Received 04/18/17

Revised 09/03/18
Accepted 11/10/18
DOI: 10.1002/jmcd.12158

Multicultural Competence–Focused
Peer Supervision: A Multiple Case
Study of Clinical and Counseling
Psychology Trainees
William Somerville, Sam Marcus, and Doris F. Chang
In this longitudinal, qualitative case study, 21 clinical and counseling psychol-
ogy trainees met in leaderless peer supervision groups for 1 training year to
discuss multicultural aspects of their clinical work. Peer supervision sessions
were audio recorded and transcribed, and the content was analyzed using
thematic analysis. Results indicated that, despite the absence of experts to
facilitate discussions, participants were able to focus on multicultural issues
and generally benefited from this type of peer supervision.
Keywords: peer supervision, group supervision, multicultural competence,
counselor trainees, regressive supervision
En este estudio de caso longitudinal y cualitativo, 21 alumnos de psicología
clínica y consejería se reunieron en grupos de supervisión entre pares sin
líderes durante un año de su formación para discutir aspectos multicultura-
les de su trabajo clínico. Se grabó y transcribió el audio de las sesiones de
supervisión entre pares, y luego se analizó el contenido usando un análisis
temático. Los resultados indicaron que, a pesar de la ausencia de expertos
para facilitar las discusiones, los participantes fueron capaces de centrarse
en los temas multiculturales y generalmente se beneficiaron de este tipo de
supervisión entre pares.
Palabras clave: supervisión entre pares, supervisión en grupo, competencia
multicultural, consejeros en formación, supervisión regresiva

I
n counseling and psychotherapy, multicultural competence is defined as the
awareness, knowledge, and skills needed to work effectively and ethi-
cally across cultural differences (Pope-Davis, Reynolds, Dings, & Nielson,
1995; Sue, Arredondo, & McDavis, 1992). Culture in this context refers to
intersections of race, ethnicity, gender, socioeconomic status, sexual orienta-
tion, age, religion, disability, nationality and immigration status, indigenous
heritage, and other dimensions of identity (American Psychological Associa-
tion, 2017; Hansen, Pepitone-Arreola-Rockwell, & Greene, 2000; Hays, 2007).
Proponents of multicultural competence argue that it allows psychology not
only to remain relevant in the 21st century but also to promote equity and
social justice (Hall, 1997; Jun, 2010; Sue et al., 1992; Vera & Speight, 2003).
However, critics question the validity of a multicultural focus, arguing that it

William Somerville, Sam Marcus, and Doris F. Chang, Department of Clinical Psychology, The New School
for Social Research. Correspondence concerning this article should be addressed to William Somerville,
Department of Clinical Psychology, The New School for Social Research, 80 Fifth Avenue, 6th Floor, New
York, NY 10011 (email: bsomerville@gmail.com).

© 2019 American Counseling Association. All rights reserved.

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“threatens to discredit traditional, insight-oriented psychotherapy and replace
it with identity politics” (Prochaska & Norcross, 2013, p. 399).
Differences of opinion in this area lead to unique challenges in the su-
pervision of counseling and psychotherapy trainees. As both mentors and
evaluators, clinical supervisors serve a powerful gatekeeping function in
the field. They preside over the intersection of theory and practice, guid-
ing trainees in diagnosis, assessment, case conceptualization, and treat-
ment. Whereas supervisors’ and supervisees’ attitudes toward multicultural
competence are sometimes aligned, they are often misaligned, leading to
conflict in the supervisory relationship (Burkard et al., 2006; Constantine
& Sue, 2007; Sangganjanavanich & Black, 2009; Wong, Wong, & Ishiyama,
2013). Consider this example: A 50-year-old supervisor and a 30-year-old
supervisee share a number of traits, including the fact that they are both
White, heterosexual, nondisabled, cisgender men. Whereas the supervisor
does not think of himself as “privileged,” the supervisee was required to
explore the concept of privilege as part of his graduate training. As a re-
sult, he now readily examines his privilege and believes that doing so is an
important part of his clinical practice. In the outpatient clinic where they
work, the supervisee has just begun treating a 25-year-old female-identifying
medical student who recently immigrated from Sri Lanka. Considering the
cultural differences between patient and clinician, what challenges are likely
to arise in supervision? Ancis and Ladany (2010) predicted the following
in a regressive supervision dyad such as this one: The supervisory working
alliance will suffer; the supervisee’s multicultural competence development
will be delayed; and the patient will receive worse care than she would if
the supervisee had more permission to use the multicultural awareness,
knowledge, and skills he already possesses.
Regressive supervision is the term used when a supervisee is more advanced than
his or her supervisor in one or more aspects of multicultural competence (Ancis
& Ladany, 2010). But how common is it? The research literature indicates that, in
fact, supervisees are often more sensitive to multicultural issues than their clinical
supervisors (Ancis & Ladany, 2010; Burkard et al., 2006; Burkard, Knox, Hess, &
Schultz, 2009; D’Andrea & Daniels, 1997; Duan & Roehlke, 2001; Fong & Lease,
1997; Fukuyama, 1994; Hird, Cavalieri, Dulko, Felice, & Ho, 2001; Sangganjana-
vanich & Black, 2009; Wong et al., 2013). There are at least two reasons this is
the case. First, as a group, supervisees are more diverse than supervisors, allowing
them to draw from lived experience when considering multicultural aspects of
their cases (Constantine & Sue, 2007; Duan & Roehlke, 2001; Hird et al., 2001;
Nilsson & Dodds, 2006). Second, changes in graduate education over the past 3
decades have provided supervisees with more multicultural competence training
than their supervisors have typically received (Ancis & Ladany, 2010; Gatmon
et al., 2001). A 1997 study illustrated this by showing that 70% of internship
supervisors had never taken a multicultural counseling course, whereas that was
the case for only 30% of psychology interns (Constantine, 1997). A later study
showed a similar pattern, but with some improvement: In 2003, 50% of supervi-

