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Journal of Marital and Family Therapy doi: 10.1111/j.1752-0606.2011.00232.x October 2012, Vol. 38, No. 4, 573–588

DEVELOPING A CONTEXTUAL CONSCIOUSNESS: LEARNING TO ADDRESS GENDER, SOCIETAL POWER, AND CULTURE IN CLINICAL PRACTICE Elisabeth E. Esmiol, Carmen Knudson-Martin, and Sarah Delgado Loma Linda University

Despite the growing number of culturally sensitive training models and considerable literature on the importance of training clinicians in larger contextual issues, research examining how students learn to apply these issues is limited. In this participatory action research project, we systematically studied our own process as marriage and family therapy (MFT) practicum students developing a contextual consciousness. Using grounded theory, we identified a three-stage process: (a) raised awareness through clinical experimentation and developing a theoretical rationale, (b) reflective questioning involving challenging old perspectives and experiencing positive client–therapist interactions, and (c) an intentional new lens based on personal responsibility and commitment. Creating and maintaining a contextual lens required a safe, empowering group dynamic and accessing other forms of support and accountability after the practicum. Competence in marital and family therapy requires that therapists ‘‘recognize contextual and systemic dynamics (e.g., gender, age, socioeconomic status, culture ⁄ race ⁄ ethnicity, sexual orientation, spirituality, religion, larger systems, and social context)’’ and provide interventions that are sensitive to the contextual needs of the clients (American Association for Marital and Family Therapy, 2004, 1.2.1). Learning how to address gender, societal power positions, and culture is thus an important aspect of clinical training (McGoldrick & Hardy, 2008a). However, addressing these issues in the classroom does not necessarily result in trainees giving attention to them in practice (Almeida, Dolan-Del Vecchio, & Parker, 2008; Leslie & Clossick, 1996). Attending to contextual issues can be difficult, even among experienced therapists (Hildebrand & Markovic, 2007). Although there is considerable literature on the importance of contextual issues (e.g., Garcia & McDowell, 2010; Knudson-Martin & Mahoney, 2009a; McGoldrick, Giordano, & Garcia-Preto, 2005; Rastogi & Thomas, 2009; Zimmerman, 2001) and a growing number of culturally sensitive training models (Almeida et al., 2008; Hernandez, 2003; McGoldrick et al., 1999), research examining how students learn to address contextual issues is limited (Nixon et al., 2010). In this article, we share our experience as part of a participatory action study designed to discover how MFT practicum students develop conscious attention to larger contextual issues within their clinical practice.

CONTEXTUAL ISSUES IN MFT EDUCATION Addressing larger cultural and societal contextual issues in family therapy is complicated by the fluidity and heterogeneity of contemporary societies (Falicov, 2007; U.S. Census Bureau, Elisabeth E. Esmiol, PhD(c), is an Assistant Professor of Marriage and Family Therapy, Division of Social Sciences, Pacific Lutheran University; Carmen Knudson-Martin, PhD, is a Professor and Director of the Marriage and Family Therapy PhD Program, Department of Counseling and Family Sciences, Loma Linda University; Sarah Delgado, MS, is a student in the DMFT (Doctorate in Marriage and Family Therapy) program, Department of Counseling and Family Sciences, Loma Linda University. This project was completed while Elisabeth E. Esmiol was a doctoral student at Loma Linda University. Portions of this project were presented at the 2008 annual meeting of the American Association of Marriage and Family Therapy, Nashville, Tennessee. Address correspondence to Elisabeth E. Esmiol, Pacific Lutheran University, East Campus, Room 28, Tacoma, Washington 98447; E-mail: esmiolev@plu.edu

