Cross-Racial Alliance Focused Training: A Qualitative Exploration of White Therapists’ Experiences of Group Supervision

Background and Purpose. Racial and ethnic minority populations bear a disproportionate burden of poor mental health due to structural risk factors and limited access to high-quality, culturally responsive care. Given the challenges of scaling culturally-adapted evidence-based interventions, and the realities of a provider workforce that is ~ 80% White, a promising approach to improving cultural responsiveness is to strengthen therapists’ ability to cultivate the therapeutic alliance (TA) across racial and cultural differences. The TA is a robust change mechanism that been shown to be predict treatment outcome in both telehealth and in-person therapy; however, it is more difficult to cultivate and maintain across racial and cultural differences. A pilot study was conducted to culturally adapt Alliance Focused Training (AFT)--an empirically supported, transtheoretical group supervision model designed to teach therapists to identify and repair alliance ruptures—to strengthen the cross-racial/cross-cultural alliance in particular. This qualitative study explores White therapists’ experiences of ~22 weeks of Cross-Racial AFT (CR-AFT) to identify self-observed changes and impact on clinical practice, critical incidents, strengths and challenges of the approach, and recommendations for improvement.

Methods. The sample consisted of 8 White-identifying licensed study clinicians (7 MA-level, 1 PhD) in a clinical trial of cross-racial therapy involving 40 Asian American patients, and 4 clinical supervisors. Clinicians were allocated to two CR-AFT supervision groups (4 clinicians/group) co-facilitated by an Asian American cultural expert and a White AFT supervisor. Groups met weekly for 90 minutes over a 6-month period to explore the alliance using therapist-selected session video clips. At the end of the supervision period, therapists completed a semi-structured debriefing interview and supervisors completed a group debriefing session. Debriefing interviews and the group session were video and audio-recorded, transcribed and analyzed using thematic analysis, and managed using Atlas.ti.

Results. Preliminary analyses of therapist interviews reveal significant variability in therapist experiences, with some reporting negative experiences and others reporting very positive experiences. All clinicians reported improvements in their cultural awareness, relational comfort with Asian American clients, and growth in their skills for bridging and navigating racial/cultural differences in therapy. Strengths included the co-facilitation model that included a cultural expert to provide cultural consultation, the opportunity to receive support and learn from others’ experiences, and the mindfulness components. Challenges included therapist self-consciousness and anxiety related to showing video clips of their sessions, lack of clarity in how to select clips for supervision, and difficulties integrating cultural and relational process analyses in a systematic way. Recommendations include shortening the supervision period to 4 months instead of 6 months and a clearer integrated structure for analyzing power dynamics, cultural and relational aspects of the rupture and repair processes in session.

Conclusions. Participation in CR-AFT supervision increased therapists’ cultural and relational self-awareness and confidence to bridge racial and cultural differences in therapy. However, preliminary results suggest the need for further refinements of the CR-AFT approach to address therapist anxiety, highlight strengths, and improve integration of cultural, structural, and relational components in case analysis.