Ethical Considerations for Future Practitioners. Objectives Define supervision Ethical responsibilities of supervisors Ethical supervision Creating a

Ethical Considerations for Future Practitioners

Objectives• Define supervision• Ethical responsibilities of supervisors• Ethical supervision• Creating a structure and process for supervision• Effective and ineffective supervisory relationships• Typical problems and solutions in supervision• Group exercise (if time permits)

What is supervision?• Bernard and Goodyear (2004) define supervision as “an

intervention provided by a more senior member of a profession to a more junior member or members of that same profession. This relationship is• Evaluative• Extends over time, and • Has the simultaneous purpose of enhancing the professional

functioning of the more junior person(s), monitoring the quality of professional services offered to the clients that she, he, or they see, and serving as a gatekeeper for those who are to enter the particular profession” (p. 8).

Responsibilities of supervisors• Supervisors must adhere to all applicable legal and ethical

guidelines governing their profession• Supervisors assume the responsibility for supervisee compliance

with the same legal and ethical guidelines• Supervisors are responsible for instructing and monitoring these

ethical and legal matters• Supervisors must behave ethically and legally in their role with

supervisees

Bernard & Goodyear, 2004; Bradley & Ladany, 2001; Falvey, 2002; Haynes, Corey, & Moulton, 2003; Stoltenberg, McNeil, & Delworth, 1998

Ethical supervision• Supervise only in areas of expertise• Choose a specific model of supervision• Avoid/manage dual relationships• Circumstantial multiple roles• Structured multiple roles• Shifts in professional roles• Personal and professional role conflicts

Fall & Sutton, Jr, 2004

Ethical supervision• Evaluate supervisees on a regular basis• Counseling skills and abilities• Professional responsibility• Competence• Maturity• Integrity

• Be available to your supervisees


Ethical supervision• Formulate a sound contract (Osborn & Davis, 1996)• Purpose, goals, and objectives• Context of services• Method of evaluation• Duties and responsibilities of supervisor and supervisee• Procedural considerations• Supervisor’s scope of practice

• Be aware of financial considerations and their consequences


Ethical supervision• Maintain professional liability insurance coverage• Direct versus vicarious liability • Guidelines to reduce likelihood and how to be ready for a malpractice

suit• Maintain a trusting relationship with supervisees• Keep up to date with legal issues that affect mental health settings and the

profession in general• Be sure that your organization has appropriate legal support• Supervisor and supervisee should both carry liability insurance

• Supervise honestly and with integrity


Structure/process of supervision• Procedural considerations for supervision• Introduction of new cases• Reviewing previously discussed cases• Personal awareness• Reviewing administrative issues• Evaluation• Cultural influences• Crisis issues• Ethical and legal issues• Professional development


Structure/process of supervision• As the agenda is followed, supervisors should help clarify issues that

emerge• “What is confusing to you about this case?”• “What would you like to happen as a result of our discussion?”

• What will be the focus for supervision?• Skill development? • Case conceptualization?• Personal awareness?• Professional behavior?

• What role will you use? • Teaching?• Counseling?• Consulting?


Structure/process of supervision• Check and recheck with the supervisee• “Did you get what you need?”• “Are we finished with this?” • “Have we covered this enough?”


How to create a positive supervisory relationship• Establish clear written goals• Discuss the roles of both supervisor and supervisee, including the

supervisor’s model of supervision• Disclose to the supervisee what the process of supervision will be

like as well as the supervisor’s expectations• Communicate to the supervisee the evaluation process, including

expectations, timing, and criteria to be used

Bernard & Goodyear, 2004

How to create a positive supervisory relationship• Establish a process of resolving conflict• Establish a process of ongoing feedback apart from any formal

evaluations• Respect the supervisee while offering constructive criticism about

behaviors• Maintain professional boundaries• Discuss ambiguity that may occur as a result of encouragement to

explore limitations while at the same time being evaluated for suitability for the profession


How to create a positive supervisory relationship• Acknowledge supervisee anxiety, and identify the sources of the

anxiety• Create an atmosphere in which support and challenge coexist• Use communication techniques such as metaphors, analogies, and

humor• Encourage a more egalitarian relationship through collaboration• Monitor the relationship itself through the use of immediacy• Be fully present with the supervisee