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2008; U.S. Yearbook of Immigration Statistics, 2011). Family therapists are called upon to respect cultural context and help families preserve cultural values important to them, while also being aware that families today live within unprecedented cultural intersections (Blume, 2006; Falicov, 2007; Winslade, 2009). Therapists must be able to attend to a convergence of multiple contextual influences that offer a wider range of choices than in the past (Winslade, 2009). However, family therapy theories and methods still tend to reflect the values and perspectives of the dominant culture (McGoldrick & Hardy, 2008b). Thus, understanding the impact of contextual factors on clients’ intrapsychic and interpersonal functioning cannot be fully realized without attention to differences in power and privilege associated with social position (Almeida et al., 2008; Winslade, 2009). To take into account the complexities of attending to the larger context, our definition of contextual consciousness in MFT education includes three dimensions: (a) consciousness about the inherent power differentials in a person’s social contexts, including gender, race, socioeconomic status, and sexual orientation; (b) sensitivity to clients’ unique experiences within these different contexts; and (c) attention to the intersection of the larger context with clients’ relational processes and presenting issues. This definition highlights a critical understanding of cultural differences as part of a wider set of societal power relations (Almeida et al., 2008; McDowell & Fang, 2007) as well as sociocultural attunement to client experience at the emotional level (Knudson-Martin & Huenergardt, 2010). The current literature indicates a number of conditions that help explain how students develop contextual consciousness. These include attention to power and privilege, integration of knowledge and experience, opportunities for self-reflection, and the role of teachers and supervisors. Power and Privilege Power and privilege are derived from social categorizations such as gender, ethnicity, race, social class, religion, migration history, geography, sexual orientation, and mental health status (McGoldrick et al., 2005). Wieling and Rastogi (2004) point to ‘‘institutionalized and internalized racism, oppression, and other White supremacist capitalist systems of domination that operate within multiple levels of our training, clinical, and research practice’’ (p. 4). They note that training programs are beginning to address these concerns. Conversations regarding power and privilege are particularly important, especially for members of the dominant culture (McDowell et al., 2005). It is important that such efforts be intentional and include conscious labeling of ways that those of us in the dominant culture resist acknowledging our privilege or hearing the voices of the oppressed (McGoldrick et al., 1999). Interpersonal gender processes must also be understood in the context of societal systems of privilege and domination (Almeida et al., 2008; Lawless, 2002; McDowell & Fang, 2007). Societal-based inequalities such as power disparities between women and men are frequently overlooked as part of taken-forgranted realities that seem natural (Knudson-Martin & Mahoney, 2009b). Knowledge and Experience Simply knowing about contextual issues does not adequately equip therapists as culturally competent clinicians (Cardemil & Battle, 2003). An increasing body of literature indicates the importance of an experiential learning approach to acquiring a contextual awareness (Ellenwood & Snyders, 2006; Guanipa, 2003). Training must begin with knowledge about others but move beyond cognitive knowledge to personal engagement and experience with others of different backgrounds (Lawless, 2002). Increasingly, educators are being asked to identify best practices through understanding how knowledge is learned and what participants really experience (Patton, 2001). MFT training programs continue to need greater diversity among students and faculty in order to facilitate personal experiences with people different from each other (Guanipa, 2003; Wieling & Rastogi, 2004). Efforts to creatively engage students will be especially empowering for marginalized students and help hold accountable students of privilege (Nixon et al., 2010). Nixon et al. advocate creating an open classroom environment that makes engagement among diverse students safe and possible. Learning to facilitate open conversations both in the class574

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room, in the therapy room, and in life about the larger sociocultural context is an important experiential element in training therapists (Hernandez, Siegel, & Almeida, 2009; McDowell et al., 2005; McGoldrick et al., 1999; Nolte, 2007). Self-Reflection Many models stress the need for therapists to become aware of their own contextual experiences by engaging in self-reflection (McGoldrick et al., 1999; Nolte, 2007). Research indicates that self-reflection is associated with positive outcomes in training therapists regarding contextual issues (Mills-Powell & Worthington, 2007; Wieling & Rastogi, 2004). Such reflection should include attending to one’s own experience of racial privilege and oppression (McDowell et al., 2005) and help students develop an internal frame of reference regarding their own cultural backgrounds (Ellenwood & Snyders, 2006). Awareness of internalized sexism and racism and how these operate within us to perpetuate patriarchal structures and androcentric norms is also an important part of learning for women and minorities (Hardy, 2008; Sharp, Bermudez, Watson, & Fitzpatrick, 2007). Students also need to reflect on and become aware of heterosexist biases and heterosexual privilege (Adams & Benson, 2005; Nealy, 2008). Teachers and Supervisors Cultural context must be directly explored in the therapist–supervisor relationship (Hernandez, 2003). Several recent authors have offered models of clinical supervision that overcome the code of silence surrounding client issues of ethnicity, gender, spirituality, and socioeconomic status (e.g., Estrada, 2005; Hernandez). In addition, research on cross-cultural supervision has highlighted the need for theoretical models that expand beyond the therapy room into the supervision process itself (Estrada, Frame, & Williams, 2004). Understanding the influence of teachers and supervisors is complex, as some research shows that teachers have a significant influence on the formation of students’ ideology (Hooper, 2008); however, the contextual competence of the supervisor does not necessarily increase a trainee’s ability to contextually conceptualize a case (Inman, 2006). Thus, it is essential to understand the experience of students themselves and how they translate what is presented in the classroom into their own learning and practice.

METHOD: THE PARTICIPATORY ACTION PROJECT In marital and family therapy training, student knowledge provides insight that cannot be accessed from other sources. Participatory action research (PAR) is thus a particularly appropriate methodology to examine the processes through which MFT students develop a contextual consciousness (Coghlan & Brannick, 2005; Mendenhall & Doherty, 2005). PAR provides a flexible style and process that is more than a methodology of research; it is also a way to systematically evaluate process and make ongoing changes to improve learning or practice (Mendenhall & Doherty). This method is consistent with a critical pedagogical model in which teachers use student diaries and dialogues to improve practice (Allen, 2009; Freire, 1970 ⁄ 2007). Participants Within participatory action research, the distinction between the researcher and the participant becomes blurred (Coghlan & Brannick, 2005). The student participants are themselves the researchers, investigating their own learning process. The participants in this study are one instructor and 18 students in four different quarters of an 11-week doctoral practicum in marital and family therapy that explicitly focused on gender, culture, and power issues. Five students were enrolled in the first practicum: one Caucasian man, one African American man, one Asian woman, one Caucasian woman, and one African Caribbean woman. The second practicum included three female participants: two Caucasians and one Hispanic. The third practicum included three participants: one Asian man, one African woman, and one Israeli woman. The fourth practicum included seven participants: one Mexican man, one African Caribbean man, one Caucasian man, one African American woman, one Asian woman, and two Caucasian October 2012

