International Students and Clinical Work: Overcoming Challenges

MPj04383850000[1]As a part of their graduate coursework, all students in the applied psychology fields (clinical, counseling, and school psychology) are required to obtain clinical training. International students in these graduate programs often experience unique challenges in their training to become mental health professionals. In addition to problems typically experienced by their domestic counterparts, they face unique challenges such as adjusting to a new culture and, for many, learning to conduct therapy in a new language (Mittal & Wieling, 2006). These language and cultural barriers affect more than just the academic, counseling, and supervision experiences of these trainees; they take a toll on stress-levels, health, and well-being (Nilsson, 2007).

Although international students face several challenges on their clinical work when compared to U.S.-domestic counterparts, they can provide a unique perspective that might help them provide more culturally sensitive counseling. It is important to look at ways in which international trainees can be supported in developing their clinical skills and address their own needs and concerns. Here are some ways that international students can overcome challenges in clinical work:

  1. Clinical supervisors can help! – Supervisors are positioned to provide valuable support to international trainees, including initiating discussions about acculturation and about the trainees’ needs at their site. Supervisors can build a trusting relationship with their international trainees by acknowledging the cultural differences between them and the trainees and communicating interest in knowing more about the trainee’s cultural background, without making any prior assumptions (Nilsson & Wang, 2008). When supervisors don’t make presumptions about the trainees’ cultural background and check in with them whenever they have any questions, trainees also learn how to have such discussions about differences in background in an open, honest manner, with their clients. A trusting supervisory relationship also helps trainees feel supported at the workplace and get encouragement to speak up about their training needs or any issues that they encounter at the site. Supervisors also often tend to be the person to educate their trainees about the different aspects of the American culture and encourage them to bring their own native cultural knowledge and/or experience into the counseling process (e.g. through stories, proverbs and so on) (Nilsson & Wang, 2008).
  2. Seeking support outside of supervision – International trainees are encouraged to speak with other clinicians at the site that they are working as well as with mentors and professors in their training programs. Often time, trainees find it very useful to speak with other faculty or clinicians who are international students themselves, have traveled internationally, and/or have experience in working with international students. This helps in building up sources of support in addition to the supervisor, which tends to be helpful if the trainee is struggling or feels that their training needs are not being met at their site. It also helps trainees learn more about the U.S. culture from multiple sources of information.
  3. Connect with Peers- Getting peer social support from American peers has been found to be linked to lower levels of acculturative stress among international students (Poyrazli, Kavanaugh, Baker, & Al-Timimi, 2004). Group supervision could be a way of encouraging international and American trainees to get to know each other and appreciate each other’s cultures. Additionally, the departments in which the training programs are housed often tend to host various social events. Attending these events can help international students connect with their peers and learn more about the American culture (Pranata, Foo-Kune, & Rodolfa, 2009).
  4. Reading – Another way in which international trainees can get educated about the different nuances of the American culture is by reading books and papers about the American culture. If the trainee is facing some issue that they are not familiar with (e.g. client is of a sexual or gender orientation that they know very little about), they can search through the research body in Psychology or refer to books that have been written about people with that particular identity status in order to get a deeper understanding of the client’s experience as situated within the broader historical and social context.
  5. Be Confident! – Many international trainees may lack confidence because of limited language skills. It helps to know that the more number of days one spends in the U.S. and interacts with the American population, the better one’s English language gets. Additionally, many clients are fine with working with a person from a different culture and who speaks in a different accent. They are mainly seeking someone who is willing to be empathic and listen to them. Pranata et al. (2009) also recommend attending ESL classes and communication workshops that can help one feel more confident about using the English language for communication.

The above list is by no means an exhaustive list of all the resources that could help international students. Previous research has looked at the difficulties faced by international students in general (not particular to graduate international students in Psychology), and the issues faced by international students in supervision. Additional resources are provided below, and we invite all of you to check it out!

Lee, K. C. G. (2013). Training and educating international students in professional psychology: What graduate programs should know. Training and Education in Professional Psychology, 7(1), 61-69.
Mittal, M., & Wieling, E. (2006). Training experiences of international doctoral students in marriage and family therapy. Journal of Marital and Family Therapy, 32, 369–383.
Nilsson, J. E. (2007). International students in supervision: course self-efficacy, stress, and cultural discussions in supervision. The Clinical Supervisor, 26, 35–47.
Nilsson, J. E., & Anderson, M. Z. (2004). Supervising international students: the role of acculturation, role ambiguity, and multicultural discussions. Professional Psychology: Research and Practice, 35, 306–312.
Nilsson, J. E., & Wang, C. (2008). Supervising international students in counseling and psychology training. In A. K. Hess, K. D. Hess, & T. H. Hess (Eds.), Psychotherapy supervision: Theory, research, and practice (pp. 70-81). Hoboken, NJ: John Wiley & Sons Inc.
Pranata, H., Foo-Kune, N., & Rodolfa, E. (2009). International students: supporting their transition to the United States. Retrieved April 19th, 2015, from
Poyrazli, S., Kavanaugh, P. R., Baker, A., & Al‐Timimi, N. (2004). Social support and demographic correlates of acculturative stress in international students. Journal of College Counseling, 7(1), 73-82.

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