The Training Model of the Center for Multicultural Training in Psychology

We believe the standards articulated in this document are essential to training multiculturally competent practitioners. By articulating our standards, we strive to hold ourselves accountable to them and to make these standards a living reality for all interns trained at CMTP.  This is a living document that we will revisit periodically.

OUR MODEL

Forty years of CMTP experience inform our understanding  that one cannot achieve professional competence without also continuously working toward multicultural competence. Professional competence requires the integration of the highest standards of multiculturally competent practice.

Originally conceived as the Minority Training Program in 1972, The Center for Multicultural Training in Psychology (CMTP) is the oldest program in the United States devoted to training psychologists to become culturally competent practitioners. When we started in 1972, we understood  “cultural competence” to mean adaptation of the highest standards of professional practice to enable work across differences of race and culture among our Black, White, and Latino staff and interns, while preserving interns’ racial and cultural identities.  As we have grown, so has our understanding of cultural competence.  We now embrace a framework of multicultural competence.  We now train our interns to meet the highest standards of the professional practice of Psychology, and to work mindfully across differences of race, ethnicity, gender, sexual orientation and identity, religion, physical ability, and all other differences that create inequities in privilege, power, and access to resources.  We seek to expand our understanding beyond the cultures and discourses, e.g., the dominant race/class discourse of the North American context in which CMTP is embedded.   Religious affiliation or membership in a political party, for example, may be much more critical to personal identity and social position in other national contexts.  Mindfulness of the social justice dimensions of difference incorporates awareness of the complexity of cultural identity:  All of us are privileged in some dimensions of identity, and marginalized in others. 

Commitment to continuous learning is integral to our understanding of cultural competence.  We do not see “cultural competence” as an end point, but as a stance:  There is always more to learn about ourselves and about our practices as cultural beings in our relationships with others as cultural beings.

Since 1986, CMTP has been a fully-accredited and APA-approved one-year psychology internship program. The model and philosophy of The Center for Multicultural Training in Psychology are best understood in light of its history, and the ways in which that history informs the current program. The history of underrepresented groups in psychology and in many other fields reveals that mentored relationships have had a central role in the success of its individuals. CMTP was started among a community of professionals dedicated to serving underserved populations and to changing how psychology, as well as the larger society, viewed and treated these populations. As more psychologists of Color joined the field, elder psychologists taught and mentored young psychologists of Color particularly with regard to populations not addressed in text books, classes and mainstream psychology. It is with this history and tradition that CMTP believed it was important to develop a model unique unto itself and distinct from the standard Boulder (Scientist-Practitioner) and Vail (Practitioner-Scholar) models.

Based on the Boulder and Vail Models, CMTP uses a Mentored-Practitioner-Scientist model to emphasize the significant role that a mentoring relationship plays in the education and development of Clinical Psychologists, and the importance of developing scientifically supported clinical skills. The mentoring espoused in our model is designed to facilitate the development and integration of an intern’s personal and professional identities. This entails not only transmission of knowledge, but also investment in the intern’s progress, success and future, serving as a role model, and provision of emotional, social and professional support. At the core of this mentoring is facilitating the integration of interns’ racial, ethnic, cultural, class, sexual and gendered identities with their professional identity. CMTP’s unique social and professional environment contributes to the mentoring process.

Mentoring is also intended to help develop the interns’ efforts at seeking social justice in the professional world, and the world at large. The faculty and instructors employed by and affiliated with CMTP have long histories of social engagement and profound investments in promoting social justice. We are continuously looking for and creating ways to enhance social justice in many areas of our professional and personal lives and are frequently involved in other organizations and projects that also seek to advance a social justice agenda.  We believe that the application of a social justice lens fundamentally transforms the goals of professional training.  As we understand it, a multiculturally competent psychologist  is not only well-versed in the fundamentals of professional practice.  S/he is also active as an agent of social change.