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women. Student ages ranged from 24 to 55. The instructor was a Caucasian female professor in her 50s with a special interest in gender and culture. Data Creation and Analysis In qualitative studies, data creation and analysis are inseparable and occur simultaneously (Daly, 2007). Rather than artificially describing these stages as distinct, we describe our data creation and analytic processes together. They include both written individual reflections and collaborative dialogic experiences. Given the participatory action nature of this study, new data continued to emerge from our ongoing analytical process (Coghlan & Brannick, 2005). We made changes in our clinical actions as a result of our analytical reflections. As we carried out and evaluated these new clinical actions, we used grounded theory methods to develop theory that described our collective experience. Because grounded theory helps identify how changes at one time are linked to outcomes at another, this method is especially suitable in analyzing the sequential findings of participatory action research (Charmaz, 2006). Individual data creation and analysis. Data in the form of students’ personal learning experience was collected over four quarters. Following the action research guidelines of Coghlan and Brannick (2005), participants kept a weekly journal in which they (a) described the new actions they took, (b) reflected on their experience, (c) evaluated the outcome, and (d) reported what actions they would take next. Individual participants were asked to reflect on their learning process and personal changes over time and then share these in their practicum groups. Collaborative data creation and analysis. The weekly process of collaborative data creation and analysis involved group discussion, grounded theory coding, and viewing clinical videos. Class sessions helped students engage in the ongoing analysis of their learning process as a result of their required weekly articles. Participants discussed what actions they took, how they worked, and what they would do next. At the end of each class meeting, students declared what they were going to focus on the next week. Initial coding. A group process of open coding occurred as students elaborated together on their reflection articles and learning experiences. For example, when a student said, ‘‘I was feeling anxious about raising culture as a relational issue, but when I did I was surprised by how engaged my clients got,’’ this was discussed and coded by the group as ‘‘experienced positive client response.’’ When another student said, ‘‘I felt more empathy for [male client] after hearing his fear about not being competent in handling his wife’s depression,’’ the group coded this as ‘‘increased therapist empathy.’’ Such initial coding helped us keep our goals simple, preserve action, and remain close to the data before we moved into focused coding (Charmaz, 2006). Focused coding. We used focused coding to ‘‘synthesize and explain larger segments of data’’ and better conceptualize our learning process (Charmaz, 2006, p. 57). For example, the open codes described earlier were grouped together to create the category ‘‘positive client–therapist interaction.’’ Through this process, we identified the concepts that would enable us to develop a theoretical explanation of our learning process. Theoretical coding. Finally, we used theoretical coding to identify relationships between categories and link them to each other. Our goal was to explain our process of learning over time. For example, we used bidirectional arrows to link ‘‘positive client–therapist interaction’’ to ‘‘committing to an intentional new contextual lens.’’ Over the course of four different practicum sections, we used all three levels of coding to develop and refine a theoretical model reflecting the collective experience of all 18 students. Our collaborative model is presented in Figure 1. Trustworthiness of the research must be viewed in the context of the participatory action methodology (Morrow, 2005), in which the goal is first to understand and improve our own process and then offer our experience as a way of contributing to the larger body of knowledge (Coghlan & Brannick, 2005). The ongoing checks among members, as part of the participatory nature of our process, contribute substantial trustworthiness to the findings (Morrow). Transferability of our findings to other settings is likely to vary depending on the reader’s context (Daly, 2007). To illustrate our process of developing contextual consciousness, the two student authors present experiences from their weekly written reflections in the following results section. At the time of the practicum, [first author] was in her fourth quarter of MFT practice. [Third author] 576

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Late Process: Intentional New Lens

Committing Identification With Privilege & Marginalization

Mid-Process: Reflective Questioning

Positive Client–Therapist Interaction

Challenging Theoretical Foundation

Early Process: Raised Awareness

Clinical Experimentation

Foregrounding

Underlying Context: Empowering Group Dynamics

Figure 1. Model of developing a contextual consciousness. had already acquired nearly all the hours needed for MFT licensure. Each worked in community settings with practice models that do not explicitly attend to larger contextual issues.

DEVELOPING A CONTEXTUAL CONSCIOUSNESS: STUDENT PERSPECTIVES By reflecting on our developmental process and struggling to name and rename our own stages of growth as contextually conscious practitioners, we [first and third authors] helped create the model illustrating our experience of evolving a contextual consciousness. Our experience involves three developmental processes: Raised Awareness, Reflective Questioning, and an Intentional New Lens. In addition, an Underlying Context of a safe and empowering group setting contained our experience and provided a facilitative context for our development. Early Process: Raised Awareness Our early developmental process began with a raised awareness of larger contextual issues through clinical experimentation and attention to theoretical issues. We were confronted with bringing together theory and practice with heightened intentionality. We were assigned readings such as McGoldrick and Hardy (2008a) and Knudson-Martin and Mahoney (2009b) that extended our previous theoretical understanding of contextual issues while we were concurrently required to experiment with applying these issues clinically. What resulted was the subjective experience of ‘‘a light turning on’’ and seeing what we had not seen before. The previously invisible societal underpinnings moved from our peripheral vision into the foreground of our awareness. Foregrounding. Initially, the process of developing a contextual consciousness hinged on our being directly confronted with larger contextual issues. We were required to make contextual issues such as culture, power, race, gender, and sexuality front and center in class discussions, weekly writing assignments, and videoed interventions with clients. Yet in reviewing our early reflection articles, we discovered that this required foregrounding began to cause significant shifts in our thinking: Throughout the past week, I have thought about formulating my treatment plan of a 33-year-old Mexican female around a particular diagnosis. However, I am tentative in forming my case plan based upon my preliminary diagnosis now that I have been challenged to think about the ties my client has to larger societal and cultural systems. [third author, week 1] October 2012

