THE IMPACT OF CULTURAL HUMILITY AND ENGAGING CULTURAL

OPPORTUNITIES ON THE SUPERVISORY WORKING ALLIANCE

A Dissertation

Submitted to the Faculty

of the

New Orleans Baptist Theological Seminary

In Partial Fulfillment

Requirements for the Degree

Doctor of Philosophy

in the Division of Counseling

DeAron Washington

BA, Delta State University, 2012

MAC, New Orleans Baptist Theological Seminary, 2019

ThM, New Orleans Baptist Theological Seminary, 2021

September 2023
© Copyright 2023
DeAron Lenard Washington
All Rights Reserved.
Neither this dissertation nor any part may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including photocopying, microfilming, and recording, or by any
information storage and retrieval system, without permission in writing from the author.
 Report of Dissertation Defense

Candidate: DeAron Washington

Degree: Doctor of Philosophy

Major Field: Counseling Education and Supervision

Dissertation Title: The Impact of Cultural Humility and Engaging Cultural

Opportunities on the Supervisory Working Alliance

Date of Defense: November 1, 2023

Approved: Craig Garrett

Faculty Supervisor

Ian Jones
1st Faculty Reader

Kathryn Steele
2nd Faculty Reader

Craig Garrett
Divisional Associate Dean

Alan S. Bandy
Associate Dean of Research Doctoral Programs

New Orleans Baptist Theological Seminary

3939 Gentilly Blvd., New Orleans, LA 70126
iv
 Acknowledgments

To God be the glory! I want to thank God because he has brought me a mighty long way. As the

saying goes “When I think of his goodness and all that he has done for me, my soul cries out

hallelujah.” Every grade, paper, test, and task is evidence of his grace. It was that grace that

sustained me and led me through this Ph.D. I can not truly express how grateful I am for God’s

unchanging hand that brought me to this point.

I thank my beloved wife Jessica. She tirelessly worked to help me achieve this degree. I

can’t truly express how much she means to me and how much her hard work means to me. She

helped us endure the hard times. She sacrificed so I can pursue this degree and I will spend the

rest of my sacrificing and showing her how much I love her. She has been my cheerleader. Her

name deserves to be on my degree too. My kids let academia borrow their daddy and I am

thankful they let their dada work.

I want to thank Ermagene Washington, Greta Washington, and Gloria Brooks for being

strong Black women and teaching me how to endure the toils of this life. I am grateful for them

carrying me to church, correcting me, and modeling how to make "a dollar out of 15 cents.” It

was the values and skills they instilled in me long ago that helped me navigate the raging seas of

academia. I am blessed to be able to be a part of this family and I hope to help others know they

can accomplish many things.

I am grateful for Dr. Garrett’s guidance and confidence in me which resulted in the

completion of this degree. He helped me navigate my “aggressive” timeline. Thank you Dr.

Farmer for helping me “do math”. I am thankful for Dr. Mike Miller who told me, “You need to

v
get a PhD.” I want to thank Jep Peavy for inspiring me that I could get a doctorate. Last but not

least, I want to thank every African-American student who is coming up on my heels and

pursuing an academic degree because they keep me going. I am thankful because I saw their

pursuit and it made me want to move out of the way so they could surpass me.

vi
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Table

1. Current Status, Participant Gender Identity, and Sexual Orientation ........................................34

2. Race and Religion of Participants ..............................................................................................35
3. Age of Participants .....................................................................................................................36
4. SWAI ANOVA ...........................................................................................................................50
5. SWAI Model Summary ..............................................................................................................51
6. Correlations ................................................................................................................................53
7. CHES Scores..............................................................................................................................56
8. Independent-Samples Mann-Whitney U Test Summary ...........................................................57
9. Tests of Homogeneity of Variances ...........................................................................................60

Figure

Figure 1 MRA Scatterplot of Studentized Residual by Unstandardized Predicted Value ............43

Figure 2 Normal P-Plot of Regression Standardized Residual SWAI ...........................................43
Figure 3 Partial Regression Plot SWA and Cultural Missed Opportunities ...................................44
Figure 4 Partial Regression Plot SWA and Situational Cultural Humility.....................................45
Figure 5 Partial Regression Plot SWA and Dispositional Cultural Humility.................................46
Figure 6 Scatterplot Cultural Missed Opportunities and Cultural Humility ..................................47
Figure 7 Scatterplot Cultural Missed Opportunities ......................................................................48
Figure 8 Histogram Cultural Missed Opportunities.......................................................................49
Figure 9 Normal P-Plot of Regression Standardized Residual Missed Cultural Opportunities ....50
Figure 10 Population Pyramid Frequency SWA by Current Status ...............................................57
Figure 11 Independent-Samples Mann-Whitney U Test ................................................................58
Figure 12 SWA and Years of Clinical Experience .........................................................................59

[L
[Li
 ABSTRACT

THE IMPACT OF CULTURAL HUMILITY AND ENGAGING CULTURAL

OPPORTUNITIES ON THE SUPERVISORY

WORKING ALLIANCE

DeAron L. Washington, PhD

New Orleans Baptist Theological Seminary

Faculty Supervisor: Craig Garrett, Associate Professor of Counseling

The purpose of this dissertation was to examine the impact of a supervisor’s perceived situational

cultural humility, dispositional cultural humility, and engaging in cultural opportunities on the

supervisory working alliance. The empirical research on situational cultural humility,

dispositional cultural humility, and engaging in cultural opportunities in supervision is at a

preliminary stage. The sample includes 172 counseling graduate students and provisional

licensed counselors. Using the Cultural Humility Enactment Scale (CHES), Supervisor Missed

Cultural Opportunities Scale (SMCOS), and the Supervisory Working Alliance Inventory

(SWAI), this study tested the hypotheses that the supervisor’s cultural humility (situational and

dispositional) and the supervisor’s engaging in cultural opportunities will positively impact the

supervisory working alliance. Multiple regression analysis and linear regression analysis were

used to test the hypotheses. The multiple regression model statistical significance predicted

SWAI F(3, 168) = 103.641, p < .001, R2 = .649. In the linear regression the adjusted R2=.080,

which means that a supervisor’s cultural humility can account for 8% of the variance in

supervisors engaging in cultural opportunities. The effect size seems to be small, however the
analysis indicates it is statistically significant. The results indicate the significance of a

supervisor’s cultural humility and engagement in cultural opportunities on the strength of the

supervisory working alliance.

 Chapter 1

INTRODUCTION

Statement of the Problem

Supervision is a multicultural experience (ACES task force report, 2011; Bernard et al.,

2019; Falicov, 2014), which involves a supervisor’s, supervisee’s, and client’s culture (Falicov,

2014). The American Counseling Association Code of Ethics (2014) states that supervisors are

responsible for having awareness and addressing multicultural issues in the relationship between

the supervisor and supervisee. Ideally, supervisors assist supervisees in developing into culturally

competent counselors (Constantine & Sue, 2007). However, supervisors can have cultural blind

spots that negatively affect how they approach supervision and counseling (Patallo, 2019). Some

biased assumptions and beliefs are transferred to mental health professionals in their training and

from their institutions (Sue et al., 1998). Inexperienced supervisors are often unsure how to

address cultural differences safely and ethically (Campbell, 2006). However, multicultural

counseling competency is necessary across all areas of counseling. Counselors are responsible

for acquiring knowledge, self-awareness, sensitivity, attitudes, and skills that are essential for the

counselor to be a culturally competent counselor (ACA, 2014). Supervisors are too often

inattentive to culture in the supervisory relationship, which puts them at higher risk of creating a

cultural rupture and failing to repair it. Cultural ruptures negatively affect one of the most vital

aspects of the supervisory relationship the supervisory working alliance (Jadaszewski, 2020;

Watkins, 2014b).

1
 2

In a study of 363 participants, a significant portion of the sample reported currently

experiencing harmful supervision or having experienced it in their supervision experience.

Thirty-six percent of the participants reported presently receiving hazardous supervision, and

over 50% reported having experienced harmful supervision (Ellis et al., 2013). Harmful

supervision is defined as actions from the supervisor that result in the supervisee being harmed

emotionally, physically, and/or psychologically (Ellis et al., 2013). In this study, 93% of

participants reported presently experiencing inadequate supervision. Inadequate supervision can

entail supervisors who are unaware of their supervisee’s cultural background and a lack of

interest in their cultural background (Ellis et al., 2013). However, pre-licensed counselors are

less likely to report these supervision-related concerns to their supervisors (Cook et al., 2020).

Negative experiences in supervision can have lasting effects on supervisees and the

supervisory working alliance (Jadaszewski, 2020; Ramos-Sanchez et al., 2002). For example,

racial microaggressions negatively impact the supervisory working alliance and result in

supervisees not feeling safe enough to share client issues in cross-racial dyads (Sukumaran,

2016). Black supervisees reported experiencing microaggression at a higher rate than other racial

and ethnic minorities (Protor et al., 2016). Black supervisees with White supervisors reported

experiencing multiple types of microaggressions in supervision like dismissing racial-cultural

issues, making assumptions about the supervisee or their minority clients, holding the clients

responsible for issues of oppression, and offering culturally inappropriate treatment

recommendations (Constantine & Sue, 2007). Stereotyping experienced by Black supervisees

can result in mistrust and negatively affect the process and outcomes of supervision. Black
 3

supervisees have reported not receiving sufficient feedback about their clinical skills because

their supervisor feared being labeled a racist (Constantine &Sue, 2007).

Microaggressions have a psychologically negative effect on Black supervisees. Black

supervisees have reported experiencing feelings of surprise, anger, and distress as a result of

microaggressions in supervision (Constantine & Sue, 2007). The experiences of

microaggressions of Black supervisees by White supervisors can result in them losing hope in

obtaining culturally responsive supervision from White supervisors. Supervision can be seen as

another setting in which they can experience racism as opposed to being in a safe environment

(Constantine and Sue, 2007). Racial microaggressions can result in supervisees feeling that

supervision is hazardous and they are reluctant to investigate multicultural issues in supervision.

The experiences of racial microaggressions in supervision can negatively impact a supervisee’s

development of counseling skills and multicultural competence (Sukumaran, 2016).

Successful multicultural supervision requires the supervisor to foster a safe environment

for discussing differences (Bernard et al., 2019). Supervisors must address multicultural issues in

supervision, especially microaggressions. The elements that are essential to decrease the effect of

microaggressions on supervisees are (a) the supervisor’s openness and readiness to acknowledge

and discuss multicultural issues, (b) rapport, and (c) the supervisor's capability of helping the

supervisee discuss the effects of microaggressions on themselves and when it happens with a

client (Sukumaran, 2016). Microaggressions can have harmful effects on supervisees of color

(Protor et al., 2016). The possibility of microaggressions makes it essential to have

multiculturally informed supervision for supervisees of all backgrounds (Jendrusina & Martinez,
 4

2019). Research is needed to identify, resolve, and prevent inadequate and harmful supervision

(Ellis et al., 2013).

The perceived cultural humility of supervisors appears to reduce the effect of negative

experiences like cultural ruptures in supervision and microaggressions (Hook, Davis, et al., 2016;

Jadaszewski, 2020). The perceived cultural humility of the supervisor and the supervisor’s

engagement in cultural opportunities in supervision have the potential to positively affect the

supervisory relationship. In contrast, supervisors who are perceived to be less culturally humble

have the potential to have a negative effect on the supervisory working alliance (SWA) (King et

al., 2020; Watkins, et al., 2018; Wilcox et al., 2021). Supervisors who acknowledge and respond

to missed cultural opportunities to talk about race or ethnicity could strengthen their supervisory

working alliance (King et al., 2020). More research is needed to explore the cultural processes in

supervision and their impact on the supervisory working alliance. Elucidating the cultural

processes in supervision has the potential to help prevent cultural ruptures and other harmful

practices in supervision.

Researchers have asserted that the Multicultural Orientation Framework for supervision

(MCO-S) could enhance the current understanding of the cultural processes in supervision, yet

the literature on the MCO-S is limited (Watkins et al., 2019). Wilcox et al. (2021) added to the

literature by studying the impact of cultural humility and engaging in cultural opportunities on

supervision. The study demonstrated that the supervisor’s perceived cultural humility and

engagement in cultural opportunities in supervision positively affect outcomes and supervisee

 5

satisfaction with supervision (Wilcox et al., 2021). Their study shows the benefit of cultural

humility and cultural opportunities in the supervision process.

The effect of cultural humility on supervision has received the most attention compared

to other elements of the MCO-S (Childs, 2020; Cook et al., 2020a; Hook et al., 2016b;

Jadaszewski, 2020), and the majority of the research has been focused on individual supervision.