Though we have taken parts of both the Boulder and Vail models, the philosophy of the Boulder model is at the core of the CMTP Mentored-Practitioner-Scientist model. Our model is intended to apply the Boulder model in culturally appropriate ways. The practitioner-scientist model is an iterative model in that practice is based on science, and in turn, science is influenced by practice. The CMTP model emphasizes the culturally competent application of state-of-the-art, evidence-based research and practice in professional psychology. It also endorses using evidence-based (that emerges from research) and empirically-based  practices (that emerges from clinical experience) when available and culturally appropriate, and is committed to evaluating the efficacy of such practices and the application of models not heretofore tested on diverse client groups.   We appreciate that there is tension between the models, but see that each makes important contributions to professional training.  As one respects and utilizes the best of scientific research, one also sees the value of skillful practical experience, which seeks solutions to problems not yet subjected to rigorous scientific inquiry.  We believe that the profession grows as practice and research inform each other.

CMTP prepares interns to meet the highest standard of professional practice. CMTP’s philosophy is that one cannot achieve professional competence without also continuously working toward multicultural competence. Thus, professional competence requires the integration of the highest standards of multiculturally competent practice. The CMTP model takes a bio-psycho-social-cultural-spiritual approach to enhance clinical understanding of a wider variety of populations. It emphasizes clients’ strengths and vulnerabilities in the context of their psychological, sociological, economic, familial and community makeup, as well as in the context of their cultural identity.

TERMINOLOGY
Throughout this document, terms such as cultural competence, multicultural competence, or multiculturally competent practice are intended to be understood as aspirational constructs.  When they are not used aspirationally, the terms imply satisfaction with one’s practice.  We believe that it is a mistake to conclude that one has achieved cultural competence.   Our aspiration to cultural competence is embodied in a commitment to continuous engagement with theoretical and practical considerations of power, privilege, and the dynamics of difference.

We make frequent use of the terms, location and identity in our discussions of difference.  Location is one’s externally recognizable position along a dimension of difference (e.g., Black, White, gay, straight, middle class, etc.).  It is difference as seen from the outside.  Identity refers to the internalized embodiment of difference.  It is difference as experienced from the inside.   Identity is a psychological experience that can be understood in a developmental framework.  The distinction between identity and location is somewhat fluid, as one’s location shapes one’s identity and one’s identity can move one to act to locate oneself socially, as in the case of “invisible” locations, such as sexual orientation.

We cultivate critical consciousness to support learning about location and identity. Critical consciousness focuses on power and social justice issues in the distribution of resources and in the dominant discourses that sustain an inequitable social order.  Critical consciousness implies active social engagement to understand society and one’s position in society.  Interns apply their critical understanding of power relations to inform their actions as agents of social change on behalf of, and with the communities they serve.

We make use of the pronouns they/them/theirs instead of the more usual he/him/his and she/her/hers. We intend to embrace an expanded understanding of gender that goes beyond the binary (she/he) model of gender.


Organizing Principles / Core Beliefs
In the world of multiculturalism, having multiple perspectives is called diversity. In the world of psychological practice, however, holding multiple perspectives, orientations or theoretical beliefs is called eclecticism.  The CMTP model is fundamentally diverse and eclectic. To achieve our goal of genuine diversity and multiplicity – among faculty and interns, across decades and across scientific, clinical and theoretical developments – we cannot adhere to one clinical orientation or theoretical perspective. However, there are several core beliefs/principles to which CMTP subscribes and that we believe are essential to the practice and teaching of multicultural psychology.

The following principles have emerged and been affirmed by nearly forty years of preparing practitioner-scientists who will be future leaders and mentors for a lifetime of practice in which they strive to be true to themselves as cultural beings and to the cultural realities of the people they serve:

• We emphasize the vital importance of understanding oneself as a cultural being.
• We believe that mentoring relationships are necessary to cultivate and support the development of a multiculturally competent practitioner.
• We emphasize the vital importance of developing an intersectional lens through which to view and understand the complexity of holding multiple social locations and identities.
• We understand that cultural differences are not neutral with respect to privilege, and social justice.
• We understand power as the capacity to act, to access and deploy resources, and to influence others. It can also serve to disguise and mystify power inequities between groups.
• We hold that one is responsible not only for understanding one’s own perceptions, actions, and experiences, but also for understanding how one is seen as a cultural being.
• We emphasize the value of an open and respectful process in which the experiences of self and other influence each other reciprocally.
• We promote compassionate empathy toward the other, regardless of whether the other is client, colleague, supervisor, intern, ally or adversary. 
• We hold that serious commitment to culturally sensitive and socially just practice must include the intention to become agents of social change.
• We believe that in order to be an effective agent of change, one must understand how organizational systems are designed and how they operate within their sociocultural  contexts.
  
  
  

 We emphasize the vital importance of our interns’ understanding themselves as cultural beings.

We ask interns to examine the complexity of their multiple social identities of race, class, gender, sexual and gender identity, religion, ethnicity, immigration status, language fluency, physical and mental abilities.  We help them to recognize how some of their identities are privileged, and some marginalized.  We explore with them the ideologies that support privilege and marginalization, e.g., racism, sexism, classism, heteronormativity, etc.  We help them to recognize how their own privilege and marginalization shift kaleidoscopically in their encounters with others - clients, colleagues, faculty, etc.  We support interns as they experience the emotional and cognitive stresses involved in developing this multicultural sensitivity.  As mentors, we help them to learn how to manage destabilizing experiences.

The internship year can often be a setting for destabilizing experiences.  For many interns, it is the first professional training setting in which the majority of faculty and interns are People of Color.   Although most of our interns are drawn to the setting because of its diversity, that very diversity can be challenging.  Cross-cultural encounters may be experienced as collisions.  Most interns of Color are fairly fluent with “biculturation” – the capacity to understand, interact, and communicate both in the culture of their own marginalized racial/ethnic group and the culture of the majority racial/ethnic group of which they are not members.  They may, however, be unaware of their unconscious assumptions of privilege until those assumptions surface in their interactions with others who do not share in those same privileges (e.g, class or  religion).  For many White interns CMTP is the first training setting in which they are in the minority, and in which positions of power and authority are held by People of Color.  As they are challenged to develop bicultural fluency, they may struggle with feelings of anxiety, confusion, or shame.  We have learned that we cannot predict on the basis of an intern’s social location which experiences will prove to be particularly challenging.  One White intern might have little difficult adjusting to minority status, while some interns of Color might find themselves struggling with unexpected reactions to the unfamiliarity of a situation in which People of Color hold power.  Differences among the interns provide unique experiential opportunities for learning and growth which we believe are critical to the development of multiculturally competent psychologists.  As faculty, we are responsible for supporting our interns through this process by helping them to make sense of these novel experiences and to use them in service of their growth as Psychologists.

Interns learn to:

• - understand the complexity of their cultural identities, in order to be conscious of how this complexity shapes their perceptions, judgments, and actions with clients.

• - continuously examine themselves – their perceptions, emotions, actions, values, and experiences – as related to gender, race, ethnicity, social class, sexual orientation, ability/disability, religion, immigration status, etc. 

• - examine critically how their multiple identities shape them, whether through unwitting accommodation, conscious compliance, or resistance.

• - respond ethically to these shaping processes, in order to respect the interests of their clients.

• - develop and maintain respectful, compassionate awareness of the emotional challenges that arise on the path toward understanding oneself as a complex cultural being.
  
  

We emphasize the vital importance of developing an intersectional lens through which to view and understand the complexity of holding multiple social locations and identities.
Every individual embodies a multitude of social locations, some of which are privileged and some of which are marginalized, in the dominant culture of the wider society. Interns must learn that, to understand the complexity of human experience and behavior, it is important to attend to how multiple social locations intersect. 

Interns learn to:

• - identify how social locations shape and are shaped by other social locations.
• - recognize how each location and identity is associated with particular privileges and vulnerabilities that necessarily change, once they intersect with other locations and identities.
• - apply this lens to themselves, others, and systems.
  