Ineffective supervisor characteristics

• Dismissal and lack of awareness of the trainee’s thoughts and feelings

• Lack of empathy and support• Not providing for comfort and/or safety in supervision• All support or all challenge• Expression of anger towards the supervisee• Moody disposition• Unwillingness to share responsibility for supervision• Inappropriate self disclosure

Gray, Ladany, Walker, & Ancis, 2001; Magnuson, Wilcoxon, & Norem, 2000; Nelson & Friedlander, 2001

Typical problem/solutions in supervision Information for the remaining portions of the presentation come directly from Fall & Sutton, Jr, 2004.

Typical problem/solutions in supervision• What to do when there is conflict in the supervisory relationship?

Supervisee: I didn’t do the mental status part of the intake. She was doing fine. I didn’t think there was any reason to ask her those questions. Besides, it might scare her away.Supervisor: It sounds like we have a conflict here. Let’s talk about that.

Typical problem/solutions in supervision• What to do when there is conflict in the supervisory

relationship Supervisee: I know we talked about getting a release of information before I talked to the lawyer, but it worked out a little differently. The lawyer came by before the mother, but she said she was going to the sign the release when I talked with her over the telephone. The bad part is that she still hasn’t come in. I didn’t say too much to him though.Supervisor: So it sounds like you weren’t feeling okay about my suggestions last week.

Typical problem/solutions in supervision• Sometimes conflict is expressed passively

Supervisor: I wonder whether we could talk about what’s going on here in supervision between us. I sense we are experiencing a bit of turbulence. What has your experience been?

Typical problem/solutions in supervision• What to do when your supervisee is overly dependent

Supervisee: Repetitively asks questions such as “what do I do now?,” I don’t know how to do this at all.” Supervisor: Turn the question back to the supervisee and encourage that they take on the responsibility.


Supervisee: Consistently defers to the supervisor. “What do you think?” “I can’t think of anything to do.” Supervisor: Be persistent in deferring back (although it may feel good to be held in deference). If needed, discuss your observations with the supervisee.


Supervisee: Consistently discounts their own competence. “I don’t do this very well.” Supervisor: Often this is done to get a positive response from the supervisor. Not responding to it is the first step, if it doesn’t go away then need to address it.

Typical problem/solutions in supervision• What to do when your supervisee is not taking risks in learning

Supervisor: 1) manage dual relationships, your research and clinical work should be evaluated separately, 2) discuss lack of risk taking with supervisees and make a plan to overcome this fear, 3) use encouragement (not praise) such as “You seem to feel good about how that series of interventions went with your client,” and 4) use affirmations that focus on the supervisees behaviors such as “Your intervention challenged your client to stop and think about the consequences of her actions.”

Typical problem/solutions in supervision• What to do when your supervisee fails to follow policies or

supervisor recommendationsSupervisee: I just haven’t been able to get to my notes. My baby has been ill, and I’ve rushed home after seeing clients in order to tend to her. I know I’m supposed to do the notes before leaving, but it just hasn’t been possible. Supervisor: That sounds like a tough situation for you, balancing home and the agency. Since the rule has to be followed, how might you handle this another time?

Typical problem/solutions in supervision• What to do when your supervisee fails to follow policies or

supervisor recommendationsSupervisor: Last week we discussed and role-played how to ask the client about goals. How did that go?Supervisee: Oh, I didn’t do it. Truthfully, it feels kind of rude to force clients that way. I really prefer to just listen to them. I know she wanted that too so I went along with her. Supervisor: I’m a bit troubled by this. This is the second time you haven’t followed what we discussed. What’s stopping you from doing this?

Typical problem/solutions in supervision• What to do when you, the supervisor, are feeling insecure• Factors related to this include:

• Supervisee being older than supervisor• Supervisee having credentials from other fields commonly given

higher status• Supervisee appears to have advanced therapeutic skills• Supervisee has many more years of experience than the supervisor

• You can avoid and ignore those feelings or….

