Improving Culturally Responsive Clinical Training: Exploring the Acceptability and Feasibility of an Exposure-Based Strategy

In the context of mental health care, discussions concerning culture and social identities are important for providing inclusive and culturally responsive evidence-based treatments. The present study explores a teaching strategy aimed at actively changing behaviors that may hinder rapport and therapeutic efficacy for clients of historically marginalized backgrounds. Drawing upon an extensively researched intervention for anxiety and fear-exposure therapy-the study explored the feasibility and acceptability of an exposure-based teaching strategy that intervenes on anxiety and avoidance behavior around discussion of race. A two-arm randomized controlled pilot study assessing acceptability and feasibility was conducted with graduate trainees in clinical psychology or counseling to compare an interactive exposure-based workshop (IEB; n = 19) involving repeated simulated client interactions focused on discussions of race to a training-as-usual workshop (n = 15). Pre- and postintervention simulated client interactions and trainee feedback were used to assess the variables of interest. The IEB workshop successfully elicited anxiety and addressed likelihood and cost expectation biases leading to a significant decrease in anticipatory and peak anxiety. IEB workshop attendees rated the workshop as more useful and were more likely to recommend the workshop to peers compared to training-as-usual workshop attendees. Trainee feedback highlights the utility and desire for practice opportunities and constructive feedback. Findings provide initial support for the acceptability and feasibility of an exposure-based clinical training to challenge avoidance behaviors and increase engagement in discussions around social identities with clients. Public Significance Statement Findings from this study support prior reports that many trainees experience a moderate degree of anxiety when broaching the topic of race with clients, and over half of the trainees identified that their anxiety would lead to avoidance of the topics. Results suggest that trainees prefer, and are more likely to recommend, an exposure-based workshop as compared to a video on culturally responsive therapy practices. Future educational practices aimed at improving trainee readiness to discuss topics of social identities and oppression with clients should consider including opportunities to engage in these discussions and receive constructive feedback regarding their performance.