  

We hold that cultural differences are not neutral with respect to power and social justice. 
Every cultural difference implies a hierarchy of power, a relationship with positions of dominance and subordination. We strive to make CMTP a place where we identify, problematize, and deconstruct the shaping forces of the interns’ multiple contexts.

Interns learn to:

• - attend to the contexts in which they, their clients, CMTP, and their field-sites, operate. 
• - understand how to identify the opportunities and constraints for one’s actions as therapist and/or social change agent.
• - understand how dominant discourses, which empower the privileged and subjugate the marginalized, shape professional practice, and the settings in which that practice occurs.
• - sustain critical awareness of dominant discourses, and the ways in which they function to marginalize and shape perceptions of differences.

We hold that one is responsible not only for one’s own perceptions, actions, and experiences, but also for how one is seen as a cultural being. 
In encounters with clients, interns must learn to track the power implications of the multiple differences between themselves and their clients, and to use this knowledge to affirm values of social justice. 

Interns learn to:

• - track and address clients’ responses to their social locations, forming and testing hypotheses about clients’ actions and experiences in the relationship.
• - be emotionally responsive to clients, while remaining alert to the relationship between their clients’ perceptions and their own perceptions of themselves as cultural beings,
• - be highly sensitive to the social justice implications of clients’ perception and understanding of the relationship.
• - employ this awareness to increase their usefulness to clients.

We emphasize the value of an open and respectful process in which the experiences of self and other influence each other mutually. 
Dialogue can be both a generative and a risky process. It requires openness to, and respect for, one’s own subjective experience and the experience of one’s partner in dialogue, as well as an awareness of how both subjectivities mutually shape one another. It also requires a commitment not to objectify the other. To objectify means to treat human beings as things, without subjective experience, as objects to manipulate in order to satisfy one’s purposes.  Objectification can result in fortifying or protecting one’s self at the expense of openness, dialogue, connection, and sometimes, at the expense of the other.  It is a costly strategy that interferes with cultivating skills as a practitioner and agent of change.

Interns learn to:

• - maintain their openness to all subjective experience, even when such experiences produce conflict or become uncomfortable.
• - distinguish and monitor internal experiences in which they may objectify the other.
• - effectively and respectfully enhance mutually shared experience and address difficult differences.
  
  We promote humility, curiosity and compassionate empathy toward the other, regardless of whether the other is client, colleague, supervisor, obstacle or adversary. 
  Humility allows one to recognize that one has limited access to another’s internal reality. Curiosity asks one to be interested in the other’s position, perspective, emotions, and behavior. Compassion promotes empathic respect for the others perspective, experience and feelings. Others are more likely to share their internal reality when approached from a compassionate stance. It generates opportunities for rich dialogue and engagement between self and other.
  
  Interns learn to:

• - cultivate and maintain humility as they improve their skills reading the other’s actions, feelings, and meanings. 
• - observe carefully how the assumptions and needs that they bring into an engagement drive them to see things their own way. 
• - engage their curiosity by letting go of their expectations of the other. 
• - develop compassion by allowing one’s feelings to be affected by the feelings of the other while not imposing one’s own feelings on the other.
• - cultivate their capacity to be aware of their responses while practicing restraint, so that neither their personal histories, beliefs, concerns, nor their anxieties take over and drive the engagement. 

We hold that serious commitment to culturally sensitive and socially just practice requires action for social change. 
For our values to be fully integrated into all domains of the practice of psychology, we must cultivate leadership skills and knowledge to challenge and transform the status quo. Internship is a substantial rite of passage into professional psychology, a developmental challenge for any psychology intern. Training to be agents of social change poses additional challenges to our interns. Interns learn to:

• deconstruct the dominant discourses of the profession.
• identify how these discourses manifest themselves in their clinical placements.
• become leaders for social change by moving marginalized discourses of class, race, and culture toward the center of the professional setting.
• distinguish when it is possible to effect observable change within a setting, and when the most that may be achieved is raising awareness of issues or perspectives that have been overlooked, denied or suppressed.
• identify effective strategies for creating observable change and/or raising awareness.