Cultural humility has been demonstrated to be an important characteristic of supervisors because

it has the potential to affect the strength of the supervisory working alliance (Hook et al., 2016b;

King et al., 2020). There is a limited amount of research about cultural humility and the

supervisory relationship, however the existing research found that supervisees who perceive their

supervisor as culturally humble reported having a stronger supervisory working alliance

(Jadaszewski, 2020; King et al., 2020; Vandament, 2018; Wilcox et al., 2021) and had lower

chances of supervisees intentionally withholding information from their supervisors (Cook et al.,

2020; Ertl et al., 2023). Cultural humility and engaging in cultural opportunities have been

shown to benefit the supervision process, yet the subject needs more empirical studies.

Moreover, cultural humility has been studied as a personality trait (dispositional) in the MCO,

and little research has been dedicated to concentrating on state cultural humility (situational)

(Zhu, 2020; Zhu, Liu, et al., 2021; Zhu, Luke, et al., 2021). The purpose of this study is to

provide more empirical research on the impact of the supervisor’s dispositional cultural humility

(DCH), situational cultural humility (SCH), and engagement in cultural opportunities on the

supervisory working alliance (SWA), which will add to the literature about the MCO-S and aid

supervisors in maintaining a stronger SWA.

 6

Definition of Terms

The term cultural humility was developed by Tervalon and Murray-Garcia in 1998.

Cultural humility is a disposition of continual self-assessment (Tervalon & Murray-Garcia, 1998,

p. 123) that involves the capability to retain an interpersonal stance that is “other-oriented” in

regard to the components of cultural identity that are the most salient to the client (Hook et al.

2013, p. 354) or supervisee (Hook et al., 2016a). It can be dispositional and situational, which

means it can be enacted in relational conflict (Zhu, 2020; Zhu et al., 2021a).

Dispositional cultural humility is viewed as a personality trait or an orientation (Foronda

et al., 2015; Hook et al., 2017). Zhu et al. (2021) proposed in their study that dispositional

cultural humility is a result of three core beliefs: (1) culture is intricate and subtle (2) studying

culture is a long-term commitment, and (3) every culture and every cultural being have values

and constraints.

Situational cultural humility pertains to emotions and occurrences of cultural humility in

a specific moment that is activated and triggers a hypoegoic state (Davis et al., 2017; Tangney,

2000; Zhu et al., 2021).

Cultural opportunities allude to the moments in supervision when an aspect or aspects of

culture manifest themselves for consideration when the supervisor can engage them or miss the

opportunity for exploration and discussion (Watkins et al., 2019). Engaging in cultural

opportunities is proposed to be the product of cultural humility (Hook et al., 2017).

Hook et al. (2017) defines a cultural rupture as a cultural injury or misapprehension. A

cultural rupture can occur when an individual considers an element of their cultural identity is
 7

being attacked. Cultural ruptures have the potential to impair trust and communicate that an

individual is emotionally unsafe (Hook et al., 2017; Owen et al., 2011).

A multicultural orientation (MCO) has been described as a “way of being” with a client

that is steered by the mental health professional’s convictions about the importance of cultural

factors and their influence on the therapist’s and the client’s lives (Hook et al., 2017; Owen et al.,

2011, p. 274).

The supervisory working alliance (SWA) is a joint effort for change that has three facets:

(a) reciprocal agreements and comprehension in regard to pursuing goals for change, (b) the

responsibilities of each of the parties involved, (c) a relationship between the parties essential to

maintain the enterprise (Bordin, 1983).

Research Questions

What effect do a supervisor's cultural humility and engagement in cultural opportunities

have on the supervisory working alliance? The questions proposed in this dissertation are the

following:

1. How does a supervisor’s dispositional cultural humility affect the supervisory

working alliance?

2. How does a supervisor’s situational cultural humility affect the supervisory working

alliance?

3. What effect does a supervisor’s engagement in cultural opportunities in supervision

have on the supervisory working alliance?

 8

4. What effect does a supervisor's missing cultural opportunities in supervision have on

the supervisory working alliance?

Hypotheses

Hypothesis 1: The supervisor’s dispositional cultural humility higher score on The

Cultural Humility Enactment Scale (CHES) will predict the supervisee’s higher rating of the

supervisory working alliance as indicated by the Supervisory Working Alliance Inventory

(SWAI)

Hypothesis 2: The supervisor’s higher score in situational cultural humility on the CHES

will predict the supervisee’s higher rating of the supervisory working alliance as indicated by the

SWAI.

Hypothesis 3: The supervisor’s higher cultural opportunities score on the Supervision

Cultural Missed Opportunities Scale (CMOS-S) will predict the supervises’ higher rating of the

supervisory working alliance indicated by the SWAI scores.

Hypothesis 4: The supervisee’s higher rating of their supervisor as culturally humble on

the CHES will predict a higher score of the supervisor’s engagement in cultural opportunities as

indicated by the CMOS-S.

Hypothesis 5: The supervisor’s lower scores on the CHES will predict missed cultural

opportunities as indicated by the CMOS-S and a lower rating of the supervisory working alliance

as indicated by SWAI scores.

 9

Assumptions

In this study, there are several assumptions:

1. One assumption is that cultural humility is dispositional and situational.

2. Other-reported instruments (SWAI, CHES, and CMOS-S) are sufficient for

measuring the theoretical concepts they profess to measure and give a more accurate

assessment of supervisors.

3. Culturally humble supervisors will miss fewer cultural opportunities in their

supervision sessions, which is in line with the Multicultural Orientation Framework

for Supervision (Watkins et al., 2019).

4. Supervisees who have had at least four sessions with their supervisor can more

accurately gauge the cultural humility of their supervisor.

5. The supervisory relationships between graduate students and provisionally licensed

therapists with their supervisors have minimal differences.

6. Cultural ruptures can significantly impact the supervisee’s perspective of their

supervisor’s cultural humility.

Delimitations

This study will focus on variables such as cultural ruptures, the developmental level of

the supervisee, and the supervisor’s use of self-disclosure. This study will focus on the
 10

supervisor’s perceived cultural humility and cultural opportunities that were engaged or

missed. This study will consider counselors who are currently under the individual

supervision of a PLPC, LPC, LPC-S, LMFT, LMFT-S, or their state’s equivalent. Participants

who reported having fewer than four individual supervision sessions with their current

supervisor will be excluded. The MCO-S has three components, however, the element of

cultural comfort will be excluded from this study.

Limitations

One limitation of the study is that it utilized a convenience sample. To address the

limitations, the survey was sent to universities, counseling associations, counseling centers,

and other groups that have access to individuals of various cultural backgrounds. Another

possible limitation is the study did not take into account the impact of supervisees’ factors that

could affect the SWA: previous negative supervisor experience, other forms of ruptures,

supervisee resistance, or a supervisee’s anxiety (Crook Lyon & Potkar, 2014; Ramos-Sanchez

et al., 2002). In addition, the study did not include responses from the supervisor to clarify the

responses of the supervisees.

 11

Chapter 2

REVIEW OF THE LITERATURE

Bordin and the Supervisory Working Alliance

Bordin’s working alliance theory is one of the most expansive theories on alliance in

therapy (Hatcher, 2010). Bordin reported his theory of the working alliance was his attempt to

discover what influences change in people (Goodyear et al., 1992). Bordin’s (1979) concept of

the working alliance was influenced by the psychoanalytic perspective, and he advocated for its

generalizability (Orlinksy & Ronnestad, 2000). Though he was influenced by the psychoanalytic

approach (Bordin, 1979) and Carl Rogers (Constantino et al., 2010; Orlinksy & Ronnestad,

2000), he developed a pan-theoretical conceptualization (Bordin, 1979; Orlinksy & Ronnestad,

2000) of the working alliance and applied it to the supervisory relationship, which birthed his

theory of the SWA (Bordin, 1983; Watkins, 2014b). He provided the field of psychology with a

conceptualization of the working alliance that could be tested with empirical research (Orlinksy

& Ronnestad, 2000). His theory of the working alliance greatly influenced the development of

the Supervisory Working Alliance Inventory (SWAI) (Efstation et al., 1990; Schweitzer &

Witham, 2018).

According to Bordin (1983), a strong working alliance is composed of three elements:

joint agreement, tasks, and bonds. The joint agreement consists of the clarity and mutuality of the

supervisee and supervisor on the goals of supervision. The tasks are the necessary assignments

from both parties to accomplish the goals of supervision. The supervisee must understand the
 12

connection between the tasks and the goals (Crook Lyon & Potkar, 2014). The bond is “the

feelings of liking, caring, and trusting that the participants share” (p. 36). The emphasis on the

bond in the alliance and responding to individuals emotionally veers away from the traditional

psychoanalytic approach (Orlinksy & Ronnestad, 2000). Bordin has had a significant impact on

the SWA literature.

The Supervisory Working Alliance

SWA has been labeled the “quintessential integrative variable” in the supervisory

relationship (Watkins, 2014a). In the literature, there is little to no dispute about the

importance of the SWA in supervision (Watkins, 2014b). Holloway (1987) surveyed the

research on the developmental approaches to supervision and proposed the supervisory

relationship is a key variable in the development of supervisees. The SWA has more impact

on supervisee satisfaction than other individual contextual variables or methodical variables

(Cheon et al., 2009). The literature and theory about the SWA have supported the notion that

the SWA facilitates positive clinical outcomes (Ertl et al., 2023).

The SWA has been found to correlate with supervisees’ satisfaction and disclosure

positively, which has been a commonly held understanding (Schweitzer & Witham, 2018).

The SWA is a partial mediator for supervisory style and supervisee satisfaction. Therefore,

supervisees who view their supervisor as utilizing multiple supervisory styles are more likely
 13

to perceive themselves as having a stronger SWA, which can result in a higher level of

satisfaction with supervision (Li et al., 2021).

The SWA is co-constructed by the supervisee and the supervisor; it matures over time and

is preserved by consistent interactions (Watkins, 2014b). Both supervisee and supervisor

factors impact the strength of the SWA such as the supervisees’ developmental level, anxiety,

resistance, disclosure, nondisclosure, and unresolved ruptures (Crook Lyon & Potkar, 2014;

Ramos-Sanchez et al., 2002). However, a stronger working alliance can reduce a supervisee's

anxiety and a weaker SWA can increase their anxiety (Ellis, 2010). In addition, a stronger

SWA can reduce supervisee intentional non-disclosure (Cook et al., 2020b; Ertl et al., 2023).

The supervisor’s effective evaluation methodology and exploration of cultural variables

can increase or reduce the strength of the SWA (Crook Lyon & Potkar, 2014; Ramos-Sanchez

et al., 2002). The supervisor’s interpersonal power (Quarto, 2002), attachment style, ethical

violations (Ramos-Sanchez et al., 2002), interpersonal skills (Bambling & King, 2014), and

supervisor’s self-disclosure (Crook Lyon & Potkar, 2014) can significantly impact the SWA.

Experiences such as incompatible tasks and goals, and the lack of reciprocity, trust, and faith

in the supervisory relationship can have lasting effects on counselors in training and weaken

the SWA (Ramos-Sanchez et al., 2002). The SWA is a crucial aspect of the supervisory

relationship that is closely related to supervision outcomes and more research is

understanding what factors impact its strength.

 14

Measuring the Supervisory Working Alliance

The Supervisory Working Alliance Inventory

Efstation et al. (1990) as a result of Bordin’s contributions developed the Supervisory

Working Alliance Inventory. They developed a supervisor and a supervisee version of the

SWAI. The researchers were influenced by Bordin’s work but suggested a two-factor model

for measuring the SWA from the supervisee’s perspective (rapport and client focus) and a

three-factor model from the supervisor’s perspective (Efstation et al., 1990). The SWAI has

limitations but has been widely accepted as an adequate measure for the SWA (Watkins,

2014). Patton’s (1992) study comparing the SWAI with the Personal Reactions Scale-Revised

suggests that the SWAI is suitable for individuals from various backgrounds with various

experiences. Watkins, (2014), examined 40 studies that measured the SWA and 17 of the

studies used the SWAI. Schweitzer and Witham (2018) highlighted the advantages of the

Supervisory Relationship Questionnaire (SRQ), another widely accepted instrument, but

confirmed the SQR and the SWAI measure similar constructs. The SWA is a critical aspect of

supervision that impacts the supervisee along with supervision outcomes. Supervisors must be

knowledgeable about the variables that can weaken or strengthen the SWA. The supervisor’s

multicultural competence is a critical variable in supervision (Ancis & Marshall, 2010;

Crockett, 2011).
 15

Multicultural Supervision and the Supervisory Working Alliance

Supervisors are responsible for discussing the cultural processes in supervision and with

clients (Bernard et al., 2019). Often supervisors do not discuss the cultural variables in the

supervisory relationship, and the responsibility to discuss culture is left to the supervisee

(Gatmon et al., 2001; Gutierrez, 2018; Sukumaran, 2016). When supervisors are aware, open,

and give sincere attention to cultural variables; supervisees reported having a stronger

working alliance and more satisfaction with their supervision (Crockett & Hays, 2015;

Gutierrez, 2018). Supervisees have reported that supervisors discussing cultural variables aids

them in understanding their clients and themselves (Ancis & Marshall, 2010). Phillips et al.,

(2017) study results demonstrated a positive correlation with the SWA and with depth of

discussion of multicultural identities. In addition, supervisees who view their supervisor as

being multiculturally competent generate a stronger working alliance. A strong working

alliance combined with perceiving their supervisor as multicultural competent results in

increased counseling self-efficacy in supervisees (Crockett & Hays, 2015). The relationship

between the supervisee's perception of the supervisor's multicultural competence and the

strength of the SWA is complex and intriguing.