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A new question raised by my intervention is how to facilitate anger management with a woman whose external circumstances are understandably beyond what one individual can tolerate? More than a simple model of dealing with anger seems to be needed. [first author, week 1] By being required to look at the greater context surrounding our clients, we began to take preliminary steps toward conceptualizing our clients’ issues within their larger cultural and societal systems. Awareness of the impact of external circumstances on our clients grew during this early foregrounding process. Theoretical foundation. New ideas from the required readings such as ‘‘White privilege’’ or ‘‘liberation therapy’’ helped us begin conceptualizing a rationale for a new theoretical lens incorporating contextual issues. We began to see how these issues impacted family therapy. Theoretical issues included critical consciousness, invisible power, and multicultural identities. However, the participatory action project helped direct our theoretical readings with an eye toward practice. I am of the belief that this week’s reading will help to lay the foundation in my quest to develop a more critical awareness of gender, power, and culture. I also believe that the content of the reading provides very practical ways of asking clients about these areas. [third author, week 1] After the session with Mike and Mindy, more questions arose regarding our specific conversation about socioeconomic status. Reading a chapter on ‘‘Cultural Genograms’’ by Treat Weeks, I discovered a list of questions on socioeconomic status in this chapter directly applicable to Mike and Mindy. . . . In response to my learning this week, I want to . . . bring in the questions from Weeks’ chapter on socioeconomic status and explore some of these specific questions with Mike and Mindy. [first author, week 3] Readings provided a new contextual framework from which we began to conceptualize our cases. Our experience seemed to hinge on our ability to practically and directly apply theory to practice: As I thought about subversive power dynamics and the idea of culture [concepts from the reading], I thought about my [homeless, Latina] female clients in my Home Again group. In this week’s session it was discussed how the dominant White culture is significantly different from their Latin American culture. . . . In my Spanish-speaking women’s group all the women processed how they feel they are very distinct in their values, and ways of interacting with others from their White counterparts. As I reflect upon the group dialogue it is clear that their process illustrates the authors’ statement and that culture cannot be understood apart from power. [third author, week 3] The primary means by which we each incorporated the required reading material seems to have been through clinical application. As we were required to integrate our weekly readings into our case conceptualizations, our awareness of contextual aspects grew. Clinical experimentation. Initially our clinical conversations felt artificial as we structured sessions around directly raising contextual issues. We did not yet know how to fluidly ask questions or articulate contextual issues with our clients. In response to my learning this week, I want to continue to practice facilitating direct conversations about the larger societal context. I practiced such direct conversations in several different sessions last week and with each attempt, felt less stilted and more natural. [first author, week 3] Despite the early discomfort with such direct conversations, we continued to make intentional decisions to raise contextual issues with our clients, as reflected in our weekly written assignments:

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This upcoming Wednesday I would like to further address how the rest of the women in the group feel in relation to their current role and how the social norms of their culture have impacted them to take on the role that they are presently assuming. [third author, week 2] Our clinical experiments hinged on intentionally integrating theoretical issues of contextual consciousness into actual clinical practice. A new framework for practice began to emerge through our conversations with clients about the contextual issues in their lives. But this framework and our previous theories did not easily fit. Mid-Process: Reflective Questioning As our process continued, we moved into a phase of productive discomfort. We began to question the rationale behind our previously accepted theoretical foundations as well as the rationale behind this new contextual perspective. Struggling to integrate seemingly incongruent views was a hallmark of this questioning process. Challenging. We began to reflect upon our sharpening contextual lens. What did it mean to see contextual issues at work in our clients’ lives and highlighted in theoretical readings? We raised new questions challenging our old perspectives on topics from personal to political to professional: This past week I have been thinking about GPC [gender, power and culture] issues and the evangelical church, and how the leadership might publicly promote egalitarian relationships, yet their organizational structure is far from egalitarian. . . . As I am beginning to take note of these issues for myself, so are my clients. [third author, week 4] We began to view our role beyond the traditional role of a therapist: As U.S. citizens, how can we fairly and justly assist immigrants who desire amnesty and governmental assistance so that they will not have to go underground to get the assistance they need to survive in this country? [third author, week 6] The ongoing accountability of the participatory action research project structured and fueled this process of challenging our previous assumptions. In addition, we struggled with how to integrate our new contextual perspective into our therapeutic work: My experience in this session generates new questions for me, such as ‘‘How can direct conversations about gender, culture and power be woven into the fabric of therapy?’’ ‘‘What would it mean to see such conversations as a regular part of therapy?’’ [first author, week 6] We began to grapple with how to assimilate information from the assigned gender and power readings with previously learned theoretical models. Instead of focusing on power issues by directly naming these issues, I see myself indirectly addressing power through attachment issues. I see my next step of growth involving the integration of larger contextual issues into my attachment and emotion focused framework. While addressing the immediate bonding experience of a couple, I want to be able to also help the couple sit back and reflect on their experience. I want part of this reflection process to include reflecting on how their society talks about intimacy and bonding. [first author, week 4] Reflecting on and questioning our methods of clinical experimentation challenged us to begin developing a more integrated model of therapy encompassing the larger contextual discourse. Commenting weekly on our ongoing growth process further challenged us to connect paradigms previously viewed as separate or even unrelated. For example, during a Southern California firestorm, one of us wrote: October 2012