We believe that in order to be an effective agent of change, one must understand how organizational systems are designed and how they operate within their social context.
Each organization creates its own organizational culture. The field sites provide critical experience of how different organizational cultures provide services to marginalized or underserved communities. Programs offering mental health services to these communities must confront a number of very real challenges, including program financing, maximizing the ability of the program to reach its intended client population, and navigating the cultural needs of the communities while also adhering to regulations and professional standards of practice. A particular setting’s change or stability is shaped by influences from wider contexts, e.g., state or federal financing or regulation. For example, how does a reduction in staff, necessitated by inescapable external forces, affect staff? What are the implications of organizational change for staff and patients of differing backgrounds? How do different models of intake management affect clinical care and outcomes? Interns gain first hand experience witnessing and participating in how each setting navigates these challenges.

Interns learn to:

• - understand the organizational culture of the systems in which they work.
• - understand and articulate their own locations in a system.
• - understand the intersections between organizational cultures and styles, the needs of the individuals and families seeking services, and those of the larger communities that are served by the clinical sites. 
• - identify and analyze the multitude of factors involved in the delivery of care.
• - identify the effects of internal and external influences on an organization’s evolution and choices.
• - identify the power dynamics within any given system.
• - understand and identify the constraints and opportunities for social change in complex organizational systems.

We believe that mentoring relationships are necessary to cultivate and support the development of multiculturally competent practitioners. 
Our vision of multiculturally competent practice is complex and demanding. We prepare interns to become competent scientist-practitioners while retaining their unique personal cultural identities. We seek to cultivate interns’ voices, their capacity and confidence to articulate their experience and make themselves heard. At CMTP we expect interns to adopt a “dual citizenship” as clinicians and as agents of social change. We encourage interns to develop maximum “response-ability,” that is, their capacity to generate, cultivate, access, and utilize the widest possible range of responses in a situation, whether the situation calls for clinical or social change intervention.  We have set high standards that we believe are essential for competent and respectful psychological practice in the context of multiple cultural differences. Although we cannot imagine relaxing our standards, we recognize how difficult it can be to meet the standards, how easy it is to make mistakes, and how important it is to persist despite missteps and frustrations.

Psychologists that come from marginalized communities and those that seek to advance social justice are likely to experience stress resulting from microaggressions, isolation and exhaustion. As faculty, we have had to learn adaptive strategies to manage these challenges in our own personal and professional lives, and we take responsibility for providing the psychological and emotional support to our interns that we have found for ourselves.

Faculty commit to:

• - be transparent in our mentoring relationships, allowing interns to witness our struggles to meet the standards we have set, our willingness to acknowledge when we are falling short of our own and others’ expectations, and our resilience as we find the strength to go on.
• - model continuous learning through our own practices, including learning from and sharing with each other.
• - model ways of integrating one’s personal and professional identities.
• - demonstrate how important our own personal communities are in sustaining us.
• - be accountable for inevitable mistakes, microaggressions, and performances of privilege in our relationships with interns and others.
• - model our struggle to find the courage to endure the anxieties and uncertainties of multiculturally competent practice.
• - undertake repair when inevitable relational ruptures occur between ourselves and others.

FOUNDATIONS OF CMTP’S APPROACH
When founded in the early 1970’s, CMTP was grounded in the work of Frantz Fanon, and  Paolo Freire, from which we drew to emphasize the intersections between social structures, power distributions and mental disorder and illness. We drew from the work of Saul Alinsky for our emphasis on activism and partnership with communities for social justice, and from Chester Pierce for inspiration on sustaining personal dignity in a world that may not be welcoming.  These authors located practitioners as agents of social change, whether in support of dominant hierarchies, or in opposition to them. Carolyn Attneave’s work with community networks and connections brought to the program the concept of the network, a strategy for connecting students, former students, faculty, former faculty and allies from a variety of professional disciplines and organizations.

Over the decades, CMTP continues to integrate into the framework of the program the work of more recent scholars. Continuous evolution enriches the experience and expands the resources available to the program.