Supervisees who reported that their supervisors were more multiculturally competent

reported having a stronger SWA (Ancis & Marshall, 2010; Crockett, 2011). Supervisees who

experience multiculturally competent supervision are more inclined to be multiculturally

competent counselors (Soheilian et al., 2014). Although, more research is needed to

 16

understand what is multiculturally competent supervision (Ancis & Marshall, 2010) and its

effectiveness (Watkins, et al., 2019; Wilcox et al., 2021).

Multicultural Supervision

The American Counseling Association (ACA) Code of Ethics (2014) urges supervisors to

be knowledgeable and address the impact of multiculturalism and diversity on the supervisory

relationship (F.2.b). One limitation of the code of ethics is that it does not define or describe

what are multicultural competencies in clinical supervision (Kemer et al., 2021). However,

supervisors have a key role in the development of the multicultural competency of their

supervisees. They are responsible for ensuring multicultural issues are handled appropriately

(Bernard, et al., 2019). Therefore, supervisors must have knowledge of and be responsive to

multicultural issues (Campbell, 2006). If mental health professionals are limited in their

ability to address cultural issues: then the avenues in which clients and/or supervisees of

culturally diverse backgrounds can explore matters like racism, discrimination, and prejudice

are limited (Sue et al., 2007).

Approaches to Culture in Supervision

Falicov (2014) emphasized the importance of considering culture in counseling and

supervision. Falicov (2014) lists three unproductive approaches to the relationship between
 17

therapy and culture: the universalist, the particularist, and the ethnic-focus approach. An

individual who holds the universalist position emphasizes similarities and assumes that

individuals and families have more similarities than differences. Those who hold to this

position assume the culture is extraneous to therapy and supervision (Falicov, 2014). The

limitation of this position is that it is prone to ethnocentrism and the therapist may believe

their position is objective and unbiased (Falicov, 2014). The particularist focuses on the

differences due to their assumption that individuals and families have more differences than

similarities (Falicov, 2014). The ethnic-focused individual focuses on the anticipated diversity

of thoughts, emotions, actions, and attitudes. However, this stance does not adequately

address combined identities like race, class, sexual orientation, disability, or nationality. The

ethnic-focused approach is incapable of addressing cultural inconsistencies, quandaries, and

contradictions. The ethnic-focused stance assumes the observer is free of culture (Falicov,

2014). In addition, this position views culture as static and stable as opposed to developing

and dynamic. The three approaches are limited in their ability to address the sources of mental

distress for a client or supervisees with diverse cultural backgrounds like racism, prejudice,

inequities, and lack of adequate resources (Falicov, 2014). In literature, multicultural

competencies are presented as an ethical requirement or agreed-upon standard (Bernard et al.,

2019).
 18

Multicultural Competencies in Supervision

In the literature, multicultural competence (MCC) in clinical supervision and clinical

practice is measured by knowledge, skills, attitudes, and beliefs (Best Practices in Clinical

Supervision: ACES Task Force Report, 2011; Falender et al., 2013; Kemer et al., 2021; Sue et

al., 1992). Bernard et al., (2019) stated competent multicultural supervisors understand and

help their supervisees understand four dimensions: (a) intrapersonal: the identities that affect

their concept of self in relationship to others such as race, class, gender, sexual orientation,

and culture; (b)sociopolitical: the number of liberties or oppression a person faces on multiple

dimensions; (c) interpersonal: bias and prejudices; and (d) interpersonal: cultural identity and

behavior (Bernard et al., 2019, p. 119). However, the elements of the MCC framework are

difficult to measure (Hook et al., 2013; Hook et al., 2017; Johnson et al., 2014).

Limitation of Multiculturally Competency-Based Supervision

Little research has demonstrated multiculturally competent therapists have better

treatment outcomes (Owen, 2013). Several measures have been created to assess MCC;

however, these measures assume that achieving sufficient knowledge or awareness about

culture makes an individual competent (Hook et al., 2017; Kumas ̧ -Tan et al., 2007). Many of

the studies that measure MCCs use self-reported measures, which have poor validity

outcomes. More instruments are needed to measure multicultural-related constructs. Self-

reported measures for MCCs must be replaced due to their questionable validity (Worthington
 19

et al., 2007). Multicultural competence has proven to be difficult to measure empirically; and

as a result, researchers asserted that the measures seem to measure self-efficacy as opposed to

competence (Hook et al., 2017; Kumas ̧ -Tan et al., 2007; Wilcox et al., 2020; Worthington et

al., 2007). More instruments are needed that measure individuals in real-life situations as

opposed to analogs. Survey-based self-reported scales must be substituted to have a more

accurate assessment of MCCs (Worthington et al., 2007).

As a result of the criticism of MCC and its measures, Hook et al. (2017) suggested more

studies should be dedicated to the MCO framework. The limitations of the MCC framework

extend to the supervision literature. Researchers have suggested more empirical studies

should be dedicated to the study of the MCO framework and supervision as opposed to the

MCC framework (Hook et al., 2016; Kemer et al., 2021; King et al., 2020; Watkins, et al.,

2019; Wilcox et al., 2021).

The Multicultural Orientation and Supervision

The Multicultural Orientation Framework (MCO) is described as a “way of being” and

consists of three components: cultural humility, cultural comfort, and cultural opportunities

(Hook et al., 2017). The MCO framework has four assumptions. The first assumption is that

the client and the clinician cogenerate cultural displays in sessions. The second assumption is

that mental health professionals focusing on their values regarding culture is more

advantageous to the therapeutic process than applying a particular intervention to a particular

 20

cultural group (Hook et al., 2017). The third assumption is that cultural activities are vital for

connecting with a client’s primary cultural identity, which can set the foundation for effective

therapy. The fourth assumption is that a robust multicultural orientation can inspire counselors

to educate themselves about their cultural perspective and worldview along with their clients

(Hook et al., 2017). The MCO framework can help counselors develop an approach to treating

their clients with intersecting identities that are characterized by openness, interest, and an

engaged orientation (DeBlaere et al., 2019).

A multicultural orientation has been recognized as a valuable element of the therapeutic

relationship (Owen et al., 2014; Owen et al., 2016; Owen et al., 2011b) and has the potential

to benefit the supervisory relationship significantly (Hook et al., 2016b; Watkins & Hook,

2016; Watkins et al., 2019a). The potential benefits resulted in Watkins et al. (2019a) creating

the Multicultural Orientation Framework for Supervision (MCO-S). The MCO-S has similar

assumptions as the MCO. The first assumption is that the supervisee and the supervisor enter

into an academic relationship that includes their co-generation of cultural expressions. The

second assumption is that the values and attitudes of the supervisor and supervisee greatly

influence the behaviors and actions that occur in the supervisory relationship. The third

assumption is that cultural humility and other cultural processes are essential characteristics

for connecting with the most important aspect of a supervisee’s and client’s cultural identities.

The fourth assumption is supervisors with a strong MCO-S will have a substantial desire to

explore their cultural identities along with the cultural influences of supervisees and clients

(Watkins et al., 2019a). The MCO-S appears to be promising, but more empirical is necessary
 21

research test the assumptions. The subject could benefit from more research on the effects of

the elements of the MCO on supervision (Hook et al., 2016b; Watkins et al., 2019a; Wilcox et

al., 2021).

Cultural Humility

Cultural humility is foundational to having a strong multicultural orientation (Hook et al.,

2017; Hook et al., 2013). The term cultural humility was developed by Tervalon and Murray-

Garcia in 1998 and was originally used to address physicians to contrast multicultural

competence. They stated cultural humility involves a continual dedication to self-assessment

that aids in rectifying power imbalances and establishing partners that are beneficial for

communities and individuals (p. 123). Hook et al. (2013) adapted the definition for

counseling: “Cultural humility involves the ability to maintain an interpersonal stance that is

other-oriented (or open to the other) in relation to aspects of cultural identity that are most

important to the client” (p. 354).

Hook and Watkins (2015) stated cultural humility is the foundation to any positive

contact with individuals and groups with culturally diverse individuals. Cultural humility is a

useful quality when working with clients with intersecting cultural identities (DeBlaere et al.,

2019). It has been proposed to be a feature that could reduce health and treatment disparities

among racial and ethnic minorities in healthcare facilities (Hook et al. 2016a). Cultural
 22

humility can act as a buffer for microaggressions and cultural ruptures that can occur in

therapy and supervision (Hook et al. 2016a; Jadaszewski, 2020). Positive therapeutic

outcomes have been linked to a therapist’s level of cultural humility (Hook et al., 2013).

Therapists who are culturally humble are viewed by their clients with religious and spiritual

commitments as ones who accept their faith, which may be a medium for healing (Owen et

al., 2014). Owen et al. (2014) stated that when therapists generate opportunities to dialogue

with clients about their cultural identity and enact cultural humility it benefits the therapeutic

process. Enacting cultural humility can help clients explore their religious and spiritual

commitments and assist them in reaching their goals (Owen et al., 2014). One of the core

elements of cultural humility involves a person knowing themselves well, which included

awareness and ownership of strengths and shortcomings (Hook et al., 2017). Cultural humility

began as a theoretical concept and then became an empirically measured concept.

Measuring Cultural Humility

Foronda et al. (2015), through a conceptual analysis of 62 articles on cultural humility,

identified openness, self-awareness, supportive interactions, and self-reflection and critique as

elements of cultural humility (p. 6). Rivera and Grauf-Grounds (2020) defined cultural

humility as a relational stance that consists of openness, respectfulness, curiosity, and

accountability. Hook et al.’s (2013) conceptualization of cultural humility has influenced other

notions of cultural humility. Hook et al. (2013) created the Cultural Humility Scale (CHS),
 23

which was the first instrument to assess the notion of cultural humility that originated from

the work of Tervalon and Murray-Garcia (1998). The CHS was created as a result of the

limitations of the MCC framework and is an other-reported measure to bypass the issues of

self-reporting. The instrument was created to assess cultural humility as a virtue or disposition

(Hook et al., 2013). The development of the CHS has resulted in the creation of the Cultural

Humility Enactment Scale (CHES) (Zhu, 2020) and the Multidimensional Cultural Humility

Scale (MCHS) (Gonzalez et al., 2021). In addition, some researchers have adapted the

measure to cultural humility in supervisors (Cook et al., 2020a; Jadaszewski, 2020;

Vandament, 2018; Vandament et al., 2021; Wilcox et al., 2021; Zhang et al., 2021).

The Culturally Humble Supervisor

Watson (2018) states, “A cultural humility approach encourages attitudes and practices

that involve a secure sense of one’s worldview and cultural identity while at the same time

developing a capacity to “take in the experience of others’” (p. 136). Culturally humble

supervisors are aware of cultural differences and their effect on the power differential in the

relationship. The supervisor remains open to the supervisee’s cultural perspective and approaches

them with humility. Supervisors communicate cultural humility by acknowledging their

limitations and continual pursuit of cultural humility (Hook et al. 2016b). Supervisors see culture

as a vital element of supervision and look for a way to discuss it in supervision (Watson, 2018).
 24

The supervisor must encourage the supervisee to explore themselves as a “person of

culture.” Supervisors have the task of assisting their supervisees in seeing the effects of power

and privilege on their clients and the families they serve ( cf. Watson, 2018, p.130). The

culturally humble supervisor is in continual pursuit of a culturally humble stance (cf. Hook et al.,

2016a). Cultural humility counteracts the desire for the supervisor to be the expert. The modeling

of cultural humility cultivates an environment for open and genuine conversation can occur

(Upshaw et al., 2019). Supervisors who have a culturally humble stance are more likely to

participate in conversations about sociopolitical and sociocultural factors (Jones & Branco,

2020), which are discussions that supervisors should have with supervisees (Bernard et al.,

2019). Supervisees have reported feeling more satisfied with supervision when their supervisors

engaged in more cultural conversations and were culturally responsive (Mori et al., 2009). In

cultural conversations, culturally humble supervisors remain open to the supervisee's cultural

perspectives and approach them with humility (Hook et al., 2016b). Open and respectful

communication is key to effective supervision (Bernard et al., 2019). Hook et al. (2016b)

proposed that supervisors who hope to create strong relationships with their supervisees with

various cultural identities must (a) subdue the inclination to perceive their beliefs, values, and

worldview as superior, and be open-minded toward the beliefs, values, and worldviews of their

supervisees; (b) attempt to foster an awareness of their limitations and comprehension of their

supervisee’s cultural background and establish a motivation to attune themselves to their

supervisees (Hook et al., 2016b).

