The Reflective Model of Triadic Supervision as a Means of Fostering Cultural Humility

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https://doi.org/10.1007/s10879-021-09496-6 ORIGINAL PAPER

The Reflective Model of Triadic Supervision as a Means of Fostering Cultural Humility

David M. Kleist¹

Accepted: 9 March 2021 / Published online: 5 April 2021

Abstract

Our increasingly diverse world of clinical practice and supervision necessitates clinical supervisors foster supervisees’ abilities to attend to clients’ cultural contexts, lenses, and frameworks (Patallo in Training and Education in Professional Psychol- ogy, 13(3), 227–232, 2019). Equally relevant is promoting clinicians’ own critique of accepted clinical practices (Hardin et al.

in American Psychologist, 69(7), 656–668, 2014). Such a stance is now being referred to as embodying cultural humility. It is emerging as central to culturally responsive and competent clinical practice (Patallo in Training and Education in Profes- sional Psychology, 13(3), 227–232, 2019). Clinical supervision provides one context for fostering cultural humility. Clinical supervision has historically been delivered in one to one or group formats. However, across the last twenty years, triadic supervision has slowly and consistently made inroads as a legitimate and effective form of clinical supervision (Stinchfield et al. in International Journal for the Advancement of Counselling 32, 225–239, 2007). This paper will describe one such triadic supervision model, the Reflective Model of Triadic Supervision (RMTS, Kleist and Hill in: The reflective model of triadic supervision, 2003) as a viable model to foster the development of cultural humility in supervision.

Keywords Supervision · Cultural Humility · Reflective practice

Clinicians worldwide are providing therapeutic services to increasingly diverse populations. It is therefore essential that clinical supervisors foster supervisees’ abilities to attend to clients’ cultural contexts, lenses and frameworks (Patallo, 2019) and to critique their own accepted clinical practices accordingly (Hardin et al., 2014). This stance is now more commonly referred to as cultural humility, an openness toward one’s cultural embeddedness and willingness to understand the cultural identities of others, and has been identified as a pillar of multicultural competence and central to culturally responsive supervision (Hook et al., 2017; Wat- kins & Hooks, 2016). This paper describes the Reflective Model of Triadic Supervision (RMTS) and illustrates in a case example how it can be used to help foster supervisees’

cultural humility.

Cultural Humility

Cultural humility has been conceptualized as a lifelong process of reflection upon oneself to not only learn about one’s own cultural identities but also that of others (Mosher et al 2017; Tervalon & Murray-Garcia, 1998). It also has been described as a way of being (Zhu et al., 2021) that attends to human existence as culturally embedded. In the clinical context, culturally humble practitioners seek to understand the intersecting cultural backgrounds of both themselves and their clients (Hook et al., 2017; Watkins & Hooks, 2016).

Practicing cultural humility unburdens a clinician from rely- ing on static generalizations about a cultural group. Rather, clinicians explore how each person embodies their unique heritage and cultural intersections and its relationship to help giving and receiving (Moncho, 2013).

This requires “an unpresuming curiosity toward individual cultural identity, self-critique, and actions that equalize relational and societal power imbalances (Patallo, 2019, p.

228). Such a level of reflexivity goes beyond Schön’s notion of reflecting-in-action (1987) to a reflecting-on-self-in action (Wong-Wylie, 2007). Although such self-reflection is essential to counselor competence (Sue et al., 1992), it requires

* David M. Kleist kleidavi@isu.edu

1 Department of Counseling, Idaho State University, Pocatello, USA

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trainees to examine previously unexamined assumptions, biases, values (Kumagi & Lypson, 2009; Tervalon & Mur- ray-Garcia, 1998), privileges and acts of microinvalidations or microaggressions with clients (Ali & Lee, 2019). This speaks to the importance of supervisory experiences that both help the supervisee to engage in those self-reflections and supports them as they do (Hook et al., 2017; Watkins

& Hook, 2016).

The thesis of this article is that the RTMS, which shares with cultural humility an emphasis on curiosity and deem- phasis on hierarchy, is well suited for its fostering. In what follows I will describe the model and then use a case example to illustrate how it could be used to facilitate cultural humility.

