pi/oema/resources/policy/multicultural-guideline.pdf [DOI] [PubMed]
  4. American Psychological Association. (2017). Multicultural Guidelines: An Ecological Approach to Context, Identity, and Intersectionality. https://www.apa.org/about/policy/multicultural-guidelines.pdf [DOI] [PubMed]
  5. American Psychological Association. (2020). Psychology’s workforce is becoming more diverse: News on psychologist’s education and employment from APA’s center for workforce studies. Monitor on Psychology, 2020(11). https://www.apa.org/monitor/2020/11/datapoint-diverse [Google Scholar]
  6. American Psychological Association. (2021). Role of psychology and the American Psychological Association in dismantling systemic racism against people of color in the United States. https://www.apa.org/about/policy/resolution-dismantling-racism.pdf
  7. American Psychological Association. (2022). Summary reports: Graduate study in psychology. https://www.apa.org/education-career/grad/survey-data
  8. Arredondo P (1994). Multicultural training: A response. The Counseling Psychologist, 22(2), 308–314. 10.1177/0011000094222005 [DOI] [Google Scholar]
  9. Bernal ME, & Castro FG (1994). Are clinical psychologists prepared for service and research with ethnic minorities? Report of a decade of progress. American Psychologist, 49, 797–805. [DOI] [PubMed] [Google Scholar]
  10. Bernal ME, & Padilla AM (1982). Status of minority curricula and training in clinical psychology. American Psychologist, 37, 780–787. [DOI] [PubMed] [Google Scholar]
  11. Berry JW (2006). Acculturative stress. In: Wong PTP, Wong LCS, editors. Handbook of Multicultural Perspectives on Stress and Coping. Langley, BC: Springer. pp. 287–298. [Google Scholar]
  12. Bidell MP, Ragen JK, Broach CD, & Carrillo EA (2007). First impressions: A multicultural content analysis of professional psychology program Web sites. Training and Education in Professional Psychology, 1(3), 204–214. doi: 10.1037/1931-3918.1.3.204 [DOI] [Google Scholar]
  13. Brislin RW (1970). Back-translation for cross-cultural research. Journal of Cross-Cultural Psychology, 1, 185–216. [Google Scholar]
  14. Callahan JL, Smotherman JM, Dziurzynski KE, Love PK, Kilmer ED, Niemann YF, & Ruggero CJ (2018). Diversity in the professional psychology training-to-workforce pipeline: Results from doctoral psychology student population data. Training and Education in Professional Psychology, 12(4), 273. [Google Scholar]
  15. Calzada EJ, Kim Y, & O’Gara JL (2019). Skin color as a predictor of mental health in young Latinx children. Social Science & Medicine, 238, 112467. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Crenshaw KW (2011). Race, reform, and retrenchment: transformation and legitimation in antidiscrimination law. German Law Journal, 12(1), 247–284. [Google Scholar]
  17. Daniel JH, Roysircar G, Abeles N, & Boyd C (2004). Individual and cultural diversity competency: Focus on the therapist. Journal of Clinical Psychology, 60, 755–770. [DOI] [PubMed] [Google Scholar]
  18. D’Alonzo KT (2012). The influence of marianismo beliefs on physical activity of immigrant Latinas. Journal of transcultural nursing, 23(2), 124–133. 10.1177/1043659611433872 [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Dávila B (2015). Critical race theory, disability microaggressions and Latina/o student experiences in special education. Race Ethnicity and Education, 18(4), 443–468. 10.1080/13613324.2014.885422 [DOI] [Google Scholar]
  20. Delgado Bernal D, Burciaga R, & Flores Carmona J (2012). Chicana/Latina testimonios: Mapping the methodological, pedagogical, and political. Equity & Excellence in Education, 45(3), 363–372. 10.1080/10665684.2012.698149 [DOI] [Google Scholar]
  21. Delgado R, & Stefancic J (with Harris A). (2017). Critical race theory: An introduction (3rd ed.). New York University Press. [Google Scholar]
  22. Dickson GL, & Jepsen DA (2007). Multicultural training experiences as predictors of multicultural competencies: Students’ perspectives. Counselor Education and Supervision, 47, 76–95. [Google Scholar]
  23. Fernandes C & Lane WD (2020). Best Practices in Multicultural Supervision in Counseling. Journal of Counseling Research and Practice, 6(1), 57–66. Available at: https://egrove.olemiss.edu/jcrp/vol6/iss1/4 [Google Scholar]
  24. Fickling M, Tangen J, Graden M, & Grays D (2019). Multicultural and social justice competence in clinical supervision. Counselor Education and Supervision, 58(4), 309–316. 10.1002/ceas.12159 [DOI] [Google Scholar]
  25. Frisby CL, & Perez OR (2018). Current status of cultural competence advocacy in clinical, school, and counseling psychology. In Cultural competence in applied psychology (pp. 33–54). Springer, Cham. [Google Scholar]
  26. Gopalkrishnan N (2018). Cultural diversity and mental health: Considerations for policy and practice. Front Public Health, 6, 179. doi: 10.3389/fpubh.2018.00179 [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Green D, Callands TA, Radcliffe AM, Luebbe AM, & Klonoff EA (2009). Clinical Psychology Students’ Perceptions of Diversity Training: A Study of Exposure and Satisfaction. Journal of Clinical Psychology, 65(10), 1056–1070. [DOI] [PubMed] [Google Scholar]