 25

Cultural Humility in Supervision

Cultural humility has received the most attention in the supervision literature compared to

the other elements of the MCO-S (Zhang et al., 2021). Researchers have suggested other

potential benefits of incorporating cultural humility into supervision and the features of

culturally humble supervision (Childs, 2020; Hook et al., 2016b; Vandament et al., 2021;

Watkins & Hook, 2016; Watkins. et al., 2019a). Studies have reported a positive relationship

between a supervisor’s perceived level of cultural humility and supervision process outcomes

(Zhang et al., 2021). Researchers have hypothesized that the integration of cultural humility

into supervisor preparation could assist them in engaging with supervisees from marginalized

populations (Patallo, 2019). The concept of cultural humility has been supported by empirical

studies over the years (Zhang et al., 2021), yet more empirical research is needed to

understand the effects of cultural humility on the supervision process.

Studies have modified the Cultural Humility Scale (CHS) to measure one of the cultural

processes in supervision and added to the literature about the effects of cultural humility on

supervision. For example, Cook et al. (2020) adapted the scale and their results imply that

supervisees are more likely to disclose cultural and clinical issues in supervision if they

perceive their supervisor is culturally humble. Ertl et al. (2023) had similar findings and found

cultural humility has an inverse relationship with supervisee nondisclosure. Cultural humility

has demonstrated the capacity to impact the SWA substantially (Jadaszewski, 2020; Jones &

Branco, 2020; King et al., 2020; Vandament et al., 2021). The supervisor’s perceived cultural
 26

humility appears to reduce the effect that cultural ruptures can have on the SWA. In addition,

cultural ruptures can affect the supervisee's perception of their supervisor’s cultural humility

(Jadaszewski, 2020). Cultural ruptures in supervision prompt negative emotions, which can

harm the SWA (Jadaszewski, 2020). However, the research on cultural humility and

supervision is growing but is still limited (Jadaszewski, 2020; King et al., 2020; Zhang et al.,

2021). One area that requires more study is situational cultural humility (Zhu, 2020).

Trait and Situational Cultural Humility

Humility can be measured on two distinct dimensions: situational and dispositional.

Dispositional humility is considered an element of a person’s personality (Chancellor &

Lyubomirsky, 2013; Tangney, 2000). Situational humility or state humility is considered

“humility in the moment” (Tangney, 2000, p. 76). However, most researchers have

conceptualized humility as a trait and have not given much attention to humility as a state or

as being situational (Chancellor & Lyubomirsky, 2013; Kruse et al., 2017). Few assessments

measure situation-specific humility, which could be the result of state humility not gaining

much traction (Chancellor & Lyubomirsky, 2013; Tangney, 2000, p. 76). The study of

situational humility can highlight the relationship between ephemeral emotions and humility

in certain situations. In addition, studying state humility can help researchers comprehend

what humility is and how it functions (Chancellor & Lyubomirsky, 2013). In addition, few

studies that have explored the state humility in cross-cultural contexts (Kruse et al., 2017).
 27

Most studies that measure cultural humility in supervision have modified the Cultural

Humility Scale to explore the cultural process in supervision. The CHS was created to

measure cultural humility as a personality trait and does not assess for situational cultural

humility (Zhu, 2020). Zhu et al. (2021) proposed a theory of cultural humility that considers

dispositional and situational cultural humility. The researchers asserted that cultural humility

can be enacted in moments of cultural tension (Zhu et al., 2021), which is a display of

situational cultural humility. The theory of cultural humility resulted in the development of the

Cultural Humility Enactment Scale (CHES) (Zhu, 2020), which is one of the only instruments

that measures state and trait cultural humility. The CHES was created for clients to assess the

cultural humility in therapists. There is little to no study of the enactment of cultural humility

or situational cultural humility in the supervisory relationship. An empirical study using the

CHES has the potential to give a more comprehensive understanding of cultural humility and

its effect on the supervisory relationship.

Cultural Opportunities

Another element of the MCO is cultural opportunities. Cultural opportunities are

moments in session in which a counselor has the opportunity to explore an aspect of a client's

cultural heritage (Hook et al., 2017; Owen, 2013; Owen et al., 2011b). Missed cultural

opportunities are the moments when a therapist does not explore a client’s cultural identity

when the topic emerges (Owen, 2013; Owen et al., 2011b). When a therapist misses cultural
 28

opportunities it negatively impacts their client's therapeutic outcomes. However, the negative

effects were assuaged if they viewed their therapist as culturally humble (Owen et al., 2016).

Missed Cultural Opportunities in Supervision

Cultural opportunities are another pillar of the MCO-S. Cultural humility and cultural

opportunities are interdependent concepts (Watkins et al., 2019a). Hook et al. (2017) assume

that therapists who are more culturally humble miss fewer cultural opportunities in sessions.

Watkins et al. (2019a) echoed this belief and suggested culturally humble supervisors miss

fewer cultural opportunities in supervision. Missed cultural opportunities have been

demonstrated to have a negative impact on therapeutic outcomes (Owen et al., 2016).

Vandament’s (2018) findings support the claim that missed cultural opportunities negatively

affect the SWA. In addition, Wilcox et al.’s (2021) study highlighted the importance of the

supervisor’s cultural humility and their engagement in cultural opportunities to the outcomes

of supervision. These concepts are associated with a supervisee’s satisfaction with

supervision. Cultural opportunities and cultural humility appear to be promising concepts in

supervision (Wilcox et al., 2021). Watkins et al. (2019) proposed that the Cultural

Opportunities Scale (COS) could be adapted for more empirical research to add to the

literature. Researchers have modified the COS for empirical research but, more research is

needed to understand these cultural concepts in supervision (King et al., 2020; Vandament,

2018; Wilcox et al., 2021) and how they can influence the SWA.
 29

Ruptures and Supervision

In Bordin’s early conceptualization of the SWA, he theorized that rupture and repair

events were vital for its growth and continuance. Ruptures are a common occurrence in

supervisory relationships (Watkins, 2014b). Ruptures in the SWA should be identified and

repaired as soon as possible since they injure the supervision process and outcomes

(Lampropoulos, 2002). Ruptures in supervision can vary in severity and can be the result of

small apprehensions or major instances of miscommunication, misunderstanding, or disunity

(Safran et al., 2011). Safran et al. (2011), influenced by Bordin’s notion of the working

alliance, defined ruptures as strife about the task, disharmony about the goals, and strain in the

client and counselor bond (p. 81). However, a rupture in supervision references a decline in

the SWA that is displayed through a conflict between the supervisor and supervisee over

goals, tasks, or the emotional bond (Watkins et al., 2019a). Supervisory relationships will

have ruptures (Watkins, 2014b), but supervisees tend not to disclose when a rupture has

occurred (Ertl et al., 2023). It is the supervisor’s job to produce an environment that is safe to

aid in the development of the supervisee (Lampropoulos, 2002). Supervisees are hesitant to

disclose when safety has been compromised in supervision; anxieties about the power

dynamic in supervision; dissatisfaction with what they are getting out of supervision; as well

as the skill, knowledge, and biases or stereotypes of the supervisor (Ertl et al., 2023).
 30

Cultural Ruptures in Supervision

Cultural ruptures occur when supervisors are unresponsive or derisive toward cultural

themes in supervision. Unresolved cultural ruptures result in the deterioration of the SWA

(Jadaszewski, 2020). Experiences of racial microaggressions result in cultural ruptures that

weaken the SWA and result in supervisees not feeling safe enough to share client-related

issues (Sukumaran, 2016). However, the perceived cultural humility of supervisors appears to

reduce the effect of negative experiences like cultural ruptures in supervision (Jadaszewski,

2020).

The cultural humility of the supervisor and the supervisor’s engagement in cultural

opportunities in supervision have the potential to have a positive effect on the supervisory

relationship. In contrast, supervisors who are less culturally humble have the potential to have

a negative effect on the SWA (King et al., 2020; Watkins et al., 2018; Wilcox et al., 2021).

Supervisors who acknowledge and respond to missed opportunities to talk about race or

ethnicity could strengthen their SWA (King et al., 2020). More research is needed to explore

the cultural processes in supervision and their impact on the SWA.

Conclusion

A review of the literature highlights the importance of the SWA and how it transcends

other variables of the supervisory relationship. The literature demonstrates the SWA

connection to supervisee satisfaction, supervision outcomes, and supervisee intentional

 31

nondisclosure. The literature has demonstrated that cultural variables such as the supervisor’s

cultural humility and engagement in cultural opportunities have a significant impact on the

SWA. The lack of a supervisor’s cultural humility and engagement in cultural opportunities

can negatively impact the SWA and the supervisee. A supervisor’s deficiency in cultural

humility and engaging in cultural opportunities can result in a cultural rupture. The literature

on cultural humility and cultural opportunities is growing as related to supervision, but the

research is scant. More literature is needed to have a comprehensive understanding of cultural

humility that includes situational and trait cultural humility. This study seeks to examine and

elucidate the relationship between the SWA, cultural humility (situational and trait), and

engaging in cultural opportunities in the supervision process.

 32

Chapter 3

METHODOLOGY

Introduction

This study examined the effect of a supervisor’s situational and dispositional cultural

humility and engaging cultural opportunities on the SWA. The hypotheses were the higher scores

on the CHES and the CMOS-S would predict a strong SWA. In addition, a positive relationship

between a supervisor’s cultural humility and engaging in cultural opportunities was predicted,

which is supported by the literature and was expected to be supported by this study.

Participants

A total of 209 participants responded to the survey. The survey was distributed

electronically through email and Facebook. The survey was emailed to the faculty and staff of

CACREP-accredited institutions listed on the CACREP directory and CACREP-equivalent

programs to recruit graduate students. To recruit provisionally licensed counselors the survey

was emailed to state counseling associations, counseling centers, and counseling supervisors. A

number of provisionally licensed counselors were contacted through Psychology Today and

asked to complete the survey. The survey was posted on a personal Facebook page and

encouraged others to share it on their Facebook accounts. The questionnaire was posted to

various counseling-related Facebook pages and groups. A link to the questionnaire was shared

with participants attending professional conferences. The recruitment message was modified and
 33

emailed to individuals, organizations, and institutions (See Appendix D for Recruitment

Message)

Of the 209 who responded, 37 were excluded from the sample for reasons such as

reporting not currently being in supervision and having 3 or fewer supervision sessions with their

current supervisor. The remaining 172 were included in the sample. The inclusion for the study is

as follows: participants are required to be under individual supervision (i.e., graduate student or

provisionally licensed counselor), and participants must have had four or more sessions with

their supervisor. The participants were selected via voluntary response sampling, through email

and social media networks; therefore, the sample may not be representative of the population of

counselors in the US. Demographic information about the participants’ current status, gender,

and sexual orientation can be found in Table 1. Appendix A contains the full demographics form.

Demographic results for race, religion, and sexual orientation can be found in Table 2.
 34

Table 1

1. Current Status, Participant Gender Identity, and Sexual Orientation

Variable n %

Current status

I am a graduate student 103 59.9

I am a professional 69 40.1

Gender

Female 151 87.8

Male 21 12.2

Sexual orientation
Straight/ heterosexual 150 87.2

Bisexual 8 4.7

Gay/lesbian 3 1.7

Queer 4 2.3

Questioning 5 2.9

Other 2 1.2

Note. N = 172
 35

Table 2

2. Race and Religion of Participants

Variable n %

Race
Black/African American 15 8.7

Asian or Asian American 5 2.9

Latino/Hispanic American 3 1.7

White/European American 135 78.5

Multiracial 11 6.4

Other 3 1.7

Religion
Christian 137 79.7

Jewish 1 0.6

Hindu 1 0.6

Buddist 1 0.6

Agnostic 16 9.3

Atheist 7 4.1

Spiritual 3 1.7

Other 5 2.9

Missing 1 0.6

Note. N = 172
 36

Table 3

3. Age of Participants
Age n %

18–30 79 45.9
31–40 34 19.8
41–50 41 23.8
51–60 15 8.7
61 and up 3 1.7
Note. N = 172

The majority of the participants were female (87.8%), which is consistent with the 71.7%

female representation of the counseling field as a whole (Data USA, 2017). Approximately

twelve percent (cf. Table 1.) of the participants were men. The sample included 103 graduate

students (59.9%) and 60 provisionally licensed counselors (40.1%). More than 20% of the

sample were from participants who self-reported to be a part of a minority racial group in the

United States. More than two-thirds (77.3%) of the participants reported having a female

supervisor, 20.3% reported having a male supervisor, and 2.4% did not disclose the gender of

their current supervisor. The majority (80.2%) of the participants reported having a supervisor

who was White/European American, 9.9% reported having an African American supervisor,

3.5% reported having a Latino/Hispanic supervisor, 2.9% reported having a multiracial

supervisor, 0.6% reported having an Asian American supervisor, 0.6% reported having an
 37

American Indian/Native American supervisor, and the remaining 2.4 % did not report the race of

their current supervisor. Thirty-six percent of the participants reported that their supervisor had

earned a PhD; 60% reported their supervisor had earned a master's degree, 1.7% reported their

supervisor had earned a PsyD, 0.6% reported their supervisor earned an EdD, and 1.2% did not

identify their current supervisor’s highest earned degree. The majority of the participants (54.