The Reflective Model of Triadic Supervision

Clinical supervision can be offered in individual, group, or triadic formats (see, e.g., Bernard & Goodyear, 2019). Of these several formats, triadic supervision—in which one supervisor works with two supervisees—is the one least addressed in the literature. This article is concerned with one particular triadic supervision approach, the Reflec- tive Model of Triadic Supervision (RMTS, Kleist & Hill, 2003). It is grounded in Andersen’s (1987, 1995) concep- tions of reflecting processes, which are in the postmodern tradition and assume that knowledge is socially constructed through collaboration, dialogue, and the sharing of multiple perspectives.

Meaning making, a central purpose of Anderson’s work, is a deliberate process that involves external (i.e., conversation with others) and internal conversations (conversations with oneself), or dialogue. Conversations are important as they facilitate change and understanding though the use of words. They, in turn, both convey meanings and move others. Thus, space, or better time, is needed in conversation to allow the words we speak to move or touch others as they seek to make meaning and understand our utterances.

Andersen prized curiosity as well as relationships that were less hierarchical than they were heterarchical, that is, ideas shared between supervisor and supervisee are treated equally in conversational space (Andersen, 1995). The supervisor adopts a “not- knowing approach” (Anderson

& Goolishian, 1998), functioning as a “master conversa- tionalist” who is expert at keeping the conversation going (Andersen, 1995) and who eschews an all-knowing and pow- erful stance. Effective conversations make space for multiple ideas and perspectives that facilitate deep, rich meaning making and understanding. Anderson is best known for introducing reflecting teams (see Anderson, 1987), though in his later writings he took a more expansive approach to

reflecting processes that extended beyond that technique (1995).

The RMTS (Stinchfield et al., 2007) is one approach to triadic supervision, a format that began to receive increased attention when the Council for the Accreditation of Coun- seling and Related Program (CACREP) integrated it into its standards (CACREP, 2001) and established it as an accepta- ble alternative to the 1–1 (i.e., individual) format for clinical supervision. Once that equivalence was made, authors (e.g., Hein & Lawson, 2008, Lawson et al., 2011; Oliver et al., 2010) began describing triadic supervision’s various pos- sible structures. For example, triadic supervision could be single focused (attention to only one of the two supervisees per session) or split focused (sequential attention to each supervisee during a session; see Hein & Lawson, 2008).

Some (Oliver, et al. 2010) have applied theories of couples therapy to triadic supervision.

The 2001 revisions to the CACREP Standards prompted my interest in triadic supervision. I already was using Andersen’s (1987, 1995) reflective practices in couples and family work and began to apply them in the triadic format (Kleist & Hill, 2003). Prior to their first supervision session, the supervisor using RMTS begins supervision by asking supervisees to review a written contract that addresses format, structure, and process of the model. They then review and discuss that contract in their first supervisory session.

That discussion is an opportunity as well for the supervisor to addresses any questions about the process at this time (and the supervisor then will continue to solicit supervisees’

questions on an ongoing basis at the beginning and end of every supervisory session).

RMTS supervision occurs in 90-min sessions, a length supported by the findings of several studies (Borders, 2012;

Lawson et al., 2011; Stinchfield et al., 2010). Supervisees are to record their work, come to session with at least one clinical case for review, and have identified 1–3 specific session segments for review. This means supervisees must have reviewed their recorded sessions, a process that helps them begin to develop their “self-supervisory” skills as they make decisions about material to cover and for what purposes.

The person who is Supervisee 1 begins by identifying portions of the counseling session to be reviewed and by articulating the specific feedback she or he wants. Super- visee 1 then begins playing the recording. This process is illustrated in Phase 1 as depicted in Fig. 1 which represents

“Mila” as now being in conversation, or in outer dialogue, with the supervisor as she plays the recorded session.

Mila and Supervisee 2 (Isaac) both understand that Mila will be in conversation only with the supervisor and not with Isaac, who is her observing peer. Both understand that Isaac’s job is to listen and observe not only the recorded session but also (a) the conversation between the supervisor and Mila and (b) any internal conversations

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he may have with himself as he resides in the observer- reflector role. Isaac has been prompted to take mental, or written, notes on whatever he observes or hears that stands out to him.

Providing the supervisee with such a broad prompt is influenced by Andersen’s emphasis on giving space for meaning making to take place in reflective conversations.

A supervisor, of course, could direct Isaac to watch for specific skills or processes. However, the RMTS is focused on empowering the supervisee to comment on whatever stands out as meaningful.

This process continues for approximately 20 min. There then is a physical shift in the seating so the second phase of the RMTS can take place. See Phase 2 as depicted in Fig. 1.

