Written by Danielle Currin, Ph.D., on behalf of Atlanta Behavioral Health Advocates

Before starting my second year of graduate studies, I was asked to decide on my theoretical orientation for therapy practice. This choice could have been overwhelming with all the possible directions that exist in the field, but my program has simplified it to three options: cognitive-behavioralacceptance and commitment and psychodynamic. These represented the “big three” in my mind, while other orientations such as interpersonal therapy and humanistic therapy were sprinkled throughout my training. Meanwhile, frameworks like liberation or critical psychology were relegated to the classroom, introduced by specific supervisors to whom I was largely randomly assigned or not mentioned at all.

Source: Kampus Production/Pexels

These frames seem to be getting more and more Careful recently, and their focus on context, oppression, and equity is not only wonderful to see, but necessary for any clinician treating human beings living in today’s world. However, for clinicians who have not gained exposure to these frameworks during their own training, it may seem intimidating to open up discussions about them with trainees. What does it mean to bring these frameworks and perspectives into the context of surveillance?

One of the most well-known frameworks that emphasize context is liberation psychology, which can take many forms, from an academic extension of critical race theory to a clinical practice used with clients of diverse backgrounds and identities. It can be defined as “the use of psychological science to address and dismantle oppressive and discriminatory systemic practices” (Singh & Gudiño, 2023). This includes cultural recognition and spiritual leaders, embracing global differences in the outlook of psychology and therapy, and generally moving away from default Western and white perspectives (Bryant, 2024).

Not easily classified as a treatment manual to follow, liberation psychology is better thought of as a tool to shape a clinician’s approach to therapy. Research has supported its inclusion in the MIND interventions (Bryant, 2024), group therapy for chronic pain (Salvo et al., 2023) and acceptance and commitment therapy (Gingles, 2021), to name a few applications. An early stage clinician seeking a theoretical orientation may resonate with liberation psychology not as a specific skill set to teach clients, but as a filter to use when working with clients.

Choosing a theoretical framework to use as a basis for clinical work is a large part of a psychotherapist’s professional development. Research has shown that some primary influences on this decision are personality of the intern, the resources and options available to the learner, and the primary setting used at the practicum (Liao et al., 2022; Petko et al., 2016). These internal and external influences can work either together or against each other as a learner selects a framework that fits their beliefs and objection.

Students and early career psychologists who want to prioritize something like cultural influences and systemic oppression in their clinical work may find themselves in settings with few resources or supervisors who are knowledgeable about these frameworks. As such, they must advocate for themselves to obtain training or, in some cases, even exposure to ways of thinking outside of their institution’s primary orientations. They can even be expected to educate their supervisors about what it really means to consider context psychotherapy.

Supervision is an essential space for early-career clinicians to learn and develop, and therefore must be considered in any discussion of implementing culturally responsive perspectives and interventions in mental health care. A supervisor’s role is multifaceted, including encouraging, challenging and releasing the trainee to bring them into a space of understanding and ownership of their own therapist. identity (Watkins, 2020).

In essence, this is not so different from the therapy process that the trainee encounters with their own clients. In fact, using a therapeutic lens in supervision is a common model implemented with trainees, where the supervisor shapes the theoretical orientation that the trainee is expected to follow (Basa, 2017). Notably, even if the supervisor does not strictly endorse this particular model of supervision, they may naturally incorporate some of these elements into their encounters with learners because of their personal theoretical orientation. For a supervisor who does not follow context-centered psychology, bringing these aspects into the practical training they provide to trainees may require a more concerted and conscious effort.

Acknowledging one’s own experiences, biases, and assumptions about oppression and discrimination (personally, generally, and in terms of psychology and psychotherapy) is an essential first step in embracing culturally aware frameworks. Sharing these with the trainee and encouraging them to reciprocate has the potential to be very uncomfortable, but a welcoming, open and vulnerable space contributes to a foundation on which to build a shared understanding of the contexts in which the supervisor, the trainee and the trainee’s clients exist. Here comes the opportunity to open the door to discussions about how these contexts influence the various relationships at play.

We can make changes as individual supervisors that impact on ourselves and our learners, but there are also systemic changes that need to happen. As such, we can also:

• Attend and participate in workshops and discussions on unfamiliar topics
• Foster productive discussions around historical and contemporary issues of oppression in psychology with peers
• Create workshops and discussions in collaboration with experts as we gain knowledge and trust in sharing our perspectives
• Incorporate our understanding of context into our own work with clients: consider how systems of oppression may interfere with a client’s willingness to participate in a session, or how our own implicit biases may change the way we interact with different individuals in our case.
• Become an advocate to have more of these discussions in our institutions

As supervisors, one of the many influences we have on our trainees is to help them develop their clinical and professional identities. By recognizing that none of us live in a bubble, and by embracing uncomfortable discussions and frameworks that we may not have been taught, we can contribute to the future by making psychotherapy accessible and relevant to as many people as possible.