1%) reported having one year or less of supervision, 17.5 % reported having two years of

supervision, 15.7% reported having three years of supervision, and 12.8% reported having four

or more years of supervision.

More than one-fourth (27.9%) of the participants reported experiencing a cultural rupture

in supervision, and 71.5% reported not experiencing a cultural rupture in supervision. The

majority of the participants (89.0%) reported being enrolled in a CACREP-accredited program or

receiving a CACREP-accredited degree. Nearly four percent of the participants (3.5%) reported

attending a COAMFTE-accredited program. A small percentage (2.3%) of the sample reported

attending an APA-accredited program. Five percent (5.3%) of the participants reported other or

were unsure about the accreditation of their institution.

After filling out the demographic information and meeting the inclusion criteria, the

participants were prompted to think about their current individual supervisor and whether they

have experienced a cultural rupture in the supervision relationship. Then they were asked to

continue to think about their current supervisor as they completed the assessments.
 38

Measures

Cultural Humility Enactment Scale (Supervisor Version)

The CHES is an instrument that was designed for clients to assess the cultural humility of

their therapists. The CHES is one of the few instruments that measure the supervisor’s perceived

situational and dispositional cultural humility (Zhu, 2020). The CHES differs from the Cultural

Humility Scale (Hook et al., 2013) by asking the participants about a particular moment of

conflict in which cultural humility was enacted (Zhu, 2020). As Zhu et al. (2021) reported,

exploratory factor analysis was used to derive the three CHES subscales: Cultural Teachability,

Cultural Superiority and Disrespect, and Other-Oriented Engagement. Data from a sample of 434

adult clients in counseling or psychotherapy, recruited through web-based surveys, supported the

validity and reliability of the CHES. Internal consistency estimates in this sample were .96 for

the total scale and .94, .92, and .92 for the subscales. The CHES shares a strong correlation (r =

.84, p <.01) with the Cultural Humility Scale (CHS; Hook et al., 2013), an established measure

of cultural humility. The CHES has been used to measure cultural humility in therapists

however, it has not been used in the context of supervision. The scale will be modified with

permission from the developer by replacing the word “counselor” with “supervisor”. This

modification has been done in recent studies with the CHS (Cook et al., 2020a; Jadaszewski,

2020) to measure situational and dispositional cultural humility in supervision.

 39

Supervision Cultural Missed Opportunities Scale

King et al. (2020) and Wilcox et al.(2021) modified the Cultural Opportunities Scale

created by Owen et al. (2011b) by replacing the word “counselor” with “supervisor.” This study

will utilize the Supervision Cultural Missed Opportunities Scale (CMOS-S) (Wilcox et al.,

2021). The Supervision Cultural Missed Opportunities Scale is a five-item Likert-type scale in

which the supervisee rates their agreement with the statements about their supervisor. The

instrument includes items like “I wish my supervisor would have encouraged me to discuss my

cultural background more” (supervisee-focused) (Wilcox et al., 2021). Wilcox et al. (2021)

reported Cronbach’s alphas for the supervisee-focused and client-focused scales of the CMOS-S

were .82 and .87, respectively. The scale has been used in very few studies but seems to be

promising.

Supervisory Working Alliance Inventory

The Supervisory Working Alliance Inventory was created to assess the working alliance

in supervision. The instrument has two subscales, which are rapport and client focus (Efstation et

al., 1990). The inventory is on a 7-point Likert scale and includes items like “I feel comfortable

working with my supervisor” and “My supervisor makes an effort to understand me.” The

authors reported internal consistency alpha coefficients as .90 and .77 for the rapport and client

focus scales, respectively (Efstation et al., 1990). Schweitzer & Witham, (2018) reported that
 40

internal consistency was higher with alpha coefficients of .95 for the rapport scale and .91 for the

client focus scale.

The Cultural Rupture Prompt

The Cultural Rupture Prompt asks participants if they have experienced a cultural rupture

in supervision. They are asked to mark “yes” or “no” and then asked to recall the most

memorable moment. Then they asked to write a brief description of the event (Jadaszewski,

2020).

Data Collection

Participants were asked to review the consent form (see Appendix F) and then check “I

consent” to indicate they consented to participate in the study. After consenting the participants

consented they were directed to the demographics survey along with the Cultural Rupture

prompt, which was succeeded by an opportunity to explain the cultural rupture. The CHES,

CMOS-S, and SWAI followed. No personal identifying information was collected so the

participants would remain anonymous.

Google Forms was used to collect responses. Then responses were exported as an Excel

sheet, which was imported into SPSS. The ordinal variables were converted into numerical data

and then analyzed using SPSS. A multiple regression analysis was used to determine the effect

size of the supervisor’s perceived situational and dispositional cultural humility, and engagement

in cultural opportunities (independent variables) on the supervisor’s working alliance (dependent

 41

variable). A commonly accepted notion about multiple regression analysis is that it requires at

least 20 participants per independent variable (Keith, 2015; Meyers et al., 2017). The study

exceeded the 20 participants per independent variable which increases the generalizability of the

results.

Data analysis plan

Multiple Regression Analysis

Using the sample participants who reported being currently under individual supervision

and having had four or more sessions with their supervisor, a standard multiple regression

analysis (MRA) was computed for Hypotheses 1–3 using the SWAI scores as the dependent

variable and the scores on the subscales of the CHES (situational and cultural humility) and the

CMOS-S. A linear regression was computed for Hypothesis 4 using the CHES scores as the

independent variable and CMOS-S scores as the dependent variable. The research ran an initial

MRA to identify outliers and test assumptions to ensure valid results on the MRA. The

assumptions of the MRA are independence of observations, linearity, normality, and

homoscedasticity, and the data must be free of multicollinearity. The independence of

observations was assessed using the Durbin-Watson statistic. The initial MRA data results

violated the assumption of homoscedasticity, and so two of the variables were transformed to

meet the assumptions (Laerd Statistics, 2015). As a result, the square root transformation was
 42

applied to the SWAI scores and the CHES subscale scores that measure dispositional cultural

humility (Questions 1–25 on the CHES) to convert the positively skewed scores to normality.

After the variables were transformed, the data met the assumptions for the MRA. There

was independence of residuals, as assessed by a Durbin-Watson statistic of 1.751, for the SWAI,

CMOS-S, and subscales of the CHES, which means there is no correlation between the residuals.

The lack of correlation between the residuals addresses the third assumption of multiple

regression analysis. The dependent variable and the independent variables have a linear

relationship as indicated by the scatterplot of the studentized residual and the unstandardized

predicted value (see scatterplot below). Homoscedasticity was determined by a visual inspection

of a plot of studentized residuals versus unstandardized predicted values. The tolerance values

for all the independent variables were greater than 0.1, indicating that the data lacks

multicollinearity. The MRA detected no outliers or influential points. Normality was assessed

using the normal probability plot for the SWAI. The dependent variable falls closely along

straight lines on the P-Plot, verifying the assumptions of normality. The data met the assumptions

for MRA analysis.

 43

Figure 1 MRA Scatterplot of Studentized Residual by Unstandardized Predicted Value

Figure 2 Normal P-Plot of Regression Standardized Residual SWAI

 44

Figure 3 Partial Regression Plot SWA and Cultural Missed Opportunities

 45

Figure 4 Partial Regression Plot SWA and Situational Cultural Humility

 46

Figure 5 Partial Regression Plot SWA and Dispositional Cultural Humility

Linear Regression Analysis

Using the sample participants who reported being currently under individual supervision

and having had four or more sessions with their supervisor, a linear regression (LR) was

conducted for Hypothesis 4 with the composite scores of the CHES scores as the independent

variable and CMOS-S scores as the dependent variable. The assumptions of the LR are

independence of observations, linearity, normality, and homoscedasticity, and the data must

exclude significant outliers (Laerd Statistics, 2015). A linear relation was determined by a visual

examination of the scatterplot (see scatterplot below). The initial linear regression analysis
 47

revealed an outlier. Case 39 was identified as an outlier due to having a standard residual of

-3.150. The outlier was removed from the study, which reduced the sample for the linear

regression to 171. However, another linear regression was conducted and no outliers were

identified. There was an independence of residuals, as assessed by a Durbin-Watson of 1.982.

There was homoscedasticity, as assessed by visual inspection of a plot of standardized residuals

versus standardized predicted values. Residuals were normally distributed as assessed by visual

inspection of a normal probability plot and histogram.

Figure 6 Scatterplot Cultural Missed Opportunities and Cultural Humility

 48

Figure 7 Scatterplot Cultural Missed Opportunities

 49

Figure 8 Histogram Cultural Missed Opportunities

 50

Figure 9 Normal P-Plot of Regression Standardized Residual Missed Cultural Opportunities

Table 4

4. SWAI ANOVA
Model Sum of squares Df Mean square F Sig.

Regression 647.085 3 215.695 103.641 <.001

Residual 349.639 168 2.081

Total 996.724 171

 51

Chapter 4

RESULTS

An MRA was used to evaluate Hypotheses 1–3. The MRA assessed the effect of the two

subscales of the CHES and the CMOS-S on SWAI scores. The multiple regression model

statistically significantly predicted SWAI F(3, 168) = 103.641, p < .001, R2 = .649. All three

variables added significantly to the prediction, p < .001. The prediction model was significant

and accounted for 64% of the variance in the SWA (R2= 64.9, adjusted R2=64.3) (See Table 5).

The mean of the transformed SWAI, scores is M = 4.84 and SD = 2.41. The mean of the CMOS-

S scores was M = 14.28 and SD = 2.83. The CHES has two sub-scales Situational Cultural

Humility (M = 56.74; SD: 8.61) and transformed Dispositional Cultural Humility (M = 4.73; SD

= 1.21).

Table 5.

5. SWAI Model Summary

Std. error
of the
Model R R2 Adjusted R2 estimate
1 .806a 0.649 0.643 1.44263
 52

Hypothesis 1

Hypothesis 1 states that a supervisor’s perceived dispositional cultural humility will have

a positive effect on the rating of the SWA. A multiple regression analysis was run to evaluate the

effect of the supervisor’s perceived dispositional cultural humility on the SWA. The relationship

between the supervisee’s perception of the supervisor’s dispositional cultural humility and the

SWA was statistically significant as indicated by p = <0.001 and B = 0.186. In addition, r =

0.606, which signifies a strong positive linear relationship between the SWA and the supervisor’s

perceived dispositional cultural humility. However, in the post hoc test, the regression

coefficients did not display statistical significance with p = .146, which means the supervisees’

perception of the supervisor’s dispositional cultural humility may had a smaller effect on the

SWA than the other variables. However, the null hypothesis can be rejected due to statistical

significance.

Hypothesis 2

Hypothesis 2 states that a supervisor’s situational cultural humility will have a positive

effect on the SWA. A multiple regression analysis was run to test this hypothesis. The

relationship between the supervisor’s perceived situational cultural humility and the SWA was

statistically significant, which is indicated by p = <0.001 and B = -0.189. The supervisor’s

situational humility has a negative effect on the SWA. In addition, r = -0.788, which indicates a
 53

strong negative linear relationship. The regression coefficient signified statistical significance

with p = <0.001. The hypothesis was not supported. The statistical significance indicates the null

hypothesis can be rejected.

Hypothesis 3

Hypothesis 3 states that the supervisor’s engagement in cultural opportunities will have a

positive effect on the SWA. A multiple regression analysis was run to test this hypothesis. The

relationship between the supervisor’s missed cultural opportunities and the SWA is statistically

significant as indicated by B =.134 (see Table 6) and p = < 0.001. In addition, r = 0.379, indicates

a small correlation between missed cultural opportunities and the SWA. The hypothesis was

supported.