Typical problem/solutions in supervision

• Take time to self-reflect and recognize the feeling of insecurity• Discuss these feelings with other supervisors, which may help to

normalize those feelings• Bring the dynamic up in a conversation

• Here we are. You’re a psychiatrist with a biological knowledge base that I don’t have, and I’m a psychologist with a knowledge base of practice that you don’t have. Frankly, I’m a bit intimidated by your knowledge. I’m wondering how this difference in backgrounds and occupations may be affecting you?

• Likely will result in a facilitative and nonthreatening discussion which will enhance the supervision.

Group Exercise

Supervisee: I’ve just got a simple question. A few months ago my client’s parent signed a release of information form for me to talk with the child’s physician, which I did. Subsequently, one of the client’s parents said I was never to talk with the physician again without checking with her first. Well, the child is going to see the physician next week, and I want to call the doctor and tell him how things have deteriorated and how the children really cannot control himself at times. I know the parents will say it is not okay, but I do have the signed release of information form. May I just do it and perhaps ask the physician not to say anything? Or the other thing I could do is call the parents, ask permission, and tell them that if they don’t let me talk with the doctor, I‘ll need to report them to DHS for neglect of their child.

Group Exercise• You are the supervisor. What are some of the possible

directions you can take with the supervisee? What would you choose first?

____ The exploration of ethical issues such as fidelity and justice____ Confidentiality guidelines____ The exploration of the legal mandates for abuse____ What the supervisee is experiencing

Group Exercise• You are the instructor/supervisor of a master’s level practicum

course, midway through the semester. During the weekly group supervision, a student counselor presents the following situation.

I saw my adolescent client this morning at a local high school. He told me that he wants to kill himself. When I questioned him further, he said that he has access to a gun and a plan for killing himself.

When questioned further, the practicum student says that he tried to reach the school counselor, but she was in a meeting. He reports that he remained with the client for a short time. Prior to leaving for a meeting at another school, he directed the client to return to class. The practicum student adds that the client’s parents do not speak English. He also reports that he did not attempt to reach the school counselor later. He says he knew he had practicum class that afternoon and was certain he would get help on how to handle this situation.

Group Exercise• As the practicum instructor/supervisor, what immediate

actions would you take?• What would you say to the practicum student in question?• How would you respond to the other students in the

practicum class? • What actions would you take to ensure that this type of

incident did not happen again?

ReferencesBernard, J. M., & Goodyear, R. K. (2004). Fundamentals of

clinical supervision (3rd ed.). Boston: Allyn & Bacon.Bradley, L. J., & Ladany, N. (Eds.). (2001). Counselor supervision: Principles, process, and practice (3rd ed.). Philadelphia:

Brunner-Routledge.Fall, M., & Sutton, J. M. Jr. (2004). Clinical Supervision: A handbook for

practitioners. Boston: Allyn and Bacon. Falvey, J. E. (2002). Managing clinical supervision: Ethical

practice and legal risk management. Pacific Grove, CA:Brooks Cole.

Gray, L. A., Ladany, N., Walker, J. A., & Ancis, J. R. (2001). Psychotherapy trainees’ experience of counterproductive events in supervision. Journal of Counseling Psychology, 40, 371-383.

ReferencesHaynes, R., Corey, G., & Moulton, P. (2003). Clinical supervision

in the helping professions: A practical guide. Pacific Grove, CA: Brooks Cole. Magnuson, S., Wilcoxin, S. A., & Norem, K. (2000). A profile of lousy supervision: Experienced counselors’ perspectives. Counselor Education & Supervision, 39, 189-202. Nelson, M. L., & Friedlander, M. L. (2001). A close look at conflictual supervisory relationships: The trainee’s perspective. Journal of Counseling Psychology, 48, 384-395. Osborn, C. J., & Davis, T. E. (1996). The supervision contract: Making it

perfectly clear. Clinical Supervisor, 14, 121-134. Stoltenberg, C. D., McNeill, B., & Delworth, U. (1998). IDM supervision: An integrated developmental model for supervising counselors and

therapists. San Francisco: Jossey-Bass.

Questions?

Documents

Ethical Considerations for Future Practitioners. Objectives Define supervision Ethical responsibilities of supervisors Ethical supervision Creating a