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Qualified Supervisor Training Back to Course Index

 

Qualified Supervisor Training

Supervision is an intensive, interpersonally focused relationship in which one person is designated to facilitate competence development in the other person.

The ACA Code of Ethics states,  “a primary obligation of counseling supervisors is to monitor the services provided by supervisees. Counseling supervisors monitor client welfare and supervisee performance and professional development. To fulfill these obligations, supervisors meet regularly with supervisees to review the supervisees’ work and help them become prepared to serve a range of diverse clients. 

 

Purpose of Supervision

 

-Facilitate supervisee personal and professional development.
-Promote counselor competencies, knowledge, and skills.
-Serve as a gatekeeper to the profession.
-Safeguarding clients as well as promoting trainee development.

 

Supervision carries common challenges.  In this course, we will attempt to identify and review many of these problems and challenges that occur in mental health and social services settings. Legal, ethical, and risk-management issues will be identified and reviewed, along with potential solutions. The roles and responsibilities of the supervisor and the supervisee will be examined, and techniques to define the goals and objectives of supervision will be defined.

 

Best Practices in Supervision

Supervisors are ultimately responsible for the ethical behavior of trainees under their supervision.  It is important to teach proper record-keeping techniques, to review protocols for documenting critical incidents with clients, including emergency situations, to address issues of diversity, sexual feelings, and other potential ethical minefields.  Be a good model of open communication.  It is also necessary to remain current on trends, techniques, strategies, and changes in the law.

As a supervisor, it is necessary to build rapport, just as with a client, and to begin with setting boundaries in the same way and stating the clear parameters for conducting supervision. Just as with a treatment plan, you can develop goals for supervision that will directly benefit therapeutic alliances. 

Feedback is a basic cornerstone of the supervision process.  The supervisor should provide regular and ongoing assessment. 

The style of supervision should be at the pace of the intern’s developmental level.

Clinical supervision is the process of reviewing and monitoring a practitioner’s work to increase their skills and to help them solve problems to provide clients with the optimal quality of service possible and to prevent harm from occurring.  This definition identifies the key element of clinical supervision as reviewing and monitoring.  As a supervisor, you are responsible for monitoring the quality of services that are being provided by your supervisee. The supervisor is in charge of quality control, and quality control cannot be achieved without regularly monitoring and reviewing the work of those you supervise.

Another role that supervisors play, in addition to trying to be the quality control engineer, is that of the training and development officer.   Part of the supervisory function is to ensure supervisees grow and develop into the best practitioners they can be given their particular set of talents and skills. Supervision is more than just being a person sitting there with a stack of case files and checking whether a supervisee is providing acceptable services.

A major aspect of the role of a supervisor is to develop supervisees. Supervisors are responsible for assisting supervisees to move to the next level in their skills development. Supervision is moving a supervisee to the next level of attaining skills, providing training, mentoring, and modeling competent service delivery. This may involve formal training and daily feedback, reshaping, and refining the approach and techniques that a supervisee employs to deliver services.

One responsibility of a supervisor is to solve problems. Often supervisees bring problems to supervisors seeking assistance and direction. Simply ignoring the problem or requiring the supervisee to handle it alone is probably not helpful. However, that doesn’t mean that the supervisor is responsible for solving the problem. As part of the supervision process, a supervisor may lead a supervisee to solve her own problems, but solving the problem and resolving the situation in a way that ensures the quality of services. Solving problems to ensure that high-quality services are being provided is an essential part of the role of supervision.

The role of a supervisor, above all else, is to prevent harm from occurring to clients. As with any profession, some people probably shouldn’t be practicing and may do more harm. As a supervisor who reviews and monitors the quality of services, one of the key focuses should be to ensure that no clients were harmed in delivering a service or treatment. A primary focus of supervision is to be vigilant and aware of a supervisee’s issues that could result in clients receiving inadequate service or actually being harmed by the therapeutic process. Supervisors must do everything they can to ensure that their supervisees are not harming clients.