Table 6

6. Correlations

SWAI CMOS-S Situational CH Dispositional CH

Pearson correlation SWAI 1.000 0.379 -0.788 0.606

CMOS-S 0.379 1.000 -0.293 0.251

Situational CH -0.788 -0.293 1.000 -0.699

Dispositional CH 0.606 0.251 -0.699 1.000

Sig. (1-tailed) SWAI . <.001 <.001 <.001

CMOS-S 0.000 . 0.000 0.000

Situational CH 0.000 0.000 . 0.000

Dispositional CH 0.000 0.000 0.000 .

 54

Hypothesis 4

Hypothesis 4 states that supervisors who are perceived to be culturally humble will

engage in more cultural opportunities. In the linear regression n = 171. A linear regression

analysis was run to test this hypothesis. The mean of the scores for the CMOS-S was 14.33 and

SD = 2.77. The mean of the CHES scores was 145.8 and SD = 18.7. The adjusted R2 =.080,

which means that a supervisor’s cultural humility can account for 8% of the variance in

supervisors engaging in cultural opportunities. The effect size seems to be small. However, the

analysis indicates it is statistically significant. In the data, F(1, 169) = 15.71, p< .0001, which is

statistically significant. However, B = -.043, which indicates a negative linear correlation.

Therefore, the hypothesis was supported.

Hypothesis 5

Hypothesis 5 states that supervisors who have lower scores on the CHES will miss more

cultural opportunities and have weaker SWA. Statistical analysis was not applied independently

to test this hypothesis. However, the results of the other statistical analyses lend partial support to

the hypothesis. The MRA results indicate that dispositional cultural humility is positively

correlated with the supervisory working alliance. However, situational cultural humility is

negatively correlated with the SWA. The LR results indicate that culturally humble supervisors
 55

engage in more cultural opportunities. The hypothesis was partially supported due to situational

cultural humility having a negative correlation with the SWA.

Testing Assumptions

Cultural Ruptures in Supervision

The assumption that a supervisee’s experience of a cultural rupture in supervision would

affect the supervisee’s perception of the supervisor’s cultural humility was tested (Jadaszewski,

2020). The means of the CHES scores of participants who reported experiencing a cultural

rupture within supervisors and those who reported not experiencing a cultural rupture in

supervision were compared. The majority of the participants (123 participants) reported not

experiencing a cultural rupture with their supervisor. However, the remaining participants (48

participants) reported experiencing a cultural rupture in supervision. The mean for all the CHES

scores is 145.9 The mean score of the CHES for those who have not experienced a cultural

rupture was 150.3. However, the mean score of those who have experienced a cultural rupture is

134.8 (see Table 7). Supervisees who experienced a cultural rupture scored nearly an entire

standard deviation below those who did not experience a cultural rupture. The results

demonstrate the experience of a cultural rupture impacted the supervisees’ perception of their

supervisor’s cultural humility.

 56

Table 7

7. CHES Scores
Experience of a Mean N Std. Deviation
Cultural Rupture
No 150.3333 123 16.76387
Yes 134.8750 48 18.80541
Note: N = 171

The means of the scores on the SWAI between those who experienced cultural rupture

and those who did not is notable. The mean of the scores of those who had not experienced a

cultural rupture was 113.3, and the mean for those who had was 83.

Supervisor Working Alliance Inventory and Current Status

A Mann-Whitney U test was run to determine whether there were differences in the

SWAI scores between graduate students and provisionally licensed therapists. Distributions of

the SWAI scores for graduate students and provisionally licensed therapists were not similar, as

assessed by visual inspection. The SWAI scores for graduate students (Mean Rank = 86.60) and

provisional licensed therapists (Mean Rank = 86.36) were not statistically significantly different,

U = 3543.5, z =-.031, and p = .975 (See Table 8).

 57

Figure 10 Population Pyramid Frequency SWA by Current Status

Table 8

8. Independent-Samples Mann-Whitney U Test Summary

Mann-Whitney 3,543.5
Wilcoxon W 5,958.5
Test statistic 3,543.5
Standard error 319.975
Standardized test statistic -0.031
Asymptotic sig. (2-sided test) 0.975
Note. N = 172
 58

Figure 11 Independent-Samples Mann-Whitney U Test

SWA and Years of Clinical Experience

Data contained no outliers, as assessed by inspection of a boxplot. SWAI score was

normally distributed, as assessed by Shapiro-Wilk’s test (p > .05). The researcher ran a one-way

ANOVA to explore the relationship between the supervisees’ years of clinical experience and the

SWA (SWAI scores). The data demonstrated that the SWA (SWAI scores) increased in the first

year of clinical practice (n = 91, M =4.7, SD = 2.3) to the second year (n = 27, M = 4.83, SD =

2.7). There was a slight decrease in the SWA with participants who reported being in their third
 59

year of clinical practice (n = 23, M = 4.80, SD = 2.07) and an increase in the scores of those who

reported having four or more years of clinical experience (n = 31, M = 5.35, and SD = 2.73). The

results displayed a homogeneity of variances, as assessed by Levene's test for equality of

variances (p >.05) (see Table 9). The results indicate that supervisees with more years (4 years or

more) of clinical experience rate the SWA higher than those who have fewer years of clinical

experience (3 years or less).

Figure 12 SWA and Years of Clinical Experience

 60

Table 9

9. Tests of Homogeneity of Variances

Levene df1 df2 Sig.
statistic
SWAI Based on mean 1.608 3 168 0.189
Based on median 1.424 3 168 0.238
Based on median 1.424 3 164.197 0.238
and with adjusted
df
Based on trimmed 1.600 3 168 0.191
mean
 61

Chapter 5

DISCUSSION

The purpose of this study was to examine the impact of a supervisor’s perceived

situational cultural humility (SCH), dispositional cultural humility (DCH), and engagement in

cultural opportunities on the SWA. The study extends the literature on the cultural processes that

occur in supervision and SWAs.

Demographic Covariate

After the main analyses, demographic covariates were calculated by isolating

demographic variables that have an effect on the SWA. In the overall sample, individuals who

reported having 4 or more years of clinical experience reported a stronger SWA than those with

less clinical experience, which implies a supervisee’s developmental level has an impact on the

SWA (Holloway, 1987; Ramos-Sanchez et al., 2002). Nearly twenty-eight percent of the

participants (n = 48) reported experiencing a cultural rupture in supervision. Those participants

who have experienced cultural ruptures reported having weaker SWA and a lower perception of

their supervisor’s cultural humility. This finding is consistent with the other researchers in the

field who have demonstrated the harm cultural ruptures can have on the SWA and the

supervisee’s perception of the supervisor's cultural humility (Jadaszewski, 2020). Zhang et al.

(2021) stated that cultural humility studies need more participants who are outside of the

university and need more diversity in the age of the participants. In this study, 40.1% of the
 62

participants were professionals and not graduate students. In addition, 54.1% of the participants’

ages range from 31–60+.

Cultural Humility in Supervision

Cultural humility has been proposed as playing a critical role in the area of supervision

(Davis et al., 2018; Ertl et al., 2023; Hook et al., 2016b; Jadaszewski, 2020; King et al., 2020;

Watkins et al., 2019; Watson, 2018; Zhang et al., 2021). Most of the studies of cultural humility

solely studied dispositional cultural humility as opposed to situational and disposition cultural

humility (Zhu, 2020; Zhu, Liu, et al., 2021; Zhu, Luke, et al., 2021) including studies about

cultural humility and the SWA (Ertl et al., 2023; Jadaszewski, 2020; King et al., 2020;

Vandament et al., 2021; Wilcox et al., 2021). This study adds to the professional literature by

distinguishing the unique effects of situational cultural humility and dispositional cultural

humility on the SWA.

Hypothesis 1 supports the notion that DCH has a positive effect on the SWA, which is

aligned with the cultural humility literature (King et al., 2020; Vandament, 2018; Wilcox et al.,

2021). The results support the findings that a supervisor's perceived dispositional cultural

humility can positively affect the supervisory relationship and result in better supervision

outcomes (Zhang et al., 2021). Previous studies have measured dispositional cultural humility in

therapy (DeBlaere et al., 2019; Foronda et al., 2015; Hook et al., 2013; Hook et al., 2016) and in

supervision. However, no study has explored the supervisor’s SCH and its impact on the SWA.
 63

Zhu (2020) began the study of SCH with the development of CHES, but his study was

limited to the therapeutic relationship. The current study is the first known study that has

explored the impact of a supervisor’s situational cultural humility and particularly its effect on

the SWA. The results of this study supported the comprehensive measurement of SCH and DCH

due to their distinct effects on the SWA. Previous research has suggested that cultural humility

counselors have stronger working alliances (Zhu, 2020; Zhu et al., 2021).

Hypothesis 2 proposed that SCH would be positively correlated with the SWA, however,

the results display a negative correlation. The data displays that as the SCH scores increase the

SWAI scores decrease. One explanation for this occurrence is that a moment of cultural tension

occurred and situational cultural humility was enacted. However, the SWA experienced a cultural

rupture that was not repaired. An unrepaired rupture tends to result in a deterioration of the SWA

(Crook Lyon & Potkar, 2014; Watkins et al., 2019) A repair refers to an attempt to restore the

supervisory relationship to working order (Watkins et al., 2019). A conflict between supervisees

and the supervisor can weaken the SWA with regard to rapport and understanding clients

(Quarto, 2002). A supervisor’s cultural blindspots or inadequate handling of culture could have

resulted in their being unaware a rupture occurred in the SWA (Campbell, 2006; Patallo, 2019).

The data could indicate in moments of cultural tension when cultural humility is enacted the

enactment does not supersede the need to repair the rupture that could have been caused by

cultural tension. This study clarifies that more than cultural humility is needed to repair ruptures

(Watkins, Jr. et al., 2019).

 64

Missed Cultural Opportunities in Supervision

Vandament’s (2018) results imply that supervisors who engage in more cultural

opportunities have a stronger working alliance. The result displays that SWA continued to

increase despite the supervisor missing cultural opportunities. Missing cultural opportunities had

a small effect on SWA compared to other variables. King et al. (2020) stated that missed cultural

opportunities can account for a small share of the variance in the supervision context. The data

could indicate that supervisors could form strong SWA despite missing cultural opportunities.

The findings seem to support the notion that a SWA can overcome other factors in supervision

(Cheon et al., 2009; Watkins, 2014a, 2014b) such as missing cultural opportunities. Another

possible explanation is that the supervisor’s cultural humility and the strong SWA diminished the

effects of the supervisor missing cultural opportunities in supervision (King et al., 2020; Owen et

al., 2016). More research is needed to understand the impact of missing cultural opportunities on

the SWA.

The Multicultural Orientation Framework for Supervision

Cultural humility and cultural opportunities are key elements in the MCO-S framework,

however, research that measures both is scant. Wilcox et al. (2021) results demonstrated that

cultural humility and engaging in cultural opportunities were correlated with supervisee

satisfaction positively. Cultural humility has proven to account for more of the variance in the

SWA than missing cultural opportunities (King et al., 2020). Cultural humility and engaging in

cultural opportunities have been shown to benefit supervisees of color and increase their
 65

perception of the quality of their supervision (Vandament, 2018). The study adds more empirical

evidence and clarity to the proposed MCO-S framework. The study supports the notion that the

central element of the MCO-S, cultural humility, is bidimensional consisting of both situational

and dispositional humility. The study explores the relationship between cultural humility

(situational and dispositional) and missing cultural opportunities. The linear regression results

indicate that the more a supervisor misses cultural opportunities, the less a supervisee perceives

the supervisor as culturally humble. The results support the notion that cultural humility and

cultural opportunities are interdependent elements of the MCO-S (Watkins et al., 2019b).

In MRA the predictor variables SCH, DCH, and cultural opportunities explained 64% of

the variance in SWA. Watkins et al. (2019b) analogized that the elements of the MCO-S such as

cultural humility and engaging cultural opportunities can benefit supervisory relationships. The

results indicate that these elements of the MCO-S play a notable role in the SWA.

Limitations

The study has strengths and limitations that should be taken into consideration. The

strength of the study is its novelty in exploring the pillars of the MCO-S and the SWA. One

strength is the study explored a more comprehensive understanding of cultural humility

(situational and trait cultural humility). A significant amount of the participants were ethnically

diverse (21%) and large enough to permit adequate statistical power for the analyses. A limitation

of this study is that it is ex post facto, cross-sectional, and correlational design similar to most of
 66

the cultural humility studies (Zhang et al., 2021). The study utilized other-reported assessments

from the supervisees and did not contain assessments from the supervisor. Cultural humility and

missed cultural opportunities were considered in this study. However, the third pillar of the

MCO-S, cultural comfort, was not measured in this study. This study focused on the supervisees

and their individual supervisors however, supervisees could be involved in group supervision and

have group supervisors. Supervisor and supervisee factors impact the SWA (Crook Lyon &

Potkar, 2014; Ramos-Sanchez et al., 2002). The primary focus of the study was the supervisor

factors in the supervisory relationship. Supervisee factors that could affect the SWA were not

fully accounted for in the study. In addition, the study did not explore other variables that could

result in the deterioration of the SWA. The majority of the participants were White, female, and

Christian; so this study could have benefited from more racial, ethnic, and religious diversity.