Mila now physically turns away from the supervisor who in turn positions him or herself to look directly at Isaac. This structural change is vital to RMTS and again is congruent with Andersen’s conceptualization of the reflecting process (Andersen, 1995). The goal is to have Mila in a reflective role where she can be with her own inner dialogue. She has no obligation to speak; only to listen. The supervisor and Isaac now discuss what thoughts or observations they wish to share regarding what they have heard between Mila and the supervisor. Consistent with Andersen’s stance of heterarchy, the supervisor and Isaac converse as equals, collaborat- ing on feedback for Mila. Phase 2 goes on for approximately 10 min. It is kept brief so that Mila is not overwhelmed with too much feedback.

This phase can initially seem odd for both supervisees:

Mila must resist the urge to defend herself her role is to be listen and to be engaged in her inner dialogue; Isaac initially may feel awkward talking about his peer without looking at or talking to her directly. This protocol is based upon

Andersen’s application of reflecting processes in clinical contexts, and supported by research (e.g., Kleist, 1999).

The final phase of the RMTS, as depicted in Fig. 1, lasts no longer than 10 min. In this phase, the supervisor turns back to Mila and speaks directly to her, processing what stood out to her when she was in the reflective-listening role, listening to Isaac and the supervisor. The supervisor listens for and supports the meanings made by Mila adds any additional feedback that might be useful for Mila to take away from supervision. This period also can be used for more tra- ditional goal setting for the coming week of clinical practice.

In the second half of the supervision session, Isaac and Mila shift roles so that Isaac takes the role of Supervisee 1.

The process unfolds then in the same sequence as when Mila was Supervisee 1.

Given the shift to online services over the past year that have occurred in response to COVID19, it is useful to add that I have conducted RMTS via Zoom quite effectively. In this case, when Supervisee 1 was in the reflective position of listening to Supervisee 2′s conversation with the supervisor (see Fig. 1), she or he would turn off their audio and video to provide structure, or a boundary, around who was in conversation with whom.

At this point, a number of scholars have examined RMTS processes (Oliver et al., 2010) and impacts. Most of that research has focused on supervisees’ experiences (Bor- ders et al., 2015) and RMTS supervisees consistently have reported the benefit of hearing the perspectives of both their supervisor and their fellow supervisee (Borders, 2012; Lonn

& Juhnke, 2017; Stinchfield et al., 2007; 2010). Likewise, some of this same research supports the value of vicarious learning (Stinchfield et al., 2007, 2010; Oliver et al., 2010). Learning is occurring whether the supervisee is in

Outer Dialogue Inner Dialogue

Supervisor

Supervisee 1

“Mila”

Supervisee Role

Supervisee 2

“Isaac”

Observer- Reflector Role Phase 1: Supervisee 1 in Outer Dialogue with Supervisor and Supervisee 2 in Observer-Reflector role

Phase 2: Supervisee 1 in Inner Dialogue and Supervisee 2 in Outer Dialogue with the Supervisor

Phase 3: Supervisee 1 in Outer Dialogue with Supervisor and Supervisee 2 in Observer-Reflector role

Supervisor

Supervisee 1

“Mila”

Supervisee Role

Supervisee 2

“Isaac”

Observer- Reflector Role

Supervisor

Supervisee 1

“Mila”

Supervisee Role

Supervisee 2

“Isaac”

Observer- Reflector Role

Fig. 1 The three phases of the Reflective Model of Triadic Supervision

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the observer-reflector or the reflective role. For example, in the example Isaac is experiencing vicarious learning both in watching a peer’s tape, but also in listening to the conversation between Mila and the supervisor. In so doing, he is potentially learning about clinical skills, and client conceptualization, personalization issues, and cultural issues (Lonn

& Juhnke, 2017).

Stinchfield et al. (2010) also found that the triadic process enhances self and other awareness. The RMTS also has been shown to facilitate peer supervision skills of feedback delivery and other basic supervision skills (Borders, 2012; Borders et al., 2015; Stinchfield et al., 2007). Last the supervisory relationship, within the triadic relationship, has been found to facilitate working alliance between supervisor and supervisee (Bakes, 2005). It also may enhance levels of trust among participants (Borders, 2012; Lawson et al., 2011) and the sense of universality and support (Stinchfield et al., 2010).