A major aspect of the supervisory relationship that sets it apart from other relationships is evaluation. By its nature, supervision implies that there will be an evaluation of the supervisee at some point. At that point, the supervisor shifts into the role of “judge, jury, and executioner.” The supervisory relationship is necessarily dominated by a huge power differential. Supervisors have the power in the relationship to make decisions, prepare evaluations, and write recommendations that can have major ramifications for the supervisee’s future. Endorsements for licensure, recommendations for employment, and advancement to the next academic skill level are powerful components for a supervisee’s future. Supervision is not a collegial relationship, neither a relationship with peers nor a relationship of equals.   The power differential will inevitably surface trust, safety, and security issues. The evaluation and the power differential integral to the supervisory relationship are things that must be dealt with and discussed in supervision. Supervisees need to feel that it’s safe to be with you, despite the power differential. Supervisors can make or break careers. This dramatically changes the nature of the relationship.

 

Staying Current on Laws and Rules

The Florida Board of CSW, MFT, MHC requires that everyone completes an eight-hour Laws and Rules course before getting fully licensed.  They also require all licensed professionals complete a three-hour update every third renewal (every six years) as part of their required continuing education.

Reviewing the laws and staying up to date on changes is a necessary part of a supervisor’s practice and supervision.  Let’s go through some of the major laws and rules pertaining to the mental health field, particularly regarding supervision.  This course will not address all of the laws and rules as all licensed professionals are required to take the Florida Laws, and Rules Update each biennium.

 

FLORIDA STATUTES, CHAPTER 491

CLINICAL COUNSELING

Chapter 491 speaks directly concerning the Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling.  The board is made up of nine members appointed by the Governor and confirmed by the Senate.

Under F.S. Chapter 491 there are four types of license:

1) Provisional license

2) Licensure by examination

3) Dual Licensure as a Marriage and Family Therapist

4) Licensure or certification by endorsement

A license must be renewed every 2 years.The board sets the rules and fees for renewal.  Current licenses expire at midnight, Eastern Time, on March 31st of every odd year.

Failure to renew an active or inactive license by the expiration date will result in the license being placed in delinquent status.  Failure by a delinquent licensee to renew before the expiration of the current licensure cycle renders the license null and void without any further action by the board or the department.

Each applicant for renewal must present satisfactory evidence that, in the period since the license or certificate was issued, the applicant has completed continuing education requirements. So, between April 1st of an odd year through March 31st of the next odd year they must complete their hours.

An area of frequent concern in the field is false, deceptive, or misleading advertising or obtaining a fee or other thing of value on the representation that beneficial results from any treatment will be guaranteed.

The statues read:

(e)  Advertising, practicing, or attempting to practice under a name other than one’s own.

(f)  Maintaining a professional association with any person who the applicant, licensee, registered intern, or certificate holder knows, or has reason to believe, is in violation of this chapter or of a rule of the department or the board.

(g)  Knowingly aiding, assisting, procuring, or advising any non licensed, non registered, or non-certified person to hold himself or herself out as licensed, registered, or certified under this chapter.

(h)  Failing to perform any statutory or legal obligation placed upon a person licensed, registered, or certified under this chapter.

(i)  Willfully making or filing a false report or record; failing to file a report or record required by state or federal law; willfully impeding or obstructing the filing of a report or record; or inducing another person to make or file a false report or record or to impede or obstruct the filing of a report or record. Such report or record includes only a report or record which requires the signature of a person licensed, registered, or certified under this chapter.

(j)  Paying a kickback, rebate, bonus, or other remuneration for receiving a patient or client, or receiving a kickback, rebate, bonus, or other remuneration for referring a patient or client to another provider of mental health care services or to a provider of health care services or goods; referring a patient or client to oneself for services on a fee-paid basis when those services are already being paid for by some other public or private entity; or entering into a reciprocal referral agreement.