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sors reported having never having taken a multicultural course, compared with
4% of supervisees (Pope-Davis, Toporek, & Ortega-Villalobos, 2003).
Despite being quite common, regressive supervision is not benign. Super-
visees tend to respond to such supervision with frustration, anger, and fear,
and clients and patients suffer when supervisees’ intended interventions
are overridden by culturally unresponsive supervisors (Burkard et al., 2006,
2009; Constantine & Sue, 2007; Falender, Shafranske, & Falicov, 2014; Fong &
Lease, 1997; Hird et al., 2001; Sangganjanavanich & Black, 2009; Wong et al.,
2013). An underexplored partial solution to this problem is trainees’ ability
to help each other via multicultural competence–focused peer supervision.

augmenting supervision with

multicultural competence–focused
peer supervision
Peer supervision can be conducted in a variety of ways: in dyads, triads, or
groups; in person or remotely; and in tightly or loosely structured formats (see
Borders, 2012, for a review of peer supervision models). Some authors prefer the
term “peer consultation” over peer supervision, emphasizing the lack of legal
or institutional authority of any one member over others (Bailey, Bell, Kalle,
& Pawar, 2014). Most peer supervision is nonhierarchical, although it is com-
mon for group members to take turns presenting or facilitating (Counselman
& Weber, 2004). Empirical findings tend to demonstrate positive outcomes for
participants, such as increases in empathy, skill, and self-confidence (Bailey et al.,
2014; Benshoff, 2001; Mills & Swift, 2015). The research in this area is lacking,
however. Although it is “widely practised and highly valued” (Borders, 2012,
p. 59), peer supervision remains understudied (Borders, 2012; Kassan, 2010).
We identified only three empirical studies in which peer supervision was
examined specifically for its potential benefits to multicultural competence
(Gainor & Constantine, 2002; Golia & McGovern, 2015; Goodman, Calderon,
& Tate, 2014). In one study, school counselor trainees in web-based and in-
person groups saw improvement in multicultural case conceptualization after
13 weeks of peer supervision (Gainor & Constantine, 2002); however, expert
facilitators moderated the supervision meetings—a departure from the more
typical leaderless peer supervision. In another study, dyadic peer supervision
was used to address sexual orientation, gender, and religious identity in a
psychotherapy case (Golia & McGovern, 2015). In ad hoc meetings about
the case, the treating author was made aware of relevant literature, given
community resources for the client, and encouraged to discuss aspects of
the therapeutic relationship that may have otherwise gone unexamined. The
authors concluded that “without this supportive interaction among peers,
the treating author would have encountered obstacles to effective, cultur-
ally competent treatment” (p. 643). In a qualitative study of counselors and
psychologists providing short-term disaster outreach, peer supervision was an

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essential component of working across cultural differences (Goodman et al.,
2014). Participants in that study were engaged in a 7-day outreach program
to Haitian communities in Florida after the 2010 Haiti earthquake. Partici-
pants met for peer supervision on a daily basis, using principles of liberation
psychology and critical consciousness to develop “liberatory counseling skills”
(p. 230) and attend to sociopolitical issues affecting the community. Those
authors concluded that peer supervision allowed the outreach program to
“engender collaborative, socially just practice” (p. 234).
Apart from these three studies, we found no empirical research in which
peer supervision was used to foster participants’ multicultural competence
development. In some respects, this is not surprising. Expertise is a key com-
ponent of any training, and trainees cannot be expected to generate cultural
knowledge ex nihilo. On the other hand, peer supervision may be ideal for
sharing already-obtained multicultural knowledge and/or cultivating new
multicultural awareness—activities arguably enhanced by the horizontal na-
ture of the peer relationship. In contrast to traditional supervision, in which
supervisees often conceal information when they anticipate feeling shame
or embarrassment or when they sense that it would be disrespectful to share
knowledge on certain topics (Ladany, Hill, Corbett, & Nutt, 1996), peer
supervision is typically experienced as “safe” for various kinds of disclosures
(Borders, 2012). Even when power dynamics are present in peer supervision
(e.g., due to differences in age, gender, or clinical experience), peers do not
typically rely on each other for letters of recommendation or formally evaluate
each other. With less need to impress or appease one another, peers may be
more able to self-assess multicultural competence development, take needed
risks, and honestly report the results of attempted interventions. This is sug-
gested by research showing that the same information being concealed from
supervisors is often disclosed to peers or friends in the profession (Ladany
et al., 1996). Together, these observations point to the potential benefits of
multicultural competence–focused peer supervision.

the present study

Using a longitudinal, qualitative case study design, we examined the process
and content of multicultural competence–focused peer supervision groups
made up of clinical and counseling psychology trainees. The study had two
exploratory aims. The first was to describe how participants used their time
together, and, if any particular models emerged, to determine what character-
ized them. Models of small group development (as reviewed in Smith, 2001)
were used to consider aspects of group process. Because we expected that
effective multicultural competence–focused peer supervision would gener-
ally exhibit features of effective supervision, we used Bordin’s (1983) theory
of the supervisory working alliance to assess the quality of supervision. For
a supervisory working alliance to be strong, supervisor and supervisee must
agree on the goals of supervision, agree on tasks related to those goals, and