THE STRUCTURE AND SETTING OF CMTPThe Program is constructed to embody the principles that we have articulated.   We strive to create a setting that supports interns in their efforts to live CMTP values in the “real world” of their training settings.

Organization Structure
CMTP is a component of the Psychiatry Department at Boston Medical Center, and of the Psychiatry Division of Boston University School of Medicine.  Organizationally, CMTP is a network of field sites, including inpatient and outpatient hospital programs, community health and social service agencies, and an evaluation and treatment program in a correctional facility, all anchored by the Center, located at Boston Medical Center, the primary safety net hospital for the Boston metropolitan area. Interns are usually assigned to two field sites, affording breadth of clinical training. Field site placements are for the full year, affording interns a lengthier mentored experience in building community. They spend four days per week at the field sites and one day the core program day, at CMTP for supervision, meetings and seminars. This day provides a setting for one-on-one mentoring by Primary Supervisors, and formal and informal group meetings for support and reflection on the challenges of developing as culturally competent psychologists-in-training.

Although our field sites welcome our interns who are predominantly Persons of Color from a program committed to multicultural competence, these field sites are shaped by the dominant discourses of the society in which they are embedded. Indeed, CMTP is also subject to the same shaping influences, even as we seek to identify, problematize, and deconstruct them. Beyond providing supervision, mentoring, and didactic information, core program days are designed to attend to intern needs for identity reparation, restoration, formation, and support. Core program days provide a supportive context to sustain critical awareness, develop appropriate and effective strategies for change, attend to and repair the effects of microaggressions, and sustain solidarity and commitment to the mission of advancing culturally competent practice.

Supervision
CMTP Core Faculty members serve as Primary Supervisor/Mentors, meeting with interns on core program days. The Primary Supervisor/Mentor is responsible for working with the intern to integrate training experiences at the disparate field sites, provide mentorship and precepting, review the intern’s progress through the training year, discuss and address the intern’s future goals, and attend to any expressed concerns about the training experience. This process is in the form of precepting, rather than case-focused supervision.  Each intern works with two Primary Supervisor/Mentors in sequence, the second replacing the first at mid-year, to give each intern the greatest possible access to the CMTP faculty.  In addition, all faculty are available to all interns for less formal learning, advice and support. Matching takes into account the intern’s training needs, and both intern’s and supervisor’s social locations and identities.   Interns receive case-focused clinical supervision from licensed psychologists, at each site, in compliance with APA standards.

Faculty
Faculty members maintain communication between CMTP and the field sites. Twice each year faculty and site supervisors meet, addressing field sites’ appraisals of the interns assigned to the site, as well as interns’ appraisals of the sites. Seminar leaders provide weekly didactic instruction and participate in annual events that occur throughout the year.

Curriculum
The training day on Thursdays includes year-long and topical seminars, individual meetings with Mentors, as well as a group meeting of all CMTP Core Faculty, staff and interns for review and reflection on the operations of the training program.  The year-long seminars taught by CMTP Seminar Leaders and the Director include Multicultural Family Therapy, Design and Delivery of Culturally Appropriate Mental Health services, Research and Dissertation Support and the Psychological Assessment Seminar. In addition, Core Faculty as well as professionals from the community provide brief presentations as single events, or in short series, covering a wide variety of topics relevant to culturally competent practice of psychology and career development. If they have not completed their dissertations before they arrive at CMTP, interns are actively supported and guided through work toward completion of their dissertations during the internship year.

CONCLUSION
Since its beginning more than forty years ago as the Minority Training Program, CMTP has witnessed the birth and growth of the field of culturally competent practice in psychology.  Our faculty who began their journeys earlier in the history of this field are challenged and enriched by our encounters with interns who come to our program already well-grounded in the burgeoning literature of multicultural competence.  We hold ourselves to the same standards of cultural competence with which we train our interns.  As we train our interns for respectful partnerships with the clients whom they serve, we strive for respectful partnership with them.  Genuine collaborative dialogue with our students is the foundation for our work together to advance the culturally competent practice of psychology.