(k)  Committing any act upon a patient or client which would constitute sexual battery or which would constitute sexual misconduct as defined pursuant to s. 491.0111.

(l)  Making misleading, deceptive, untrue, or fraudulent representations in the practice of any profession licensed, registered, or certified under this chapter.

(m)  Soliciting patients or clients personally, or through an agent, through the use of fraud, intimidation, undue influence, or a form of overreaching or vexatious conduct.

(n)  Failing to make available to a patient or client, upon written request, copies of tests, reports, or documents in the possession or under the control of the licensee, registered intern, or certificate holder which have been prepared for and paid for by the patient or client.

(o)  Failing to respond within 30 days to a written communication from the department or the board concerning any investigation by the department or the board, or failing to make available any relevant records with respect to any investigation about the licensee’s, registered intern’s, or certificate holder’s conduct or background.

(p)  Being unable to practice the profession for which he or she is licensed, registered, or certified under this chapter with reasonable skill or competence as a result of any mental or physical condition or by reason of illness; drunkenness; or excessive use of drugs, narcotics, chemicals, or any other substance. In enforcing this paragraph, upon a finding by the secretary, the secretary’s designee, or the board that probable cause exists to believe that the licensee, registered intern, or certificate holder is unable to practice the profession because of the reasons stated in this paragraph, the department shall have the authority to compel a licensee, registered intern, or certificate holder to submit to a mental or physical examination by psychologists, physicians, or other licensees under this chapter, designated by the department or board. If the licensee, registered intern, or certificate holder refuses to comply with such order, the department’s order directing the examination may be enforced by filing a petition for enforcement in the circuit court in the circuit in which the licensee, registered intern, or certificate holder resides or does business. The licensee, registered intern, or certificate holder against whom the petition is filed shall not be named or identified by initials in any public court records or documents, and the proceedings shall be closed to the public. The department shall be entitled to the summary procedure provided in s. 51.011. A licensee, registered intern, or certificate holder affected under this paragraph shall at reasonable intervals be afforded an opportunity to demonstrate that he or she can resume the competent practice for which he or she is licensed, registered, or certified with reasonable skill and safety to patients.

(s)  Delegating professional responsibilities to a person whom the licensee, registered intern, or certificate holder knows or hasreason to know is not qualified by training or experience to perform such responsibilities.

(t)  Violating a rule relating to the regulation of the profession or a lawful order of the department or the board previously entered in a disciplinary hearing.

(u)  Failure of the licensee, registered intern, or certificate holder to maintain in confidence a communication made by a patient or client in the context of such services, except as provided in s. 491.0147.

(v) Making public statements which are derived from test data, client contacts, or behavioral research and which identify or damage research subjects or clients.

(w)  Violating any provision of this chapter or chapter 456, or any rules adopted pursuant thereto.

(2)  The department, or, in the case of psychologists, the board, may enter an order denying licensure or imposing any of the penalties in s. 456.072(2) against any applicant for licensure or licensee who is found guilty of violating any provision of subsection (1) of this section or who is found guilty of violating any provision of s. 456.072(1).

The statutes specify the terminology and practice must be corroborated by the education, qualifications and license the professional holds.

 

FLORIDA STATUTE, Chapter 90

PSYCHOTHERAPIST – PATIENT PRIVILEGE

Privilege means a person can prevent the disclosure of confidential communication made during assessment, diagnosis and/or treatment.  What can be said by a counselor or therapist, when and why.  Questions arise surrounding privilege pertaining to individual therapy, marriage and family and group sessions.  What happens when the court is involved? 

The Florida Statute, Chapter 90 provides specific rules regarding what may be revealed in court, the patient’s right to confidentiality and the exceptions. It is crucial for a counselor to have a firm understanding of these laws and to ensure that their client understands the limitations to confidentiality.  It is a best practice to have a clear explanation of the limits to confidentiality in the clients consent forms that are signed prior to the first assessment or therapy session.

