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Psychotherapy and clinical supervision outcomes are influenced by client and supervisee factors, one of which is cultural identity. Those with diverse racial and ethnic minoritised identities often experience disparities in therapy outcomes. Therapists and supervisors need to be responsive to the identity of those they support. The multicultural orientation (MCO) framework is an emerging concept in psychotherapy and clinical supervision that may offer these practitioners a framework to be responsive.

A preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews was conducted. Six databases, PubMed, Scopus, Embase, Academic Search Complete, Web of Science and PsychInfo, were searched for peer-reviewed literature published in English between the years 2000 and 2023.

A total of 1,553 sources were identified, of which (n = 42) are included in this review. Findings suggest that MCO is still in its infancy as applied to therapy and clinical supervision. Most of the research has been conducted in America, using quantitative methodologies with white western populations. Cultural humility is the most studied MCO pillar, and variables such as reductions in psychological stress, the working alliance and microaggressions are reported on as outcomes. MCO applied to the group therapy process is an emerging finding of interest. However, more research is needed, especially experiential designs across different and diverse populations and contexts.

MCO is an emerging therapy and clinical supervision process that has the potential to improve the outcomes for therapy clients and supervisees. Further research is needed to replicate current studies, and further research with diverse populations, countries and contexts should be undertaken as a priority.

Organisations and systems of care working within both specific and non-specific trauma-informed approaches must adapt a multicultural lens, in design, delivery and evaluation of services and interventions. Cultural and social factors can directly influence the exposure of individuals to traumatic events (Roberts, Austin, Corliss, Vandermorris, & Koenen, 2010). At the same time, social and cultural identities influence the development and experience of trauma and symptoms, including treatment outcomes (Marsella, 2010; Wilson, 2007). In this chapter, Ravind Jeawon and I provide some of the essential factors that trauma-responsive systems may wish to consider. The first part of this chapter deals with the idea of multicultural identities and practices and highlights some of the outcomes associated with accessing behavioural healthcare. The impact of intersectionality and microaggression on those from diverse backgrounds is also considered. Finally, a guiding framework is provided that examines what needs to be implemented across organisations in order to provide the system with a multicultural lens in which to view and deliver appropriate services. Crucially, multicultural responsiveness will not come from tick box training regimes, it is something that needs to be kept on the agenda and is a lifelong trajectory.

In this chapter, Ravind Jeawon and I discuss the ideas around being responsive to diversity in an evidence based manner. Although this chapter belongs within the evidence based responsiveness section discussed in the previous chapter, we both considered it essential to provide a whole chapter on its theory and application, as it is an integral area often overlooked in clinical training and provided a curtesy overview during ongoing professional development and clinical supervision. The multicultural literature uses different terminology to refer to the practice of responsiveness, we discuss these ideas and the evidence base for them, while introducing the reader to other processes and theories which will help developing practitioners make sense of what can be a vastly complex area of clinical work. Several adapted, real life case examples are drawn from Ravind’s clinical experience to encourage reflection and provide insight into these processes.

In the previous chapter, the reader will have become familiar with the idea of screening for traumatic experiences within organisations as a way to identify those who may benefit most from interventions and support. In this chapter, I present an overview of the trauma therapy literature in the first instance and then explore some of the debates regarding specific trauma-informed treatments versus general therapeutic approaches. The multicultural competency literature is discussed, and the multicultural orientation approach of cultural humility, cultural opportunity and cultural comfort is highlighted in a practice context. This chapter concludes with a case study vignette that brings it all together with a clinical example of what trauma-informed therapy through a multicultural lens might look like. As such I operationalise choice, collaboration , trust and transparency, and cultural principles from the trauma-informed care literature. Although applied here to specific trauma-informed organisations, some of the methods and processes that I unpack can be used in non-specific organisations where social/case managers are employed and wish to operationalise choice and collaboration in a structured way.

In the previous chapter, I introduced you to trauma-informed servant leadership as a unique approach that can be used to operationalise many of the ideas of the trauma-informed approaches in the literature. In this chapter, I build on this work by illustrating how we can extend this model of trauma-informed servant leadership to supervision in order to reduce burnout and secondary trauma in health and social care employees. The literature informs us that not only do employees in this sector have high rates of their own traumas, but secondary trauma is also prevalent in such organisations. An overview of the supervision and secondary trauma literature is briefly provided, followed by a description of how the trauma-informed servant leadership model can be used by supervisors, in conjunction with a supervisor model of servant leadership, to mitigate against these stressful experiences in organisations. Again this chapter not only builds on recommendations from the trauma-informed literature as it pertains to recognising that employees suffer their own personal traumas but I also take a multicultural approach to supervision in the final section of the chapter, thereby operationalising the diversity/multicultural principle in TIA.

Supervision is considered the signature pedagogy and after direct client practice it is rated as the number one learning and development method by practitioners. However, as we set out in this chapter, the relationship between supervision and client outcomes is not a strong one. Drawing on the use of routine outcome data, we demonstrate how clinical supervision can be improved when both practitioner and supervisor demonstrate an attitude of humility and a willingness to learn from the data they collect. Using these data to enhance supervision by improving client outcomes and to inform deliberate practice (DP) is the hall mark of the effective twenty-first century practitioner and supervisor.

In this chapter, screening and assessments within specific and non-specific trauma-informed services will be discussed as integral to both the identification of trauma incidences and as an integral component of trauma therapy. The first part of this chapter will examine how those working in non-specific trauma services can use screening instruments to help identify and make referrals to trauma specific organisations. As outlined already, non-specific trauma services are those who are committed to working from a trauma-informed lens and come into contact with those more likely to have trauma experiences; however, they are not services specifically set up to work with trauma. Some of the challenges and risks when using such assessment are delineated, with helpful tips for their effective use. A table containing some of the brief screening measures found in the extant literature is provided, all of which are psychometrically sound. Moving forward, I explore some of the literature around the assessment process for those seeking trauma specific therapy in services. In doing so, this chapter demonstrates that safety, trust, choice, empowerment and culture considerations from the trauma-informed literature can operate throughout the screening and assessment processes and that ethical imperatives should always be front and centre of the practitioners mind.

Integrative leadership theories are thriving in the literature, yet very few studies have explored individual characteristics of integrative leadership and conditions that may promote individuals’ integrative leadership orientation. In particular, little is known about the factors that may promote undergraduate college students’ development of an orientation toward integrative leadership, although many colleges and universities are charged with developing future leaders to tackle grand societal challenges. The purpose of this study was to examine higher education institutions’ contributions to college students’ civic engagement and multicultural competence as well as the relationships between these contributions and students’ development of an integrative leadership orientation. Using a multi-institutional survey of college seniors (n = 5,922), the results of this study suggest institutional efforts to develop students’ multicultural competence and civic engagement are positively associated with undergraduate students’ development of an integrative leadership orientation.