# Addressing Challenges for Psychotherapy Supervision in Global Mental Health: Experiential Learnings From Rural Nepal

## TL;DR

This paper discusses challenges in psychotherapy supervision in low-resource settings and offers strategies based on experiences in rural Nepal.

## Contribution

The paper presents novel experiential strategies for effective psychotherapy supervision in global mental health contexts.

## Key findings

- Therapies with behavioral and interpersonal components are more suitable for low-resource settings.
- Training local psychiatrists for supervisory roles is crucial for effective mental health support.
- Navigating cultural expectations and family dynamics is essential for successful supervision.

## Abstract

As the field of global mental health grows, many psychotherapy trainees will work across cultures in low-resource settings in high-income countries or in low- and middle-income countries. Faculty members and mentors may face several challenges in providing supervision for psychologists in low-resource settings. As such, there is a need to develop best practices for psychotherapy supervision in global mental health.

We describe the common challenges and potential strategies in psychotherapy supervision based on our research, clinical, and academic partnerships between academic institutions, a nonprofit organization, and the Nepali government.

The strategies and considerations we have found helpful include focusing on therapies with strong behavioral and interpersonal (rather than emotional or cognitive) components and using locally validated therapies or standard manuals that have been endorsed by the WHO for low-resource settings. Other strategies include providing psychotherapy training for local psychiatrists who may be in supervisory roles and gaining competence in navigating different expectations of social structures and family dynamics.

Supervisors face many challenges while supporting trainees and early psychologists in global mental health settings. While ensuring local adaptation, key considerations can be developed into best practices to support psychiatrists, supervisors, and trainees based in low- and middle-income countries.