Despite the limitations, this study provides beneficial data to further the literature

Further Research

More research is needed to provide more empirical support for the MCO-S framework

and the interdependence of the pillars. Future researchers should consider the impact of SCH,

DCH, cultural opportunities, and cultural comfort on the SWA. The supervisees’ years of clinical

experience seemed to have a positive correlation with their SWAI scores. Researchers could

explore the effect of the supervisees’ clinical years of experience on their perception of their

supervisor’s cultural humility. This study considers the impact a cultural rupture can have on the
 67

supervisee’s perception of the supervisor’s cultural humility. Further study needs to be done on

the impact of cultural ruptures and the SWA, along with other pillars of the MCO-S. More

research should be dedicated to identifying effective and ineffective repair strategies after a

cultural rupture has occurred (Jadaszewski, 2020).

Graduate-level supervisees are required to attend group supervision, and the literature

would greatly benefit from having the MCO-S and SWA considered in the group supervision.

The primary participants of this study were supervisees. Additional research should include the

perspectives of the supervisee and the supervisor such as the supervisor’s self-report of their

cultural humility or the supervisor’s perceived cultural humility of the supervisee. This study was

ex post facto, cross-sectional, and correlational design like other studies of the MCO-S

framework (Zhang et al., 2021). More qualitative, mixed methods, or experimental research will

help accurately conceptualize cultural humility, cultural opportunities, and the SWA. The SCH

literature is in its infancy. More studies about SCH are needed in settings like individual

supervision, group supervision, and therapy. The literature confirms SCH can be measured

however, the field would benefit from studies on how to increase SCH. Further research must be

done to consider the variables that increase a supervisor’s cultural humility, increase their

engagement or disengagement of cultural opportunities, and make them more likely to cause a

cultural rupture.
 68

Implications for Supervisors

Supervisors are responsible for helping supervisees learn how to engage culture (2014

ACA Code of Ethics, 2014; Bernard et al., 2019). However, the results imply that supervisors

must consider how they engage culture along with their bias (Hook et al., 2016b). Supervisors

must assess their cultural humility through assessments like the CHES. Incorporating the CHES

into the supervision process or training supervisors has the potential to benefit the SWA.

Institutions that train supervisors must consider how to cultivate culturally humble supervisors.

Supervisors must evaluate their enactment of cultural humility by reviewing their supervision

and giving the CHES to their supervisees. Cultural ruptures seem to negatively impact the

supervisee's perspective of the supervisor's cultural humility and the SWA. It would benefit the

supervision relationship for the supervisee if supervisors are able to identify and repair cultural

ruptures. Hook et al. (2017) suggested four components of dealing with cultural ruptures: (a)

addressing defensiveness; (b) creating an environment that is conducive for an individual to

reveal a cultural rupture; (c) obtaining feedback about the cultural rupture; and (d) creating a

cultural rupture repair plan. Supervisors could benefit from being able to identify and prepare for

cultural ruptures. Based on the research, supervisors should consider how to increase their

cultural humility and engage in cultural opportunities because these elements have the potential

to enhance the supervision relationship (Zhu et al., 2021) and prevent cultural ruptures.
 69

Conclusion

The results elucidate the cultural processes that occur in supervision by examining the

supervisor’s cultural humility and cultural opportunities, and their impact on the SWA. One of

the most vital aspects of the supervisory relationship is the SWA and the study displays that the

SWA can be positively or negatively impacted by cultural factors. This study highlights the need

for supervisors to monitor the SWA and their approach and engagement of culture in supervision.

More research is needed to clarify other factors in supervision. However, this study contributes

helpful insights to the literature.

70
 71

Appendices
 72

Appendix A. Demographics Questionnaire

Please click the button or buttons that answer the question most accurately for you. For those
questions that ask you to specify further, please do so in the text box.
Which response best describes you?
I am a graduate student
I am a professional

Are you currently receiving routine individual supervision of psychotherapy (at least twice a
month) as part of graduate training or provisional licensure requirements?
(1) Yes (2) No

What is your age in years?: _______________

What is your gender identity?: (please select one or more options below)
(1) Female
(2) Male
Other (please specify): _______________

How do you identify your race?: (please select the option that best represents your race, and use
the text box to specify further if needed)
(1) Black/African American
(2) Asian or Asian American
(3) Latino/Hispanic
(4) American Indian/Native American
(5) White/European American/Caucasian
(6) Multiracial
(7) Other (please specify):_______________

How do you identify your ethnicity?

(1) Latino or Hispanic
(2) Not Latino or Hispanic

7. How do you identify your sexual orientation? (please select one or more options below)
(1) Gay/lesbian
(2) Bisexual
(3) Straight/Heterosexual
(4) Queer
(5) Questioning
(6) Other (please specify): _______________
 73

8. Religion (please click the button or buttons that best represent your religion and use the text
box to specify branch or sect)
(1) Christian
(2) Jewish
(3) Muslim
(4) Hindu
(5) Buddhist
(6) Pagan
(7) Agnostic
(8) Atheist
Other – please specify __________________

9. Your highest degree received:

(1) PhD
(2) PsyD
(3) EdS
(4) MA
(5) MS
(6) MEd
(7) BS
(8) BA

Are you currently enrolled in a graduate training program?

(1) Yes
(2) No

The degree you are currently seeking:

(1) PhD
(2) PsyD
(3) EdS
(4) MA
(5) MS
(6) MEd
Other - please specify: _________

What is your primary field of graduate study?:

(1) Clinical Psychology
(2) Counseling Psychology
 74

(3) Marriage and Family Therapy

(4) Clinical Mental Health Counseling
(5) Counseling
(6) Counselor Education
(7) Rehabilitation Counseling
(8) School Counseling
(9) Other (Please specify:_____________)

Current Status
(1) Graduate Intern
(2) Provisional Licensed Counselor
(3) Licensed Professional Counselor
(4) Licensed Marriage and Family Therapist

Please specify your program’s accreditation type:

(1) APA
(2) CACREP
(3) COAMFTE
Unsure
Other

What year of your graduate program are you in?: ____________________

How many semesters of clinical training (e.g., practicum, internship) have you completed?:
_____________________

What is your current level of training?

(1) Beginning Practicum
(2) Advanced Practicum
(3) Internship
(4) Post-Internship
(5) Other (Please specify:_____________)

Year(s) of clinical experience:

4+
3
2
1
No clinical training
 75

How many total years of supervision experience do you have? (This is an experience in which
you were the supervisee and received supervision from another professional.):
4+
3
2
1
No clinical training

For the remaining items, please answer to the best of your knowledge about the supervisor you
described when completing the writing prompt at the beginning of this survey.

What is the gender identity of the supervisor you wrote about at the beginning of this survey?:
(please select one or more options below)
(1) Female
(2) Male
(3) Other (please specify): _______________

What is this supervisor’s racial identity?: (please an option or options below, and use the text box
to specify further if needed)
(1) Black/African American
(2) Asian or Asian American
(3) Latino/Hispanic
(4) American Indian/Native American
(5) White/European American/Caucasian
(6) Multiracial
(7) Don’t know
(8) Other (please specify):_______________

What is your supervisors’ ethnicity?

Latino or Hispanic (2) Not Latino or Hispanic (3) Don’t know

What is this supervisor’s highest degree?

(1) PhD
(2) PsyD
(3) EdS
(4) MA
(5) MS
 76

(6) MEd
(7) Don’t know
Other - please specify: _________

The approximate number of supervision sessions with this supervisor?:

_____________________

Hours of individual supervision per week you have/had with this supervisor? _______________

Supervisor’s Credentials

(1) PLPC
(2) LPC
(3) LPC-S
(4) LMFT
(5) LMFT-S
Other___________________
 77

Appendix B. Cultural Rupture Prompt

CULTURAL RUPTURE PROMPT

There are several different aspects of one’s cultural background that may be important to

a person, including (but not limited to) race, ethnicity, nationality, gender, age, sexual orientation,

religion, disability, socioeconomic status, and size.

Psychotherapy supervisors may sometimes contribute to difficulties or breakdowns in

supervision relationships when they (1.) discuss important aspects of supervisees’ or clients’

cultural background in a negative or insensitive way, or (2.) when they are unresponsive to or

dismissive of discussions about cultural background that supervisees see as important. Such

difficulties sometimes lead to open confrontations in supervision. At other times, supervisees

may not feel comfortable in expressing their reactions to their supervisor. Can you think of a

time in which you experienced something like this in supervision of psychotherapy?

(a) Yes (b) No

Please think about the most memorable difficulty or breakdown which occurred in your

supervision based on your supervisor’s insensitive or unresponsive handling of discussions about

culture. Write a brief description of this event below.

______________________________________________________________________________

______________________________________________________________________________

______________
 78

Appendix C. Cultural Humility and Enactment Scale (Supervision Version)

Instructions: There are many aspects that may be considered relevant to one’s culture, including
(but not limited to) one’s race/ethnicity, nationality, gender identity, age, sexual orientation,
religion, disability, and socioeconomic status.
Please identify aspects of your culture that are most central or important to you:
_____________________________________________________
How similar are you with your individual supervisor in terms of the cultural aspect(s) you
identified?
Not at all similar Somewhat Very Similar
Similar

1 2 3 4 5

One’s values and worldview may be influenced by their culture. In general, how similar are
your and your supervisor’s values and worldview?
Not at all similar Somewhat Very Similar
Similar

1 2 3 4 5

Instructions: Please think about your interactions with your supervisor in general. Using the scale
below, please indicate the extent to which you agree or disagree with the following statements
about your counselor.
1 = Strongly Disagree; 2 = Disagree; 3 = Somewhat Disagree; 4 = Somewhat Agree; 5 = Agree;
6 = Strongly Agree
When approaching
cultural topics, my
supervisor...

1. Is open to exploring cultural 1 2 3 4 5 6

topics.

2. Is willing to see things from 1 2 3 4 5 6

my perspective.
 79

3. Is open to changing their 1 2 3 4 5 6

views on cultural issues.

4. Is curious about what my 1 2 3 4 5 6

culture means to me.

5. Is interested in my cultural 1 2 3 4 5 6
views.

6. Is open to cultural views 1 2 3 4 5 6

that are different from their

7. Is rigid in their cultural 1 2 3 4 5 6

beliefs.

8. Enjoys discussing ideas of 1 2 3 4 5 6

different cultures.

9. Asks clarifying questions 1 2 3 4 5 6

about cultural issues when
they are uncertain.

10. Has a stereotypical view of 1 2 3 4 5 6

my culture.

11. Is willing to examine their 1 2 3 4 5 6

own biases.

12. Recognizes the limitation 1 2 3 4 5 6

of their cultural views.

13. Is oblivious to their own 1 2 3 4 5 6

biases.

14. Seeks corrective feedback 1 2 3 4 5 6

for their cultural views.

15. Is open to corrective 1 2 3 4 5 6

feedback for their cultural
views.
 80

16. Is willing expand their 1 2 3 4 5 6

cultural view(s).

17. Recognizes his/her biases. 1 2 3 4 5 6

18. Has a clear understanding 1 2 3 4 5 6

of their own cultural views.

19. Pretends to know 1 2 3 4 5 6

something when they have no
idea.

20. Prioritizes their cultural 1 2 3 4 5 6

views over mine.

21. Shows off their knowledge 1 2 3 4 5 6

on cultural issues.

22. Is arrogant about their 1 2 3 4 5 6

cultural views.

23. Imposes their cultural 1 2 3 4 5 6

views on me.

24. Makes me feel like my 1 2 3 4 5 6

cultural views are inferior

25. Patronizes me in 1 2 3 4 5 6
discussing cultural views.

Instructions: Please recall a moment when you and your supervisor had some forms of conflicts (e.g., difference of
opinion, disagreement, tension) related to culture and cultural values. Using the scale below, please indicate the
extent to which you agree or disagree with the following statements about how your supervisor behaved in that
specific moment. If you cannot recall such a moment, please imagine how your supervisor would behave based on
your prior interactions.
1 = Strongly Disagree; 2 = Disagree; 3 = Somewhat Disagree; 4 = Somewhat Agree; 5 = Agree; 6 = Strongly Agree

In moments of cultural
tension, my supervisor...