Facilitating Cultural Humility via the RMTS:

A Case Example

As noted earlier, a supervisee’s cultural humility can be fostered in a supervisory environment that is characterized by curiosity about the cultural identities of supervisor and supervisee and in interactions that equalize relational power imbalance (Patallo, 2019). The case example the follows illustrates how a supervisor might use RMTS using these processes. I will first provide a case example as it unfolded, then critique that work to show how I might have been more effective in fostering cultural humility.

The Actual RMTS Session

My RMTS supervision with Isaac and Mila¹occurred over a contracted period of 15 weeks. Both are cisgender White students in their mid-thirties. In this session, Mila was “Supervisee 1.” She was providing services at a university counseling center and the focus of her work in this session was an individual counseling intake session with a 35 year-old, male international student from Saudi Arabia.

Mila reported that he did not understand the counseling process, confidentiality, the need for taping, and other logistical aspects of the counseling process and supervision and that she had to be quite “literal” with him.

Phase 1. In this phase, Mila discussed her work with the supervisor while Isaac listened.

Mila: “I can tell already that the way we do counseling here is not going to work for him. I set the chairs up directly facing each other, and he came in and turned his chair 45 degrees, sitting looking away from me.

There was a bit of gender issues … he only wants to talk about his fear of making presentations. That’s all. He won’t go any farther. If I reflect a feeling (she shakes hands indicating “no way”), he’s pretty firm about it. I just wonder how effective just sitting there and reflecting feelings and paraphrasing is going to be with him. … I’m wondering what I should do, cause I don’t think he’s going to be around very long [as]

he already told me it’s not common in his country to seek out help. He just wants help getting through his presentation.”

Supervisor: “So, ok, what’s your primary question for me?” (said with some laughter intended to lighten the tension)

Mila: “What the heck do I do with him”…[some chuckling amongst she, Isaac, and the supervisor]. If I tried to interrupt him he would go on … [and] say

“hold on, let me finish”… I don’t want to be disre- spectful but I’m like “dude, you know, I gotta get in on this.”…I’m not sure….I guess my question is: How do I do our normal skills with him?...Knowing that there’s gender differences with him…you know there are expectation differences on both our parts…”

For most of the remainder of our 20 min of Phase One we watched a portion of the initial intake session so I could directly observe the interactions Mila had described. We focused on her use of foundational counseling skills, like paraphrasing and feeling reflections, and I asked a number of process-oriented questions about skills and how she might otherwise have used in this session. Although we addressed Mila’s reactions to the client’s nationality and gender, I did not enter into an intentional, structured conversation about culture. In part, this was to wait for Isaac to share his thoughts on the case while Mila would be in the reflective role.

Phase 2: In this phase, Isaac transitioned from the observer to the reflector role.

Supervisor: “ so I noticed some head nods. What thoughts do you have about the cultural issues, cultural differences Mila brought up?

Isaac: “I think the one that stood out to me was,

“How does he feel going to a female counselor?

... I think that, that gender difference, from what I understand about Saudi Arabian culture … is big.

So that is what I would wonder about … how that

1 This material is presented with the supervisees’ permission. Their names and other identifiers about them and the client have been changed to protect identities.

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is for him personally? And education wise, too, that was mentioned that he had concern that Mila was a student. How is that for him? How is it going to be to talk about any other issues than this one problem?

Supervisor: What thoughts and ideas do you have about ways to discuss these issues with this client?

What additional cultural considerations might you entertain?”

This phase lasted 10 min before we transitioned into Phase 3.

Phase 3: Mila now engaged in conversation about what she had heard Isaac and me discussing.

Supervisor: “What reactions, or thoughts/ideas are you having regarding the brief talk that Isaac and I had?”

Mila: “I was actually just thinking about bringing it up with him, the gender thing and I was trying to think how he’d respond to that.…a part of me thinks not too open to that only because I asked about his support system and he said he has none. The fact the he even talked to me about it [suggests] he’s a little ok with the relationship we have, as I asked if he had spoken to his wife about it [i.e., his presenting problem]. He said “its not ok to do” as its not ok to show weakness. He said his family would fall apart if he told them, …he’s the oldest child, and you just don’t do that. The fact that he’s opened up to me…I wonder if he is a little ok with the gender thing even if there’s a little bit of nervousness.

Supervisor: “so there’s a little bit of nervousness.

He’s kind of ok with it, but I get a sense from you that there’s this tenuousness, and you don’t want to tamper with it in the next session….as it (i.e., the therapeutic relationship) might break or dissolve.”

