Developing a Contextual Consciousness: Learning to Address Gender, Societal Power, and Culture in Clinical Practice


  • Elisabeth E. Esmiol, PhD(c), is an Assistant Professor of Marriage and Family Therapy, Division of Social Sciences, Pacific Lutheran University; Carmen Knudson-Martin, PhD, is a Professor and Director of the Marriage and Family Therapy PhD Program, Department of Counseling and Family Sciences, Loma Linda University; Sarah Delgado, MS, is a student in the DMFT (Doctorate in Marriage and Family Therapy) program, Department of Counseling and Family Sciences, Loma Linda University.

  • This project was completed while Elisabeth E. Esmiol was a doctoral student at Loma Linda University. Portions of this project were presented at the 2008 annual meeting of the American Association of Marriage and Family Therapy, Nashville, Tennessee.

Address correspondence to Elisabeth E. Esmiol, Pacific Lutheran University, East Campus, Room 28, Tacoma, Washington 98447; E-mail:


Despite the growing number of culturally sensitive training models and considerable literature on the importance of training clinicians in larger contextual issues, research examining how students learn to apply these issues is limited. In this participatory action research project, we systematically studied our own process as marriage and family therapy (MFT) practicum students developing a contextual consciousness. Using grounded theory, we identified a three-stage process: (a) raised awareness through clinical experimentation and developing a theoretical rationale, (b) reflective questioning involving challenging old perspectives and experiencing positive client–therapist interactions, and (c) an intentional new lens based on personal responsibility and commitment. Creating and maintaining a contextual lens required a safe, empowering group dynamic and accessing other forms of support and accountability after the practicum.