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As I am figuring out how to incorporate a more panoramic method of addressing larger contextual systems, I also discovered this week that the lens I utilize must also be adept enough at capturing how environmental factors impact the relational functioning of my clients. . . . I intend on raising questions specifically aimed at finding out about their relationship with various institutions (i.e., the United States Immigration and Naturalization Service (INS), social services, local law enforcement, medical providers, etc.). I hope. . . they will encourage one another to persevere toward overcoming the obstacles that our government places on undocumented immigrants. [third author, week 5] Grappling with our own emerging inquiries about integration and application characterized our process from awareness to reflective questioning. Identification with privilege and marginalization. We were also challenged as we reflected on our own experiences of gender, power, and culture. Identifying aspects of our own privilege and marginalization emerged through open dialogue in class. The process evoked feelings of discomfort, highlighting the isolation of marginalization as well as the complacency of privilege. Listening to [the third author] in class reminded me of my own pain of feeling different from the dominant culture as a teenager. As I remembered this part of my history, I was struck by how helpful it would have been to have talked about my experience and have someone ask me about how hard it was to always feel different and like I never quite could fit in with my peers. The emotion that I felt in remembering this experience was surprising in its intensity. I realized how comfortable I’ve become fitting into a White culture where I no longer feel like an outsider looking in. All of our class discussions on having direct conversations with our clients about their experiences as a minority took on a new intensity and importance for me. [first author, week 7] Identifying with privilege and marginalization was not an end in itself but a pivotal part of the process in being able to more deeply connect with clients’ experiences of marginalization. Discussions about our own experiences had the galvanizing impact of reawakening a commitment toward action. After hearing the testimony of a fellow classmate and reflecting on my own personal experience of marginalization as a teenager, I have become much more aware of racial, gender and cultural issues. . . . This heightened sense of my marginalization and privilege yield a greater awareness of these issues which in turn I carry back into the therapy room. [first author, week 8] All my life I have been consciously aware of the ‘‘isms’’ that plague our society and have been the first to expose them when there was an inequity. But for some reason my ability to discern inequities became dull. . . . Whatever the reason may be, my eyes have been reawakened to the forces that continue to be very present, and very real. . . . Now I see myself cast in a different role. I see myself cast as a beacon—a beacon that illuminates power dynamics that can be harmful to relationships. [third author, week 4] Personalizing our experiences of marginalization and privilege motivated us to take action and address power issues with our clients. We felt personally changed as we took ownership of our responsibility to address contextual issues in our own lives and the lives of our clients. The action I am taking away from this week is a new sense of cultural sensitivity which I did not previously possess. . . . Through reuniting with my own minority experiences, I am carrying into my practice a deep respect for the minority experiences of all my clients. [first author, week 7] 580

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As we identified ourselves within the larger social context, our compassion for our clients grew and our role as active change agents was more fully owned. Positive client–therapist interaction. We each began to move beyond questioning to embracing a new contextual lens as we participated in constructive conversations in our clinical sessions. Although we continued to question the relevancy of a clinical focus on larger societal issues, consistently experiencing positive interactions with our clients was one of the strongest proponents for our adopting a contextual lens in therapy. As I gathered a history of Hilda’s past experience in therapy, she shared about two positive experiences in therapy and one poor experience. When I asked about these, the positive experiences were with Latina therapists as compared to a White therapist. I chose to be direct and acknowledged that as a White therapist myself I am an outsider to her [Hispanic] culture and will need to have her help me understand her experience. We talked about how we could work together and what I could do to make therapy a safe place for her to share her experience as a minority. What happened as we talked was that Hilda opened up, became noticeably more relaxed, and verbally stated how different I was from her previous White therapist. [first author, week 7] Directly addressing gender, power, and cultural differences with our clients noticeably improved the client–therapist relationship. Having contextual conversations also led to a variety of other meaningful outcomes, including clients strengthening their relationships: As I reflect upon the overall group process [in my group of homeless women] of asking questions about the larger contextual issues clients are a part of, it appears as if the . . . members are making personal efforts to extend their relational networks with each other outside of the sessions. I have noticed that after the weekly sessions many of the group members stay after to talk to each other to assist with childcare and ⁄ or transportation assistance. This is exciting for me as the therapist to see community occur both in and out of sessions. [third author, week 7] This week I asked Eddie and [her daughter] Yvonne about their experience of being Latina women. To my amazement, this simple question at the beginning of the session filled the entirety of our time. Eddie’s experience of immigrating to the U.S., learning the language as an adult, and struggling to raise her children with a sense of the culture and values of Mexico was very different from the experience of her [more Americanized] daughter. . . . Their differences in experience as Latina women shed light on some of their difficulties relating as mother and daughter. [first author, week 7] Through voicing their different cultural experiences, this mother and daughter began to better understand the other’s perspective and relate with more mutual vulnerability. As therapists we became increasingly convinced that addressing contextual differences helped our therapy. Our new role as contextually conscious therapists, while still awkward at times, seemed to help open new options for our clients and provide clients with hope: I had surprisingly felt only slightly uncomfortable when I first initiated the questions about ethnicity and exposed my own ‘cultural ignorance.’ However, as Mike shared, I felt my own genuine curiosity encouraging him to explore his experience. . . . I was able to see how the conversation about work illuminated his identity as a Latino male . . . [and] resulted in a fruitful discussion about new options. A general sense of hopefulness in both Mindy and Mike was a surprise to me, and a result I had not anticipated from initially addressing the larger cultural issues. [first author, week 6] Exploring the larger contextual issues of Mike’s gender and culture fueled a discussion that instilled hope, increased understanding, and opened new possibilities not previously considered. Our excitement as therapists continued to build as we more consistently experienced such positive October 2012