Mila: “yea, and I resonated with what Isaac was talking about, just focus on the problem. I really think I can accomplish that ... Because when I first asked him about the problem he did describe all the physical aspects but I think I probably can get to emotion if I am really careful how I word it.”

Supervisor: “What do you think you are going to ask about first, or what is going to come up first that might be one of those cultural variables between you two?”

Mila: “hmmm. I don’t know what first. I guess the openness due to the gender difference. I mean he’s been pretty open, but within a very strict context. I think I can discuss that……I feel like I can breathe now. At first I was just so panicky thinking “oh no, they taught me everything I can’t use: these skills work with every other client but he’s his own little individual.”

Reimagining the RMTS Session to Improve Impacts on Cultural Humility

The segment above is an excerpt of the actual RMTS session with its focus on how culture was a factor in Mila’s work with the client. What follows is a reimagined version of that session to more effectively draw on current conceptual and research knowledge on infusing cultural conversations into supervisory conversations to enhance supervisee cultural humility.

Recent advancements within the Multicultural Social Jus- tice Counseling Competencies (MSJCC, Ratts, et al., 2015, 2016) emphasize an infusion of intersectionality theory, or lens, into such cultural conversations in supervision. Inter- sectionality theory brings attention to the multiple factors, contexts, positionalities that influence one’s identity (i.e., of client and clinician). An intersectionality lens allows an understanding of individuals as a complex interplay of multiplistic influences that vary over time, and place, and emphasizing their situatedness in larger institutional structures of society (Chan et al., 2018). For the reimagined RMTS session below, this means for Mila, Isaac, and myself as supervisor to explore and interrogate our various positionalities, their privileging and oppressing aspects, and overall impact on the clinical services provided (Singh et al., 2020).

Phase 1 Restoried: During Mila’s initial case presenta- tion she indicated awareness of “gender issues,” the client’s apparent discomfort with sitting face to face with counselor, different “expectations” for counseling, information on the client’s nationality (Saudi Arabian), client’s preference for problem focus, cultural attitudes toward help-seeking, and apparent disinterest in focusing on affect. My initial inquiry was to clarify with Mila what she wished to receive from supervision. This led to a review of the recorded session and primary attention given to process skills, with much less attention to how she conceptualized the case and her personal reactions to him and their interactions.

The following questions are ones I might have asked that would have centered culture into the conversation more effectively:

1. As you were in the session with your client, at this moment, I’m curious what thoughts and ideas you had about the gender issues that might be at play?

2. I’m curious what your response to your client’s pres- entation might indicate about your personal culture, about the culture of your client, and about developing your therapeutic relationship? (see Collins et al., 2010).

Alternatively: How might you explore your therapeutic relationship from your client’s cultural frame of how help-seeking via counseling is viewed?

3. What are the client’s cultural understandings about confidentiality and preferences for informal versus for-

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mal relationships, communication styles (i.e., degree of directedness)?

To effectively facilitate cultural humility requires that the supervisor be attuned to his or her own experience during the session (Zhu et al, 2021). Therefore, I might be having my own internal dialogue in which I am asking myself, “How comfortable am I in this moment to ask Mila such questions?

What is my awareness, and knowledge of the client’s cultural context and their influence on seeking counseling?” To be even more transparent, and to model authenticity (Patallo, 2019; Zhu et al., 2021), I might even share with Mila that these are questions I am considering myself in the moment as we process her session.

Centering culture into supervisory conversations can heighten supervisees’ awareness of themselves as cultural beings as well as the ethicality of such practice (Mullen et al., 2017). Collins et al. (2010) have developed a rich array of culturally-centered questions to integrate into supervision. Facilitating such conversations in an authentic manner is not only encouraged but has garnered research support for fostering supervisee awareness as a cultural being (Zhu et al., 2021).

Phase 2 Restoried. As Mila and I were engaged in outer dialogue, Isaac has been observing and listening, and making his own meaning of the session and our cultural conversations. In this restoried version of the session Phase 2 would still begin with the typical opening: “Isaac, what thoughts and ideas have surfaced for you as you have watched the tape and listened to Mila and I discuss her case?” Heterarchy (Andersen, 1995) drives this phase so that Isaac’s observations are of equal value to mine in terms of their potential to add meaning for all parties in the triad. Nevertheless, as supervisor, I can intentionally center culture into my questions which might be:

1. What information about the counseling process might the client require in order to understand the roles and processes involved?