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experience the bond that facilitates goals and tasks (in group contexts, bond is
described as cohesion; Bernard et al., 2008). This foundational model has received
significant empirical attention in the decades since its introduction and is now
considered essential for effective supervision (Constantino, Ladany, & Borkovec,
2010; Ladany, 2005). No explicit theoretical models were used for the second
aim of the study, which was to describe participants’ subjective experience in the
groups: their likes, dislikes, and impressions of the groups’ impact. Together, the
two aims of the study were expected to provide insight into the potential benefits of
peer supervision for the development of multicultural competence, and to clarify
processes that facilitate growth and learning in this area.
The study used a qualitative multiple case study design (Yin, 2014). Case study
research is a good fit for “how?” or “why?” research questions that involve con-
temporary, rather than historical, events and over which the researcher has little
or no control (Yin, 2014, p. 14). The unit of analysis (i.e., the case) was the peer
supervision group.

method
RECRUITMENT AND PARTICIPANTS
After the institutional review board’s approval of the study, we used email,
social media, printed flyers, word of mouth, and personal appeals to recruit
clinical and counseling psychology students from North American graduate
programs. Interested individuals were directed to a study website where they
learned about requirements for participation, the study’s timeline, and its
purpose. Inclusion criteria stated that participants needed to be currently
enrolled in a clinical or counseling psychology master’s or doctoral program.
Twenty-five graduate students completed an online form indicating interest
in the study; 21 entered the study and completed the initial and midpoint
questionnaires. One participant dropped out two thirds of the way through
the study, leaving 20 who completed the termination survey. Participants were
organized into five groups, three that met in person and two that met via con-
ference call. Groups ranged in size from three to five members. One group
agreed to meet monthly, whereas the others agreed to meet twice a month.
In practice, all groups met less frequently than they originally planned (see
Figure 1 for the distribution of peer supervision meetings), and attendance at
scheduled meetings was not perfect: On average, participants attended 77%
of their group’s scheduled meetings. Of importance to group dynamics, in the
three-person group, a single member’s absence from any particular meeting
effectively changed the group into a dyad for that meeting. Participants’ geo-
graphic locations included urban and suburban areas in Canada and the U.S.
Midwest and Northeast. Because of the comparative effectiveness of personal
appeals and word-of-mouth recruitment, most (n = 15) of the participants were
doctoral students in our own clinical psychology PhD program in New York
City. See Table 1 for demographic characteristics of the sample.

278 JOURNAL OF MULTICULTURAL COUNSELING AND DEVELOPMENT • October 2019 • Vol. 47

 FIGURE 1
Frequency and Distribution of Peer Supervision Meetings Over the
Course of the Study by Group
Note. Black bars (dates shown) indicate meetings selected for transcription and analyses. Gray
bars (dates not shown) indicate all other meetings.

MEASURES AND PROCEDURE

Months 1, 2, and 3. During this period, group assignments were made based on
participants’ availability and geographical proximity to each other. A confer-
ence call option was provided for participants who lived too far away to meet
in person, or who preferred that format. After each group had at least three
members, participants reviewed the study procedures and provided written,
informed consent to participate in the research.
Months 4 and 5. Participants used Qualtrics, a web-based data collection platform,
to provide information about themselves and their training programs, includ-
ing clinical hours accrued and experiences related to multicultural competence
development (e.g., courses taken). They were then given guidelines regarding
confidentiality, the nonhierarchical structure of the groups, and the multicultural
focus of the study. Suggestions were provided for the first meeting (e.g., discussion
of expectations of the group, discussion of the term multicultural competence).
Participants then met with their groups for the first time, and one member from
each group volunteered to audio record sessions for transcription. Groups began
meeting regularly, according to their own schedule preferences. On average,
group meetings were 1 hour long. The shortest meeting over the course of
the study was 42 minutes (Group 3, Meeting 7); the longest was 1 hour and 22
minutes (Group 3, Meeting 2). On occasions when one or more members could
not make a particular meeting, other members of the group decided whether to
meet as planned or postpone the meeting. In most cases, meetings proceeded
when a minimum of two members were present (effectively turning groups into
dyads in nine out of 48 total meetings throughout the study).
Month 8. The midpoint survey was administered, including questions about
participants’ primary supervisors, training site, type of work (e.g., individual

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 TABLE 1
Group Demographics
Group 1 Group 2 Group 3 Group 4 Group 5
Demographic (N = 5) (N = 3) (N = 4) (N = 5)a (N = 4)
Age (in years)
M 30.20 31.00 27.75 30.80 29.00
SD 3.47 3.06 1.65 2.50 0.00
Range 26–44 27–37 24–32 23–37 29–29
Race
Asian 1
Latina/o 1 1
Mixed (White and Indian) 1
White 4 2 3 5 3
Ethnicity
“Eclectic” 1
“Jewaspy” 1
“None” or no answer 1 1
American 1 2
Chinese American 1
Jewish 3 1 1
Mestizo 1
Puerto Rican 1
Southern European/French- 1
Canadian
Turkish 1
Western European 4
Gender identity
Cisgender man 1
Cisgender woman 5 2 4 4 3
Gender nonconforming man 1
Genderqueer 1
Socioeconomic status
Poor 1
Lower class 2
Middle class 2
Upper class 2 1 4 1
Wealthy 2 1 1 2
No answer 1 1
Sexuality
Bisexual 1 1 2
Heterosexual 4 2 2 1 1
Mostly heterosexual 1
Pansexual 1 1
Queer 1 2
Questioning 1
Meeting type and location
Conference call
  New York, NY 4
  Worcester, MA; Chicago, IL; 5
   Toronto, Ontario, Canada
In person
  New York, NY 5 3 4
Program type
Clinical PhD 5b 3c 4b 3 4d
Counseling master’s 2b
(Continued)