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client–therapist interactions. The revisionary process of the participatory action project aided in our success: ‘‘Through my experimentation, I’m able to discover what works and what makes it effective and how I can improve what is and is not working’’ [first author, week 8]. Experiencing the benefits with our clients directly helped us understand the value of a contextual lens. Late Process: Intentional New Lens Near the end of the quarter, we noticed a significant shift occur in our motivation. We were no longer required participants in an obligatory class research project. We were becoming personally committed to intentionally using a contextual lens with our clients. Committing. Reviewing our weekly responses revealed an overwhelming number of statements about our emerging commitment to being contextually conscious therapists: As I reflect upon the beginnings of my courtship with ‘‘GPC’’ over the past quarter . . . I felt like it was a relationship that I didn’t really want to accept, and was skeptical about whether or not there would be ‘‘anything in it for me.’’. . . As I began to see movement in the sessions, and saw adherence to attendance increase, then that. . . reinforced my desire to integrate the GPC [lens], and ‘‘accept’’ my relationship with GPC. [third author, week 9] I feel as though this week I finally learned the importance of raising the issue of culture in a therapeutic setting. I feel as though this week marks my ‘‘conversion’’ into being a proponent of acknowledging cross-cultural experiences. [first author, week 7] We committed ourselves to more actively noticing contextual issues with our clients. With a deepening sense of responsibility, we committed ourselves to more personally addressing these issues with our clients. I have come to the realization that it is incumbent upon me as the therapist to bring up GPC and larger contextual issues because it seems to have a way of gaining a more comprehensive understanding of my clients’ experiences, and the systems they are a part of. [third author, week 6] I hope to maintain my growing sensitivity to gender, culture, and power. . . . The general trend of engaging in new interventions with a gender, culture, and power lens is what I want to carry over into all of my work with clients. [first author, week 9] As we owned the importance of our role in addressing contextual issues, we became more nuanced in how we thought about integrating this model into our therapeutic work: I was aware this week of how this [contextual] theory has become integrated into my conception of practicing therapy. I was also aware of the more fully developed rationale I have regarding the importance of addressing power, gender, and cultural issues, either directly or indirectly. . . . By indirect, I mean focusing on what I’m listening for, how I name things. . . and what I expect from partners or parents or siblings. This is a more comprehensive intervention that weaves an awareness of [GPC] issues into all my work. [first author, week 8] At some point, the distinction blurred between consciously integrating a contextual lens and automatically viewing clients through this new lens: As I was conducting a new intake with a client this week I couldn’t help but think about GPC and larger contextual issues. And I came to a heightened awareness that my conceptualization of issues seems to have shifted. It felt like I had acquired a completely new way of treatment planning, interacting, and talking! [third author, week 7] 582

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The implications of our new commitment were multifaceted, evoking new questions about our therapeutic work as well as our personal lives: The question I have been compelled to wrestle with is more of a personal one. Now that my way of thinking has broadened to include GPC issues, what does that mean for me and how I work with my clients? It also makes me question how the shift in my thinking will influence the way I am in my own personal relationships (i.e., with family members, colleagues, friends, etc.). [third author, week 7] With our intentional commitment to place contextual issues front and center in our own personal worldview came a certain level of fear of the future: I have a real appreciation for this new lens, and what it brings to the therapeutic context, and how it has impacted me. I am now somewhat fearful that I may veer from integrating GPC into my sessions because I won’t be engaging in an academic dialogue around it as often. [third author, week 9] As our involvement in the participatory action research project came to a close, we wondered how we would maintain the momentum in our own development as contextual therapists. We had embraced a new lens and [third author’s] words spoke for us both: ‘‘I am very grateful for this learning experience. . . . It’s definitely transformed the way in which I see the world and how I understand relationships’’ (third author, week 9). Yet we wondered what would happen in the months to come. Ongoing experience. Four months after our class ended, we voluntarily met to discuss our progress in maintaining a contextually conscious therapeutic orientation. We recorded our ongoing experience in reflection articles, which revealed a mixture of successes and struggles. On the positive side, we continued discussing issues of gender, power, and culture with our clients: I’ve been able to . . . facilitate a dialogue between undocumented women in which they grieved over their ‘‘invisible’’ status here in America, and expressed their desire to see changes occur with the help of the next Presidential candidate in the present governmental laws. [third author, 4 months later] I have continued to be aware of the cultural issues and attempted to integrate discussions of culture where appropriate to the clients’ process. [first author, 4 months later] Our ongoing process also included taking personal responsibility for our continued learning and introducing peers to this new lens. I am taking Advanced Quantitative Research in which we are required to conduct research using a survey. I am working with three other students whom I have persuaded to complete our research requirement by surveying current trainees and interns regarding their experience of how cultural issues are or are not addressed in supervision. [first author, 4 months later] Despite making some individual headway, we missed our classroom discussions and contextually focused clinical supervision. We found ourselves uncertain about how to navigate new clinical situations: I felt kind of ‘‘lost’’ from my learning process after the class ended. And I wanted to continue to have this ongoing dialogue ⁄ experience with this particular group. I still find myself floundering about, but I really feel like this lens is worth exploring more as I continue to grow as a family therapy practitioner. [third author, 4 months later]