Alternatively: I’m curious what thoughts you have, Isaac, about how this information might be communicated that best fits, or respects, the cli- ent’s cultural understanding of help-seeking, or the receipt of counseling?

2. In your viewing, and listening, to the tape and our con- versation, I wonder how, as a male, you see and hear gender issues at play with Mila and her client?

3. I am wondering how Mila might establish a collabora- tive interaction that equalizes power in the session?

Alternatively: I am wondering what ideas you have, Isaac, about how you would establish a col-

laborative interaction that equalizes power in the session given your positionality of being a White male?

4. I wonder what might indicate to Mila that her cultural identity, or position, might be inhibitive to the coun- seling process? Curious how she might first see this arise in the therapeutic relationship?

5. As a White, Western-based supervisor, I am now won- dering how my assumptions influence how I see prob- lems arise and how change occurs. How about for your- self, Isaac? And I wonder, Isaac, if Mila’s client were here in our supervision session, how might he answer this question?

Others (e. g., Collins et al., 2010) have described culturally centered questions in supervision, but their benefit is amplified in a triadic context that embraces open dialogue and reflection. Although the potential for centering culture in such reflective conversations is seemingly infinite, it would be important to limit the conversation with Isaac in this phase to about 10 min length so Mila is not overwhelmed with information to process and therefore restricted depth of reflection as a result (see Andersen, 1987).

Phase 3 Restoried. As with the original case dialogue, I would retain here the typical meaning making question:

“What reactions, or thoughts/ideas are you having regarding the brief talk that Isaac and I had?” This gives Mila space to make sense of what stood out to her and empowers her developing reflexive self-supervisory skills. I would follow that question with one focused on Mila being in charge of her own goal setting for the week ahead: “Given what has stood out to you in listening to Isaac and my conversation, what might be two to three things you’d like to see yourself do in next week’s session with your client?”.

As supervisor I do have the ethical duty to navigate the quality of service provided, and I am free to add other areas of focus or direction I would like Mila to take with her client. The RMTS is by theoretical design structured to facilitate co-constructive conversations between supervisor and supervisee. However, the RMTS can easily be modified to provide more structure or directedness as per the supervisor’s theoretical leanings.

Conclusion

Cultural humility is the ongoing critical consciousness of examining oneself and one’s view of helping in every session with a client. Facilitating cultural humility in supervision requires the creation of an open and safe relational space to sit with discomfort and develop awareness of one’s privilege in clinical contexts (Guanipa, 2003; Hernandez &

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McDowell, 2010; Sue & Sue, 2008). Supervisor and supervisee join together in an exploration of their cultural identities as it relates to clinical work and allow themselves to sit in discomfort (Patallo, 2019). When the supervisor can join supervisees in such a space and role model authentic self- exploration (Zhu et al., 2021) supervisees can experience the trust and safety necessary for their own cultural work with the goal of ethical and culturally valid service. The creation of such a supervisory space normalizes discussions of power, privilege and oppression, all in service of expanding one’s sense of cultural humility and culturally valid clinical care. Such discussions that infuse an intersectional lens embody the goals of the MSJCC (Ratts et al., 2016). Triadic supervision, particularly use of the RMTS creates such conversational space and facilitates vicarious learning (e.g., Fel- ton et al., 2015; Stinchfield et al., 2010). As well, the various dyadic conversations taking place within the presence of a witnessing and listening peer amplifies the co-construction of multiple perspectives. At the heart of RMTS’ benefit in fostering cultural humility is its emphasis on Andersen’s concept of heterarchy, decentering of the supervisor as the prime location of learning and guidance. Supervisees experience this as constructing a safer, more creative, and more vibrant relational dynamic (e.g., Felton et al., 2015; Stinch- field et al., 2010). In short, it is in such a reflexive space, harnessing the power of heterarchy via Andersen’s emphasis of internal and external dialogues, where the RMTS distin- guishes itself from other triadic models.

Although this article and case example only touch the sur- face of the possibilities of such culturally humble, reflexive conversations in supervision, readers are encouraged to step into their own clinical wisdom and curiosity to ponder what questions best facilitate conversations focused on cultural humility. The articles by Chang and Hays (2003), Collins and Arthur (2005), and Marlot et al., (2015) all could be helpful in that process. In the end, though, our success in fostering cultural humility in our supervisees will be suc- cessful only to the extent that we embrace our own humility and commit to our own continued personal and professional development.

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