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 TABLE 1 (Continued)
Group Demographics
Group 1 Group 2 Group 3 Group 4 Group 5
Demographic (N = 5) (N = 3) (N = 4) (N = 5)a (N = 4)
Year in programe
1st 1
2nd 2
3rd 1 4 1
4th 1 1
5th 3 1
6th 1 1 1 3
Clinical hours accumulated
M 500 603 92 282 678
SD 295 475 77 341 199
Note. Socioeconomic status categories were coded based on responses to the following
prompt: “Compared to other families in North America, my parents are/were financially . . .”
much worse off (coded as “poor”); somewhat worse off (“lower class”); neither worse off nor
better off (“middle class”); somewhat better off (“upper class”); or much better off (“wealthy”).
a
One individual switched from Group 4 to Group 5 midyear. She is included in Group 4 in this
table. bAll in same program. cTwo in the same program. dThree in the same program. eIncludes
terminal master’s degree, where applicable.

therapy, diagnostic assessment), and the populations participants were serving.

Participants were also asked about expectations they had of their group before
starting, impressions of their experience to date, if they believed meeting in the
group was a valuable use of their time, and what, if anything, they would change
about their group.
Month 12. The termination survey was administered, including open-ended
questions about classes, workshops, conferences, or other experiences participants
believed contributed to their multicultural competence development over the year.
Participants also answered questions about likes and dislikes of their group, if their
view of the group’s value had changed, if and how differences between members
contributed to the group dynamic, and if they had suggestions for individuals seeking
to form multicultural competence–focused peer supervision groups in the future.
Month 24. Participants were provided a draft of the finished paper and asked to
provide feedback on the findings (i.e., “member checking”). Critiques and clarifica-
tions were provided by two participants and were incorporated into the final draft.
Measures administered but not reported. Several quantitative measures were ad-
ministered, but not used in this report. Statistical analyses of the data were
unusable due to small sample size and the lack of nonindependence between
observations within groups.

DATA ANALYSIS
Data preparation. Prior to analyses, audio recorded meetings were selected from
the beginning, middle, and end of the study and then transcribed by the first
two authors (three transcripts per group; 15 transcripts total). The “middle”

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session was defined as the meeting that occurred before groups paused for
winter break during the study year (see Figure 1 for a visual representation of
meetings). The first two authors met frequently during this phase to ensure
fidelity of the orthographic transcription technique and to become familiar
with the data (Braun & Clarke, 2013). Next, open-ended survey responses
from the study’s midpoint and termination were collated by group and time
interval and then uploaded to Dedoose (Version 7.0.16), a web-based quali-
tative research application. The qualitative data corpus was not used in its
entirety for all analyses; instead, each of the two aims was addressed using
the data set(s) most relevant to the specific research question.
Analytic method and epistemology. For all qualitative analyses, thematic analysis
was used as the analytic method due to its epistemological flexibility, relative
simplicity, and appropriateness for the data collected (Braun & Clarke, 2006,
2013; Willig, 2013). The epistemological position taken in this study was critical
realism, located between the two extremes of naive realism and radical relativism
(Willig, 2013). A critical realist position allows for both “empathy” and “suspi-
cion” in the analysis (Willig, 2013, p. 42), simultaneously valuing participants’
intended use of language while also locating meaning beneath the surface.
Aim 1. To describe how participants used their time together, we conducted
a deductive thematic analysis on the entire qualitative data corpus (survey
responses and transcripts). Deductive, or theoretical, thematic analysis is the
preferred approach when a specific research question is being addressed: it is
top-down versus bottom-up (Braun & Clarke, 2006). Relevant concepts used
for the analysis were the supervisory working alliance (i.e., goals, tasks, bond;
Bordin, 1983), small group development models (Smith, 2001), and domains
of multicultural competence (i.e., awareness, knowledge, and skill; Sue et al.,
1992). Replication logic (Yin, 2014, p. 57) was used to systematically examine
similarities and differences between groups in terms of structure, format, and
group dynamics. Codes generated for each group were used to code the next
group’s survey responses and transcripts, and additional codes were generated
as needed. After all codes were reviewed and consolidated, the first two authors
searched for themes across codes and then discussed and defined them. The
themes were then grouped into higher order themes, which were then reviewed
for thoroughness. They are presented in a cross-case comparison.
Aim 2. To capture participants’ experiences in the groups, we conducted
an inductive thematic analysis on the open-ended responses provided in the
midpoint and termination surveys. We chose inductive, versus deductive,
thematic analysis due to the exploratory nature of the research question,
as well as to minimize the influence of a priori expectations. Replication
logic (Yin, 2014, p. 57) was again used, with codes generated as needed in
group-by-group analyses. After all codes were reviewed and consolidated,
the first two authors searched for themes across codes, discussed, and
defined them. Group-level themes were then merged into higher order
themes, which were named, reviewed, and discussed. They are presented
in a cross-case comparison.