26. Is defensive when their 1 2 3 4 5 6

cultural view(s) are
challenged.

27. Listens to my cultural 1 2 3 4 5 6

view(s).

28. Tries to justify their 1 2 3 4 5 6

cultural view(s).
 81

29. Admits when they made 1 2 3 4 5 6

mistakes.

30. Seeks to understand my 1 2 3 4 5 6

cultural view(s) better.

31. Wants to understand my 1 2 3 4 5 6

cultural view(s) better.

32. Makes room for me to 1 2 3 4 5 6

have a different cultural
perspective.

33. Minimizes my cultural 1 2 3 4 5 6

view(s).

34. Collaborates with me. 1 2 3 4 5 6

35. Makes me feel valued in 1 2 3 4 5 6

our relationship.

36. Is attentive to how I feel 1 2 3 4 5 6

about our conflict.

37. Empathizes with how I 1 2 3 4 5 6

feel about our conflict.

38. Is uncomfortable to talk 1 2 3 4 5 6

about our conflict.

39. Has authentic dialogue 1 2 3 4 5 6

with me about our conflict.

40. Avoids having dialogues 1 2 3 4 5 6

about our conflict.
 82

Appendix D. Supervision Cultural Missed Opportunities Scales

(CMOS-S; Wilcox et al., 2021)

There are times where supervisees wish their supervisor would have discussed certain issues
regarding their own cultural identity more in-depth. These opportunities come and go.
Sometimes they are important and other times, they are not. Please rate the following items
regarding these opportunities.

Regarding the core aspect(s) of my cultural Strongly Mildly
eutral Mildly Strongly
background… Disagree Disagree Agree Agree
(1) (2) (3) (4) (5)
1. I wish my supervisor would have 1 2 3 4 5
encouraged me to discuss my cultural
2. My supervisor discussed my cultural 1 2 3 4 5
background in a way that worked for me.*
3. My supervisor avoided topics related to 1 2 3 4 5
my cultural background.
4. There were many chances to have deeper 1 2 3 4 5
discussions about my cultural background
5. My supervisor missed opportunities to 1 2 3 4 5
discuss my cultural background.

Now think about your contribution to discussions about your cultural identity.

Regarding the core aspect(s) of my cultural Strongly Mildly
eutral Mildly Strongly
background, Disagree Disagree Agree Agree
(1) (2) (3) (4) (5)
1. I toned down the way I expressed my 1 2 3 4 5
culture in front of my supervisor
2. I hid parts of my culture from my 1 2 3 4 5
supervisor
3. I dodged questions my supervisor asked 1 2 3 4 5
about my culture
4. I did not feel comfortable brining up topics 1 2 3 4 5
related to my cultural background.
5. I did not talk about parts of my cultural 1 2 3 4 5
identity.

There are times where supervisees wish their supervisor would have discussed certain issues
regarding their clients’ cultural identity more in depth. These opportunities come and go.
Sometimes they are important and other times, they are not. Please rate the following items
regarding these opportunities.
 83

Regarding the core aspect(s) of my clients’ Strongly Mildly
eutral Mildly Strongly
cultural background… Disagree Disagree Agree Agree
(1) (2) (3) (4) (5)
1. I wish my supervisor would have 1 2 3 4 5
encouraged me to discuss my clients’ cultural
2. My supervisor discussed my clients’ 1 2 3 4 5
cultural backgrounds in a way that worked
3. My supervisor avoided topics related to 1 2 3 4 5
my clients’ cultural backgrounds.
4. There were many chances to have deeper 1 2 3 4 5
discussions about my clients’ cultural
5. My supervisor missed opportunities to 1 2 3 4 5
discuss my clients’ cultural backgrounds.

Now think about your contribution to discussions about your clients’ cultural identity.

Regarding the core aspect(s) of my clients’ Strongly Mildly
eutral Mildly Strongly
cultural background, Disagree Disagree Agree Agree
(1) (2) (3) (4) (5)
1. I toned down the way I discussed my 1 2 3 4 5
clients’ cultures in front of my supervisor
2. I hid parts of my clients’ cultures from my 1 2 3 4 5
supervisor
3. I dodged questions my supervisor asked 1 2 3 4 5
about my clients’ cultures
4. I did not feel comfortable brining up topics 1 2 3 4 5
related to my clients’ cultural backgrounds.
5. I did not talk about parts of my clients’ 1 2 3 4 5
cultural identities.
 84

Appendix E. Recruitment Message

Hello,

I am a doctoral candidate in Counselor Education and Supervision at New Orleans Baptist

Theological Seminary. I am conducting a quantitative study on the relationship between an
individual supervisor’s cultural humility and engagement of cultural opportunities on the
strength of the supervisory relationship.

The study has the potential to assist supervisors and counselor educators in understanding the
cultural processes in the supervisory relationship. The research can potentially assist supervisors
in cultivating cultural humility and preventing behaviors that can harm the supervisory
relationship and/or the supervisee.

If you are a counseling graduate student or provisionally licensed counselor that is currently
under individual supervision please consider completing this survey and contributing to my
study. The responses will be confidential and will take 15-20 minutes.

Thank you for considering volunteering your valuable time to this study.

It would be great if you would announce it to others who may qualify.

Survey Link: https://forms.gle/ohEAMZbR5GRtr6Et6

DeAron Washington MA, PLPC

dearonl@gmail.com

New Orleans Baptist Theological Seminary Doctoral Candidate

Faculty Supervisor: Craig Garrett, Ph.D., LPC-S, NCC

 85

Appendix F. Supervisory Working Alliance Inventory

Supervisory working alliance inventory (SWAI) – Supervisee (Efstation, Patton, & Kardash,
1990)
The SWAI is designed to measure the working alliance in supervision from both a supervisor and
supervisee perspective. Higher scores are generally indicative of alliances that are more
effective. The SWAI can be used as an ongoing repeated measure of the SWA.

Instructions: Indicate the frequency with which the behaviour described in each of the
following items seems characteristic of your work with your supervisor (or how you would like
to work with a supervisee). Estimate the frequency of occurrence within supervision on the
seven-point scale from almost never to almost always
Scale: 1 2 3 4 5 6 7
almost rarely occasionall sometime often very often almost
never y s always

Rapport Circle most relevant

1. I feel comfortable working with my supervisor. 1 2 3 4 5 6 7

2. My supervisor welcomes my explanations about the clients’

1 2 3 4 5 6 7
behaviour.

3. My supervisor makes the effort to understand me. 1 2 3 4 5 6 7

4. My supervisor encourages me to talk about my work with

1 2 3 4 5 6 7
clients in ways that are comfortable for me.
5. My supervisor is tactful when commenting about my 1 2 3 4 5 6 7
performance.
6. My supervisor encourages me to formulate my own
1 2 3 4 5 6 7
interventions with the client.

7. My supervisor helps me talk freely in our sessions. 1 2 3 4 5 6 7

8. My supervisor stays in tune with me during supervisions. 1 2 3 4 5 6 7

9. I understand client behaviour and treatment technique similar

1 2 3 4 5 6 7
to the way my supervisor does.
10. I would feel free to mention to my supervisor any troublesome
1 2 3 4 5 6 7
feelings I might have about him/her.
11. My supervisor treats me like a colleague in our supervisory
1 2 3 4 5 6 7
sessions.
 86

12. In supervision, I am more curious than anxious when

1 2 3 4 5 6 7
discussing difficulties with clients.

Rapport Circle most relevant

13. In supervision, my supervisor places a high priority on our

1 2 3 4 5 6 7
understanding the clients’ perspective.
14. My supervisor encourages me to take time to understand what
1 2 3 4 5 6 7
the client is saying and doing.
15. My supervisor’s style is to carefully and systematically consider
1 2 3 4 5 6 7
the material I bring to supervision.
16. When correcting my errors with a client, my supervisor offers
1 2 3 4 5 6 7
alternative ways of intervening with that client.
17. My supervisor helps me work within a specific treatment plan
1 2 3 4 5 6 7
with my clients.

18. My supervisor helps me stay on track during our meetings. 1 2 3 4 5 6 7

19. I work with my supervisor on specific goals in the supervisory

1 2 3 4 5 6 7
session.
 87

Scoring

Rapport: sum items 1 through 12, then divide by 12

Client focus: sum items 13 to 19, and then divide by 6

The subscales can also be combined (due to high correlation between scales) to give an
overall score of the alliance from the supervisee’s perspective. Higher scores on each of the
subscales and overall are indicative of alliances that are most effective.
Norms derived from the Efstation et al. (1990) study for supervisee version; 5.85 for Client
focus and 5.44 for Rapport.
 88

Appendix G. Participant Informed Consent

Researcher (PhD candidate): DeAron Washington, M.A., Th.M., PLPC, Department of

Counseling at New Orleans Baptist Theological Seminary
Faculty Advisor: Craig Garrett, Ph.D., LPC-S, Department of Counseling at New Orleans
Baptist Theological seminary; cgarrett@nobts.edu

I am inviting you to take a survey for research that will lead to a doctoral dissertation. This
survey is completely voluntary. There are no negative consequences if you do not want to take
the survey. If you start the survey, you can always change your mind and stop at any time.

What is the purpose of this study?

The purpose of the study is to examine cultural humility and engaging in cultural opportunities
as potential predictors of a strong supervisory working alliance. This may help inform the
preparation of supervisors in building a strong supervisory working alliance and engaging culture
in supervision.

What will I do?

This survey includes five parts: demographics, a few short answer questions, a short prompt
about past cultural ruptures, cultural humility assessment, a cultural opportunities assessment,
and a supervisory working alliance assessment. The whole process should take approximately
15 minutes. You will be asked to rate on a scale how much certain statements apply to your
supervisor and supervision experience. The questions will ask about how you see your
supervisor and the supervisory alliance.

Risks
• Some questions may be personal or upsetting. You can quit the survey at any time.
• Online data being hacked or intercepted: Anytime you share information online there are
risks. I am using a secure system (Google Forms) to collect this data, but I cannot
completely eliminate this risk.
• Breach of confidentiality: There is a chance your data could be seen by someone who
should not have access to it. We are minimizing this risk in the following ways:
◦ Data is anonymous (no identifying information will be collected)
◦ I will store all electronic data on a password-protected computer.

Possible benefits: There will be no direct benefits to you for participating in this study.
However, your participation in this study will help us to understand the experiences of
psychotherapy supervisees.
 89

Estimated number of participants: 380

How long will it take? ~15 minutes

Costs: There are no costs other than time.

Future research: Data may be shared with other researchers. You will not be told specific
details about these future research studies.

Where will data be stored? On the researcher’s computer and on the servers for the online
survey (Google Forms).

How long will it be kept? Data will be stored indefinitely to aid in future research.

Who can see my data?

• I (the researcher) will have access to the results of the surveys, which do not include any
identifying information. This is so I can analyze the data and conduct the study.
• My faculty advisor and my committee to evaluate my findings.
• The Institutional Review Board (IRB) at NOBTS, which enforces ethical guidelines in
research.
• I may share my findings in publications or presentations. If I do, the results will be presented
in aggregate form with no identifying information.
• Data may be shared with other researchers for future research. All data will remain
anonymous.

Questions about the research, complaints, or problems: Contact DeAron Washington by

email: dwashington@nobts.edu

Questions about your rights as a research participant, complaints, or problems: Contact the
NOBTS IRB (Institutional Review Board) at phd@nobts.edu.

Please print or save this screen if you want to be able to access the information later.

Agreement to Participate
Your participation is completely voluntary, and you can withdraw at any time.
To take this survey, you must be:
At least 18 years old
A provisionally licensed counselor or graduate student who is currently under an individual
supervisor
 90

Acceptance: I have read the information provided above and all of my questions have been
answered. I voluntarily agree to participate in this study. My completion and electronic
submission of this questionnaire will serve as my consent. I may print a copy of this consent
statement for future reference.

Those who consent by clicking the button will then be taken to the survey. We recommend that
you print this page for your records.
Thank you for participating!

(1) I agree to participate

(2) I do not agree to participate
 91

Appendix H. Permission From CHES Developer

92
 93

Appendix I. Permission From SCMOS Developer

 94

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VITA

DeAron L. Washington

EDUCATIONAL

BA, Delta State University, 2012

MA, New Orleans Baptist Theological Seminary, 2019

ThM, New Orleans Baptist Theological Seminary, 2021

PROFESSIONAL

Provisional Licensed Counselor, Louisiana

American Counseling Association 2022-
International Center for Excellence in Emotionally Focused Therapy, 2021-
Christian Association of Psychological Studies, 2021-
Louisana Association of Counselors, 2020-
Evangelical Theological Society, 2019-2020
Louisana Emotionally Focused Therapy Advisory Board, 2023


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