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I struggle to have direct discussions about cultural issues at the school site where I see mainly Latino elementary students. While I maintain an awareness of the cultural issues, I remain uncertain of whether or not to and if so, then how to integrate cultural discussions directly into [play] therapy. [first author, 4 months later] The difficulties we encountered stemmed from desiring to be true to a contextually conscious lens but needing continued support. Lacking accountability and structured guidance, outside distractions became an additional obstacle: Right now I am finding my GPC learning process losing steam because I have so many other things going on in my life (i.e., personal and physical loss, 50-hr work weeks and their stressors, applying for grants, studying for licensure, getting dissertation project together, family commitments, etc.). . . I still want to give my attention to learning more about the GPC model, but . . . it’s really hard for me to get in touch with my ‘‘zeal’’ for acquiring and processing new knowledge that I had not too long ago. [third author, 4 months later] After 4 months on our own, we realized that being committed to contextual consciousness was not enough. To be contextual therapists, we needed to keep practicing, learning, discussing, and using this lens in a collaborative community. Looking back at our class experience, we had that context of relational support. From hindsight, we examined the meaning of community in our learning experience. Underlying Context: Empowering Group Dynamics Our process of developing a contextual consciousness was made possible by the underlying context of a safe and empowering group dynamic. The importance of the group dynamic and the relationships that we developed became evident over time and made clear through final reflection articles written 4 months after our class. Our articles surfaced themes such as safety, acceptance, and empowerment, which we experienced as an essential and necessary accompaniment to our learning process. Safety. Our collaborative learning experience depended on being safe with each other. ‘‘I really do appreciate the people I was with in this class, because I felt like they made the learning experience a safe and supportive one for me—and I think that made all the difference’’ [third author, week 9]. We saw this sense of safety grow into group experiences of respect and trust: ‘‘The safety I felt in the class was also an important aspect that contributed to my learning. More than a basic level of respect, I experienced a sense of trust among the students and our professor’’ [first author, 4 months later]. In addition, our learning process was aided by ‘‘openness to deepening and forming relationships [and] establishing a very safe holding environment . . . where personal dialogue could ensue’’ [third author, 4 months later]. In the context of safe relationships, our learning flourished. We were able to share our personal and professional experiences and explore our process of becoming contextually conscious. Acceptance. In our final reflection articles, we also described feeling accepted and treated as coequals, having the ability to influence one another. ‘‘Overall, I felt like I had nothing to prove. I felt like each person in the group knew where I was at in my program and I wasn’t overly anxious to perform academically as I have in previous classes’’ [third author, 4 months later]. This sense of being accepted as mutual participants in an action research project helped cement the underlying safety that fueled our development. Furthermore, an ‘‘air of sincere humility and teachability reigned in the class’’ [third author, 4 months later]. By accepting the influence of each other and treating each other as equals, we were able to collaborate together and with our professor as equal participants. In addition, students felt free to question and challenge each other regarding their diverse cultural, racial, sexual, and religious perspectives. Empowerment. The very purpose of participatory action research was empowering as ‘‘we worked on a model for how MFTs develop a cultural consciousness. The changes, discussions, revisions, and conversations that stemmed from this process were a huge part of my own

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development’’ [first author, 4 months later]. Our group dynamics fostered this environment of creative empowerment. We wrote that ‘‘one of the primary factors [was] experiencing the professor as encouraging and believing in us as persons, students, and colleagues and expressing that our process was worth . . . listening to’’ [third author, 4 months later]. Our growing confidence as researchers and clinicians motivated us to collaborate with our peers in creating a model of how we as student practitioners developed contextual consciousness.