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 RESEARCHERS’ BACKGROUNDS, EXPERIENCES, AND BIASES
In qualitative research, it is standard practice to identify aspects of the researchers’
backgrounds that are likely to influence findings. The first author is a 42-year-old,
White, heterosexual, nondisabled, middle-class, cisgender man. He identifies as an
atheistic existentialist, a worldview he experiences as open and empathic compared
with his evangelical Christian upbringing. His interest in this research stems from
a desire to see counseling and psychotherapy become more critically self-aware of
oppressive systems and structures within the field. His own positive experience in
peer supervision was the impetus for the study; however, he held in mind the pos-
sibility that participants might find the groups unhelpful or even counterproductive.
The second author is a White, nonbinary, queer, culturally Jewish, middle-class,
nondisabled doctoral student in their late twenties. Their interest in multicul-
tural competence comes from their educational background in gender studies,
their clinical experience, and their academic interest in trans and gender non-
conforming experiences, intersectional feminism, and social constructionism.
The third author is a second-generation Chinese American, cisgender, het-
erosexual, nondisabled female professor and practicing clinical psychologist.
She teaches and conducts research on multicultural issues in mental health
practice and values qualitative approaches for challenging normative assump-
tions and building knowledge regarding minority experiences and perspectives.
She expected that the groups convened for this study could support a process
of reflection and growth for trainees that could augment traditional training
structures. However, given the difficulties that individuals have identifying the
ways that their own racial and cultural socialization has shaped their understand-
ings of the world, she also expected that these groups would present relational
challenges that would require careful negotiation to maintain cohesion.

results and discussion of themes

The deductive thematic analysis conducted for Aim 1 resulted in five themes.
The inductive thematic analysis conducted for Aim 2 resulted in six themes.
Pseudoynms are used for quoted material below.

AIM 1: MODELS OF MULTICULTURAL COMPETENCE–FOCUSED

PEER SUPERVISION
Theme 1.1: Establishing goals and tasks. In Bordin’s (1983) theory of the su-
pervisory working alliance, effective supervision requires agreements about
the goals of supervision and the tasks that facilitate them (e.g., presenting
cases, working through case material, honing skills). Given that they were not
explicitly told to set goals and tasks, each group approached this challenge
differently. In all groups, participants followed at least some of the recom-
mendations provided for the first meeting: They introduced themselves (if
they did not already know each other), described their clinical or counseling
placements, and discussed expectations of the group. In all groups but one,

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multicultural competence was discussed in the first meeting, and some attempt
was made to arrive at a shared definition of the term. There was significant
variation in how groups agreed to use peer supervision time. In Group 1,
four more clinically experienced participants quickly set goals and tasks that
a less experienced group member, who joined in the next meeting, was easily
able to grasp. Group 2’s first meeting was a fluid, free-ranging conversation
in which neither goals nor tasks were directly addressed. Group 3 entertained
the idea of a formal structure for their meetings but ultimately decided to
“show up and chat.” In Group 4, the most clinically experienced member led
a discussion of goals and tasks. In Group 5, members debated between various
models of group supervision, ultimately agreeing on a format in which each
meeting focused on a particular dimension of identity (e.g., gender, race,
sexuality). Importantly, all five groups maintained a focus on multicultural
aspects of clinical work throughout the study. In general, groups with more
clinically experienced participants were better able to apply the generic goals
and tasks of clinical supervision to the novel frame of multicultural compe-
tence–focused peer supervision. Groups with more clinically experienced
members were also more efficient, in that they were able to quickly agree on
tasks, stick to what was agreed upon, and revise goals and tasks as needed.
In all cases—including groups made up of less experienced members—time
and energy given to discussing goals and tasks contributed to participants’
assessment that attending group meetings was worthwhile.
Theme 1.2: Variations in group cohesion. Group cohesion is defined as “the
emotional bonds among members for each other and for a shared commit-
ment to the group and its primary task” (Bernard et al., 2008, p. 493); it is the
group equivalent to the quality of bond described in Bordin’s (1983) theory
of the supervisory working alliance. Cohesion was aspired to in all groups,
worked toward in different ways, and achieved to varying levels of success.
In Group 1, three members who knew each other well before the study were
very active in peer supervision meetings, whereas the other two members were
less so. At times the more active members seemed to assume that the comfort
and familiarity they experienced was shared by everyone, when that was not
always the case. In Group 2, members did not know each other beforehand
and gradually built rapport over time. One member of Group 2 appeared
to lose interest in the group toward the end of the study. He did not attend
the last four meetings (although he did complete the termination survey),
effectively making Group 2 a dyad at the end of the study. The two remaining
members exhibited liking, caring, and trusting behaviors associated with a
strong bond (Bordin, 1983) in their final meetings. In Group 3, two members
began the study as close friends, whereas the other two members were only
casually acquainted with each other and the other group members. Unfortu-
nately, halfway through the year, the two friends developed a personal conflict
unrelated to the study, which affected the group’s overall cohesion. In Group
4, no members knew each other beforehand. Although they were generally
able to develop cohesion, this was more challenging due to the conference