  28. Gregus SJ, Stevens KT, Seivert NP, Tucker RP, & Callahan JL (2020). Student perceptions of multicultural training and program climate in clinical psychology doctoral programs. Training and Education in Professional Psychology, 14(4), 293. [Google Scholar]
  29. Hsueh L, Werntz A, Hobaica S, Owens SA, Lumley MA, & Washburn JJ (2021). Clinical psychology PhD students’ admission experiences: Implications for recruiting racial/ethnic minority and LGBTQ students. Journal of Clinical Psychology, 77(1), 105–120. [DOI] [PubMed] [Google Scholar]
  30. Inman AG, & Ladany N (2014). Multicultural competencies in psychotherapy supervision. In Leong FTL, Comas-Díaz L, Nagayama Hall GC, McLoyd VC, & Trimble JE (Eds.), APA handbook of multicultural psychology, Vol. 2. Applications and training (pp. 643–658). American Psychological Association. 10.1037/14187-036 [DOI] [Google Scholar]
  31. Iwamasa GY, & Hays PA (2019). Culturally responsive cognitive behavior therapy: Practice and supervision (pp. xi–348). American Psychological Association. [Google Scholar]
  32. Liu WM, & Liu RZ (Forthcoming). Systems of white supremacy and white privilege: A racial-spatial framework for psychology. Oxford University Press. [Google Scholar]
  33. Liu Liu, & Shin (In Press). Understanding systemic racism: Antiblackness, white supremacy, racial capitalism, and the re/creation of white space and time. Journal of Counseling Psychology. [DOI] [PubMed] [Google Scholar]
  34. Murphy JA, Rawlings EI, & Howe SR (2002). A survey of clinical psychologists on treating lesbian, gay, and bisexual clients. Professional Psychology: Research and Practice, 33, 183–189. [Google Scholar]
  35. Newell ML, Nastasi BK, Hatzichristou C, Jones JM, Schanding GT Jr, & Yetter G (2010). Evidence on multicultural training in school psychology: Recommendations for future directions. School Psychology Quarterly, 25(4), 249. [Google Scholar]
  36. Organist KC. Latino Clinical Perspective on Montalvo’s Ethnoracial Gap in Clinical Practice with Latinos. Clin Soc Work J 37, 287 (2009). 10.1007/s10615-009-0231-3 [DOI] [Google Scholar]
  37. Pew Research Center. (2016). 10 demographic trends that are shaping the U.S. and the world. https://www.pewresearch.org/fact-tank/2016/03/31/10-demographic-trends-that-are-shaping-the-u-s-and-the-world/
  38. Renninger SM, Phillips JC, Magnus K, Armstrong SK, Cahill B, Herman M, Savino F, Taylor KM, & Vajk F (2015). Outcomes of an organizational diversity initiative: Diversifying trainers to diversify psychology. Training and Education in Professional Psychology, 9(3), 229–234. doi: 10.1037/tep0000089 [DOI] [Google Scholar]
  39. Salter P, & Adams G (2013). Toward a critical race psychology. Social and Personality Psychology Compass, 7(11), 781–793. [Google Scholar]
  40. Stern JA, Barbarin O, & Cassidy J (2021). Working toward anti-racist perspectives in attachment theory, research, and practice. Attachment & Human Development, 1–31. doi: 10.1080/14616734.2021.1976933 [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Sue DW, Sue D, Neville HA, & Smith L (2019). Counseling the culturally diverse: Theory and practice. John Wiley & Sons. [Google Scholar]
  42. Taylor E (2009). The foundations of critical race theory in education: An introduction. In Taylor E, Gillborn D, & Ladson-Billings G (Eds.), Foundations of critical race theory in education (pp. 1–12). Routledge. [Google Scholar]
  43. The Sávila Collaborative. (2022). http://www.centrosavila.org
  44. Trent F, Dwiwardani C, & Page C (2021). Factors impacting the retention of students of color in graduate programs: A qualitative study. Training and Education in Professional Psychology, 15(3), 219. [Google Scholar]
  45. U.S. Census. (2015). New Census Bureau Report Analyzes U.S. Population Projections. http://www.census.gov/newsroom/press-releases/2015/cb15-tps16.html
  46. U.S. Census. (2020). Racial and Ethnic Diversity in the United States: 2010 Census and 2020 Census. https://www.census.gov/library/visualizations/interactive/racial-and-ethnic-diversity-in-the-united-states-2010-and-2020-census.html
  47. Venner KL, & Verney SP (2015). Motivational interviewing: Reduce student reluctance and increase engagement in learning multicultural concepts. Professional Psychology: Research and Practice, 46(2), 116–123. 10.1037/a0038856 [DOI] [Google Scholar]
  48. Vespa J, Medina L, & Armstrong DM (2020). Demographic turning points for the United States: Population projections for 2020 to 2060. P25–1144. U.S. Census Bureau, Washington, DC. https://www.census.gov/library/publications/2020/demo/p25-1144.html [Google Scholar]
  49. Woods-Jaeger B, Cho B, & Briggs EC (2020). Training psychologists to address social determinants of mental health. Training and Education in Professional Psychology. Advance online publication. 10.1037/tep0000307 [DOI] [Google Scholar]

RESOURCES