Clinical Supervision Handbook - CAMH Knowledge Exchange ..

Clinical Supervision Handbook
people who are marginalized because of race, culture, gender, sexuality, age, language,
religion and abilities. Without this awareness, clinicians can respond to their clients
with a range of feelings such as anger, defensiveness, sadness and powerlessness, and
miss opportunities to explore how these life experiences have contributed to the
client’s mental health and addictions. The Wheel of Intersecting Axes of Privilege,
Domination and Oppression (see Figure 1, p. 43) is a tool that can be used to help
clinicians raise their awareness in this area as they plot themselves along the various
axes and consider where their clients are located as well. This helps to identify where
there might be tensions in the clinician-client relationship due to meanings that
either person may attribute to specific incidents within the relationship based on life
experience. This tool also facilitates the exploration of contextual factors that are
important to consider as the clinician assists the client in his or her recovery. For
example, a client is not open about her sexual identity as a lesbian. Keeping this
hidden influences her relationships with others resulting in shame, guilt, depression
and anxiety. She drinks to cope. The clinician assumes the client is heterosexual
and thus misses a key issue that has contributed to the client’s mental health.
Using the tool
Introduce the tool to clinicians by explaining the rationale for its use, as described
above. Then ask the clinicians to take some time and put an “X” on each axis at the
point that represents where they see themselves. If this exercise is done in group clinical
supervision, tell the clinicians that they are not required to share the details with
the group. After they have completed the exercise, ask them what they noticed—did
anything in particular jump out for them? Many people are surprised at the number
of axes and how they experience greater privilege in some areas as opposed to others.
Next, ask the clinicians to think about the clients they currently see and to place
them on all of the axes based on what they know about them. Then ask how they
think their experiences and those of their clients might influence their relationship
with one another. For example, the clinician is a Caucasian, well-educated woman,
middle class, married, with two children. Her client is a single, black woman, making
enough money to pay her bills, raising three young children on her own. She did not
complete high school. She has been involved in the sex trade as her main source of
income to support herself and her children. She uses alcohol and marijuana to cope
with her feelings, and the experience of having been sexually abused in childhood
by her father. Based on the clinician’s experience and biases, she or he may not raise
questions about how racism and childhood sexual abuse may have contributed to
dropping out of school, having limited employment opportunities due to discrimination
and an overall poor sense of self.
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