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call format, inconsistent attendance, and the decision of one member to
switch to Group 5 halfway through the study. Similar to Group 2, another
member of Group 4 appeared to lose interest and did not attend the final
three meetings of the group (although she did complete the termination
survey). Group 5 was unique in that, of the five members, three members
knew each other well and began with a strong bond; one member did not
know the others but appeared to fit in well with the group; and the fifth, less
clinically experienced member, who switched into the group from Group 4
halfway through the year, struggled to fit in with the others. She ultimately
dropped out of the study before completing the termination survey. In general,
positive preexisting relationships between particular members appeared to
benefit those members only, and not the group as a whole. Groups in which
some or all members knew each other beforehand tended to make assump-
tions about how the group climate was experienced by everyone. Groups in
which members had no prior history experienced fewer distortions in their
perceptions of cohesion but also took longer to reach optimal functioning
as a supervision group. Finally, major ruptures in group cohesion (e.g., se-
vere disagreements between members) tended not to be repaired, whereas
minor ruptures (e.g., less severe experiences of tension or discomfort) were
occasionally addressed and repaired.
Theme 1.3: Dynamic interplay between goals, tasks, and group cohesion. As predicted
by models of small group development (Smith, 2001) and the supervisory
working alliance (Bordin, 1983), goals and tasks were influenced by group
cohesion, and vice versa. Group 1’s ability to quickly set an agenda was based
on the expectation that members felt comfortable disclosing supervision needs.
In Group 2, academic discussions of multiculturalism gradually became more
supervisory over time, as members grew to like and trust each other. Group
3 was unusual in that it moved further away from typical supervision goals
and tasks over time, in the context of an unprocessed rupture between two
members. In Group 4, case material became lengthier and richer over the
course of the year, and group members expressed increasing gratitude for the
help they received from one another. Group 5’s developing cohesion allowed
them to productively revisit goals and tasks. Midway through the year, they
decided that the meeting format they had chosen was less useful than they
had hoped, and they began using a format very similar to Group 1’s model of
presenting cases according to urgency of need. In general, cohesion, goals,
and tasks were mutually reinforcing: Stronger group cohesion was associated
with better ability to revise goals and tasks over time, and well-developed goals
and tasks were generally accompanied by greater group cohesion.
Theme 1.4: Keeping the multicultural focus. Throughout the study, participants
were able to maintain a focus on multicultural aspects of their clinical work.
This resulted in some participants sharing less than they otherwise might
have: Group members sometimes reported that they had “nothing cultural”
to discuss. When they did present cases, participants always cited the client’s
or patient’s membership in one or more target groups, often presenting

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them intersectionally (e.g., discussing gender and race together). Almost
all participants shared multicultural expertise they had obtained outside of
their group. Sources cited included graduate coursework, research literature,
workshops and lectures, prior clinical or personal experience, and nonaca-
demic sources such as TED Talks and podcasts. When groups reached the
edges of their collective multicultural competence, they often engaged in
problem-solving to identify solutions. In Group 1, for example, a participant
who worked with Latinx children was encouraged to consult with a Puerto
Rican member of her clinical faculty regarding a question about culturally
normative parent–child relationships. Finally, in all five groups, participants
referenced their own target group identities (i.e., race, ethnicity, gender, class,
disability, sexual orientation, nationality, religion, and intersections of those
identities), sometimes requesting help with clinical issues related to identity.
Theme 1.5: Leadership-sharing in leaderless groups. Whereas all five groups
remained technically leaderless throughout the study, they managed needs
for leadership functions in a variety of ways. Leadership needs in all groups
were (a) establishing goals and tasks, (b) avoiding “task drift” (Counselman &
Weber, 2004, p. 129), (c) managing conflict, and (d) imparting multicultural
knowledge. In general, Counselman’s (1991) assertion that a “well-functioning
leaderless group is truly a leadership-shared group” (p. 255) was borne out in
this study. In higher functioning groups, members with more clinical and/or
multicultural experience often took the lead in helping to establish goals and
tasks, after which all members shared the responsibility of maintaining the
agreed-upon frame—for example, by helping to clarify and work through case
material. In Group 4, the awkwardness of who should keep the group on task
was lessened through the adoption of a rotating facilitator model, in which
members took turns running meetings. Unfortunately, no groups excelled in
the area of conflict management. Conflicts that were mentioned in termination
surveys were often not disclosed to the group, or were larger than members of
the group felt prepared to address (see Theme 2.4 for examples of conflicts
discussed in surveys). Some minor conflicts were addressed. For example, in
Group 4, one member took a risk by stating that their gender identity had
been misperceived in the group. This elicited a positive response from other
members, who expressed regret that the issue had not been addressed earlier.

AIM 2: PARTICIPANTS’ EXPERIENCE IN THE GROUPS

Theme 2.1: Groups are both valuable and enjoyable. This theme captures the
sentiment expressed by most participants that they looked forward to peer
supervision meetings, valued one another’s input, and appreciated having a
time and space set aside for discussion of multicultural issues in their clini-
cal work. In line with this theme, Kara (Group 1) noted in her termination
survey that “I found the group very warm, supportive, insightful, helpful, and
engaging.” In her termination survey, Olivia (Group 2) said, “I found it really
helpful to have specific space and time dedicated to multicultural competence

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and discussing and processing thoughts and feelings related to it.” Finally, in
his termination survey, David (Group 5) stated, “I think that it was incredibly
valuable to have different people’s takes on mine and others’ clinical issues
and I often found it useful in keeping me thinking about multicultural issues
and how to navigate them.”
Theme 2.2: Salience of member similarities and differences. Diverse identities and
experiences within the groups were generally viewed as a strength. In her
termination survey, Giselle (Group 2) stated, “Being able to discuss these is-
sues with peers coming from different backgrounds and interests allowed for
rich conversations about the clinical cases and other experiences discussed
throughout the group.” However, when clinical experience or theoretical
orientations differed widely, this sometimes created tension, as Julia (Group
5, termination survey) described:

I didn’t feel [other participant] had the same exposure to thinking about these issues
that the rest of us had, and it also felt as though she was so new to clinical work that it
was difficult to integrate her feedback.