DISCUSSION The gradual development of a contextual consciousness by the students in this study is similar to the process of developing a critical consciousness as described by Freire (1970 ⁄ 2007). He also emphasized the importance of dialogue and interpersonal questioning in the sequential process of knowing. For the 18 student participants and one professor who worked together to develop our learning model, it appeared that one set of experiences were precursors to the next. To more easily discuss our learning experience, we created a model that divided our process into early, middle, and late stages. However, these stages were not as clear in our experience as they may appear. Our experience was more of a recursive process than one marked by distinct stages. Within this holistic perspective, examining key turning points in our learning process may shed light on possible implications for training, practice, and future research. Key Turning Points While the entirety of our learning process was important in propelling us toward committing to a contextual worldview, several key turning points seemed pivotal in our experience. It was our experience that the following four shifts helped our clinical practice reflect a contextual consciousness. Positive group dynamics. We experienced that students did not learn contextual consciousness without feeling safe and accepted among professors and peers. In programs where trainees may not feel safe, discussing the lack of safety may be the first step toward changing negative group dynamics. We recognize safety is also linked to a person’s sense of self and recognize that developing a self-concept occurs within community. Students in training are continuing to develop their own self-concept, and encouragement in this process seems important. Questions. The major impact of having contextual issues brought to the foreground through required theoretical and clinical integration was that we started to question what we had previously learned. The shift from passive learner to active participant began to occur as we questioned the relevancy, process, and rationale of a contextual approach. Being challenged to engage with the literature, intentionally integrate the theory into our clinical practice, and evaluate our learning process helped force us into this active stance of reflective questioning. With this shift, we began to take ownership of our own learning. Of the 18 student participants, some began practicum with more questions and reservations, while others were further along their journey in accepting the importance and relevance of a contextual lens. Yet regardless of where we each began, the practice of questioning seemed significant in our learning process. Positive clinical experience. Another shift seemed to occur as we began to observe what we collectively perceived as the powerful and positive impact of addressing contextual issues with our clients. Again, of the 18 student participants, some seemed to experience positive client– therapist interactions around contextual issues for the first time. Others experienced an increase of positive client interactions. Yet regardless of our prior experiences, we agreed that our clinical experimentations of intentionally addressing larger contextual issues were not enough in themselves. But witnessing what we perceived as therapists as a repetitive, positive impact of this new clinical orientation on our clients’ lives and relationships seemed to fuel a significant shift in our process toward becoming contextually conscious. Personal experience. How we identified with privilege and marginalization in our lives varied based on our own backgrounds and life experiences. Yet in our own ways we each October 2012

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revisited personal experiences with marginalization and power in what we perceived as meaningful ways. Readings and especially safe and accepting class dialogues seemed to enable this process. Student participants reflected that locating contextual issues in our own lives was a deeply personal process. Another powerful shift, even a transformational change, seemed to emerge from these personal experiences, influencing students to commit to a contextual lens. While some students began practicum seemingly closer to a commitment than others, all 18 students reflected that grappling with personal experiences in the diverse context of classroom dialogues seemed important in developing contextual consciousness. Implications for Training and Practice Our experience suggests the importance of activities that directly raise awareness of larger contextual issues including race, culture, gender, power, religion, and sexuality. Those training new marriage and family therapists may want to consider how they are foregrounding these issues. A combination of integrating theoretical issues into clinical practice and reflecting on clinical experimentations is suggested. Training programs and practicum sites may want to implement ways to aid students in exploring and discussing their own stories of privilege and marginalization and the impact of their experiences on their clinical work. Using participatory action research helped us engage in our own learning process. Professors and clinical supervisors may benefit from experimenting with different learning methodologies that creatively shift the onus of learning into the students’ hands. In our experience, learning to address larger contextual issues also involves challenging practice as usual. Training that begins with a clear framework for addressing larger contextual issues from the outset may help reduce some of the conflict we experienced as we tried to integrate a contextual consciousness with other, previously learned clinical frameworks. Even so, the shift from the academic setting to community context is likely to remain a particular challenge for students and suggests the need for ongoing theoretical learning, support, and supervision. Finally, we view training and practice from a contextually conscious lens as an ethical responsibility. Reaching current professional standards of competence and integrity involves intentional integration of larger social contextual issues. Future Research One of our biggest lessons was our perception of clients responding positively to our evolving contextual consciousness. Yet there is little research that examines the link between addressing larger contextual issues and outcomes. There is a need for better integration of theory, research, and practice application if the field is to remain relevant and abreast of our clients’ diverse needs. This study also did not focus on client perceptions. As therapists and clients may not experience clinical work in the same way (Helmeke & Sprenkle, 2000), there is a need to study contextual practice from the clients’ perspective. A limitation of our findings is that participatory action research is meant to be unique to our own experience and setting. Moreover, the examples in this article drew only from the experiences of the two student authors. Thus, the quotes offered do not reflect the full range of contextual issues addressed in the practicum, such as heterosexual privilege, or the full experience of the intergroup dynamics among such a diverse group of students. Yet we hope our experience may be useful for others. We still need to consider how the process of learning to be contextually conscious may differ for students depending on their own contextual backgrounds and how other aspects of the training program are structured. We also need to consider the personal experiences and contextual backgrounds of the supervisors and the resulting interactions between supervisees and supervisors. We need to know more about the process of moving from theory to practice. Our hope is that the field will continue to develop the body of knowledge that will enable more therapists to develop a contextual lens, becoming more fluent and effective in addressing gender disparities, addressing societal power discrepancies, and attending to culturally different stories. Our experience seems to indicate that as we become responsive to the social positions of clients and their diverse experiences, we may be better able to enhance their well-being. 586

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REvistas