Kara (Group 1, termination survey) added, “It might be more useful to or-
ganize groups according to cohort so that the level of peer support remains
mutual and no hierarchy emerges.”
Theme 2.3: Struggling with structure. Some groups were able to establish goals
and tasks fairly easily, whereas others had more difficulty. Several participants
expressed a wish that more structure had been either provided by the re-
searchers or worked out in the group at the beginning. In her termination
survey, Olivia (Group 2) stated, “I would advise [future groups] perhaps to
establish a stronger frame or some rules for the group or a bit more structure,
and perhaps some clear goals for the group, at the outset.” Similarly, Kate
(Group 3) stated in her midpoint survey, “At times it feels as though there
is not enough anchoring, and some training materials would be helpful.”
Theme 2.4: Tension and conflict. Although moments of conflict were present
in all five groups, many of them went unaddressed. In Group 1, some mem-
bers reported that it was difficult to disclose feelings of tension or discomfort
when they surfaced. In Groups 2, 3, and 4, one participant from each group
stopped attending meetings toward the end of the study—possibly because of
problems they were experiencing within the group. Other members of those
groups sometimes reacted negatively to the abrupt withdrawal of those par-
ticipants; for example, Olivia (Group 2) noted in her termination survey, “I
disliked, or more like felt a little disappointed in, the way our group ended,
with [other member] dropping out.” In Group 5, one member dropped out
of the study altogether for unknown reasons, although she seemed increas-
ingly isolated in her group. In cases in which all members of a group were
aware of a conflict, it was not always clear to them how they should address
the problem. For example, Ayla (Group 3, termination survey) said, “In the
second semester, I felt like there was a personal falling out or tension between

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two members of the group, which got in the way of the group’s cohesion and
upset the dynamics.”
Theme 2.5: Divergent experiences/Making the most of it. In several groups,
one or more members reported significant personal growth while oth-
ers in the same group expressed ambivalence, or even displeasure, with
their experience. For example, in Group 4, Renee reported moments of
profound learning: “What was surprising to me, which seems obvious in
hindsight, was how much my own stereotypes, biases, and assumptions
were challenged during group discussions” (midpoint survey). In contrast,
Shawn from Group 4 was more blasé: “I have found the group to be a
pleasant experience, but not something that was particularly challeng-
ing or thought provoking” (termination survey). In Group 2, Adam was
reluctant to attend meetings: “When I think about going to the group, I
frequently have a mild aversion. I think about the group, and I imagine
having to make up conversation just to keep it going” (midpoint survey).
In contrast, Olivia from Group 2 reported looking forward to meetings:
“My experience has been very positive. I’ve been having the experience of
the group discussion and thoughts that it stimulates informing my clinical
work, and vice versa, which is great” (midpoint survey).
Theme 2.6: Group’s focus is not the most urgent need. This theme may be consid-
ered a variant theme, as it was identified only in Group 3. All four members of
Group 3 appreciated the group’s multicultural focus, but wondered if other
issues, such as clinical technique or models of supervision, should have been
a higher priority at their level of training (all four participants were 1st-year
doctoral students). For example, in her termination survey, Ayla said,

Even though I liked the multicultural focus of the supervision group, there were times
when I wanted to bring up implementation of certain therapeutic techniques or other
thoughts and feelings about a case, and felt like I couldn’t bring it up because it wasn’t
related to the topic.

discussion
As a partial solution to problems that arise in regressive clinical supervision
(Ancis & Ladany, 2010), this study explored group process and participant
subjective experience in multicultural competence–focused peer supervi-
sion groups using a longitudinal, qualitative case study design. As far as we
know, this is the only study to follow several such groups for a full training
year, providing a unique contribution to the literature joining peer supervi-
sion with the development of multicultural competence. A key finding of
the study is that, in the absence of imposed structure or expert facilitators,
participants generally benefited from multicultural competence–focused peer
supervision. Group members were able to help each other work with clients’
and patients’ complex cultural identities, and—despite missteps and course
corrections—leaderless groups generally found ways of working together and
staying on task. Satisfaction with peer supervision was high in most groups,

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and in less satisfied groups, one or more members still reported significant
learning and/or benefit to clients or patients as a result of participation. The
relatively high retention rate of the study, combined with the 77% overall
meeting attendance rate, suggests that participants valued the groups and
were, for the most part, able to prioritize them over competing commitments.
Overall, participants in this study benefited in ways that are consistent with
other available research on peer supervision and multicultural competence
(Golia & McGovern, 2015; Goodman et al., 2014).
Within this broad finding, however, perceptions of value and satisfaction
differed between groups, and between individuals within groups. As predicted
by Bordin’s (1983) model of the supervisory working alliance, experiences
were more positive in groups with well-defined goals and tasks. Although
groups that lacked clear goals and tasks at the beginning of the study were
usually able to self-correct over time, in one instance (i.e., Group 3) that did
not happen, to the detriment of that group’s process. Positive outcomes also
corresponded highly with group cohesion; however, cohesion was sometimes
assumed to be experienced by all members of a group, when the reality was
more complex (e.g., in Group 1). The cohesion problems observed in this
study suggest that leaderless groups may need clearer guidelines for identifying
and repairing ruptures in group process. Counselman (1991) noted that “the
greatest difficulty encountered in a leaderless group may be handling conflict
and aggression without a referee” (p. 254). Multicultural competence–focused
peer supervision groups may be particularly susceptible to problems in this
area, given that cohesion might be expected more than in other types of
groups (e.g., compared with mandatory group supervision). Expectations of
group cohesion may make it especially difficult to acknowledge tension or to
address it when it arises. Of note in this study, when participants were able to
address tension, cohesion was typically strengthened rather than weakened.
This is predicted by models of rupture and repair in the supervisory alliance
(Safran, Muran, Stevens, & Rothman, 2007). Finally, the naturalistic nature of
this study does not permit us to draw conclusions regarding how many meet-
ings are required for a multicultural competence–focused peer supervision
group to achieve optimal functioning. Group 1, which met less frequently and
had fewer sessions overall than other groups, operated more cohesively and
made better use of their time than other groups which met more frequently
and more often. This may be due to the fact that most members of Group 1
had prior experience in traditional supervision and were comfortable setting
goals and tasks. However, further research is needed to clarify the individual
difference factors that contribute to peer supervision processes and outcomes.

LIMITATIONS AND DIRECTIONS FOR FURTHER RESEARCH

Although the size of the sample was adequate for the study’s qualitative
aims, unique characteristics of the sample limit its generalizability. Most
participants lived in New York City and were enrolled in the same psy-
chodynamically oriented clinical psychology PhD program. Additionally,

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some participants were personally known by one or more of the authors,
which may have contributed to their experience of the groups. The use
of member checking may also be considered a limitation. Although that
process allowed participants to be experts in their own experience and was
valuable from a participatory perspective, it prioritized participants’ explicit
evaluation of the findings over latent meanings in the text that may have
been outside of their awareness or uncomfortable for them to endorse
(Willig, 2013). This is likely to have produced a more conservative write-
up of the findings than if participants had not weighed in and provided
feedback prior to publication. Relatedly, some relevant content from the
transcripts was omitted from the findings, due to the unique identities
of the participants in question and the need to keep them anonymous.
For example, participants sometimes shared examples of being targets of
xenophobia, racism, homophobia, and sexism at their training sites. It is
unfortunate that without these concrete examples, the reader is not able
to fully appreciate, in a felt sense, the supportive value of the groups for
those participants. Finally, the fact that some participants stopped attend-
ing meetings toward the end of the study is an important limitation. In
the sole three-person group in the study (Group 2), one member’s ab-
sence effectively turned that group into a dyad for its final four meetings.
Furthermore, a non-negligible number of meetings throughout the study
(nineout of a total of 48) took place with only two members present. The
use of dyadic data in the analyses therefore limits group-level interpreta-
tions that can be made.
Very little empirical research has been conducted on peer supervision, gen-
erally, which creates both challenges and opportunities for the specialized
area of multicultural competence–focused peer supervision. In the future,
quantitative research may be able to isolate variables that were associated with
positive and negative outcomes in this study. For example, were differences
in individual and group outcomes primarily functions of participants’ clinical
experience, supervision experience, preexisting multicultural competence, or
a combination of the three? How much, if any, prior clinical or supervision
experience should be considered a prerequisite for joining a multicultural
competence–focused peer supervision group? Assuming a baseline level of
preexisting multicultural competence is necessary, what is that baseline? Ad-
ditionally, randomly assigned intervention and comparison groups can help to
determine the impact of specific models of peer supervision on participants’
multicultural competence, and more comprehensive measures will aid in
determining whether multicultural competence–focused peer supervision
actually fills in gaps left by regressive traditional supervision. Finally, the tele-
conference format should be assessed further. Although supervision groups
typically prefer to meet in person (Gainor & Constantine, 2002; Kaduvettoor
et al., 2009), the drawbacks of phone or videoconference may be acceptable
for participants in remote areas.

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 RECOMMENDATIONS
Based on the findings of this study, the following recommendations are of-
fered to individuals wishing to form multicultural competence–focused peer
supervision groups:

1. Collaboratively outline supervision goals and tasks, as well as procedures

for repairing ruptures that will inevitably occur. Groups may wish to de-
velop a written or verbal contract, which should be revisited periodically.
2. Create a plan for sharing leadership functions. Members may wish
to take turns facilitating meetings, or the group can work to develop
the ability to notice and intervene when one or more members ha-
bitually assume leadership roles.
3. In groups where some or all members know each other already,
discuss group cohesion explicitly. In groups of friends, members
should be willing to critically examine perceptions of group har-
mony, which may be difficult for individual members to challenge.
4. Use outside resources to fill in gaps in the group’s knowledge of
multicultural issues and supervision models. Academic literature is
one such resource; others are popular articles, videos, or events that
group members attend together.
5. Do not underestimate the group’s potential impact. Embrace the
possibility that members can help each other achieve multicultural
awareness, knowledge, and skills that would otherwise not be ob-
tained, or—just as importantly—hold onto multicultural awareness,
knowledge, and skills that can be lost over time.

conclusion
Multicultural competence–focused peer supervision appears to be a promis-
ing partial solution to the problem of regressive supervision (Ancis & Ladany,
2010). By formalizing a practice that many trainees naturally use when cultural
issues become problematic in traditional supervision (Golia & McGovern,
2015; Ladany et al., 1996), multicultural competence–focused peer supervision
potentially legitimizes peers’ ability to benefit from one another’s experience
and expertise. Although future research is needed to develop and refine
specific models of multicultural competence–focused peer supervision, the
findings of this study may be encouraging to trainees who currently consult
with one another on culturally complex cases or are considering doing so.

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