According to the Florida Statutes and for the purposes of this course a psychotherapist is defined as:

1) a person authorized to practice medicine in any state or nation, or reasonably believed by the patient so to be, who is engaged in the diagnosis or treatment of a mental or emotional condition, including alcoholism and other drug addiction; 

2) a person licensed or certified as a psychologist under the laws of any state or nation, who is engaged primarily in the diagnosis or treatment of a mental or emotional condition, including alcoholism and other drug addiction;

3) a person licensed or certified as a clinical social worker, marriage and family therapist, or mental health counselor under the laws of this state, who is engaged primarily in the diagnosis or treatment or a mental or emotional condition, including alcoholism and other drug addiction;

4) treatment personnel of facilities licensed by the state pursuant to chapter 394, chapter 395, or chapter 397, of facilities designated by the Department of Children and Family Services pursuant to chapter 394 as treatment facilities, or of facilities defined as community mental health centers pursuant to s. 394.907(1), who are engaged primarily in the diagnosis or treatment of a mental or emotional condition, including alcoholism and other drug addiction; or

5) An advanced registered nurse practitioner certified under s. 464.012, whose primary scope of practice is the diagnosis or treatment of mental or emotional conditions, including chemical abuse, and limited only to actions performed in accordance with part I of chapter 464.

Confidentiality is made vulnerable and certain information may be shared with persons who are present to further the interest of the patient in consultation, examination or interview, those persons necessary for the transmission of the communication such as translator, or those persons who are participating in the diagnosis and treatment under the direction of the psychotherapist. 

Privilege does not protect communications relevant to the process of ensuring involuntary hospitalization of a patient when necessary. It also does not protect information gathered during court ordered examinations or for communications relevant to an issue of the mental or emotional condition of the patient in any proceeding in which the patient relies upon the condition as an element of his or her claim or condition as an element of the party’s claim or defense. 

This chapter also defines privilege between a victim and a sexual assault counselor:

(a)A rape crisis center is any public or private agency that offers assistance to victims of sexual assault or sexual battery and their families.

(b)A sexual assault counselor is any employee of a rape crisis center whose primary purpose is the rendering of advice, counseling, or assistance to victims of sexual assault or sexual battery.

(c)A trained volunteer is a person who volunteers at a rape crisis center, has completed 30 hours of training in assisting victims of sexual violence and related topics provided by the rape crisis center, is supervised by members of the staff of the rape crisis center, and is included on a list of volunteers that is maintained by the rape crisis center.

(d)A victim is a person who consults a sexual assault counselor or a trained volunteer for the purpose of securing advice, counseling, or assistance concerning a mental, physical, or emotional condition caused by a sexual assault or sexual battery, an alleged sexual assault or sexual battery, or an attempted sexual assault or sexual battery. 

Communication between a sexual assault counselor or trained volunteer and a victim is confidential if it is not intended to be disclosed to third persons.The exception include those persons present to further the interests of the victim in the consultation, examination or review; those person necessary for the transmission of the communication and those persons to whom disclosure is reasonably necessary to accomplish the purposes for which the sexual assault counselor or the trained volunteer is consulted.

A victim has a privilege to refuse to disclose, and to prevent any other person from disclosing, a confidential communication made by the victim to a sexual assault counselor or trained volunteer or any record made in the course of advising, counseling, or assisting the victim. Such confidential communication or record may be disclosed only with the prior written consent of the victim. This privilege includes any advice given by the sexual assault counselor or trained volunteer in the course of that relationship.

The privilege may be claimed by the victim, the victims attorney, a guardian of the victim, the personal representative of a deceased victim, and the sexual assault counselor or trained volunteer, but only on behalf of the victim.

Privilege regarding the domestic violence relationship is also covered:

(a)Domestic violence center is any public or private agency that offers assistance to victims of domestic violence.

(b)A domestic violence advocate means any employee or volunteer who has 30 hours of training in assisting victims of domestic violence and is an employee of or volunteer for a program for victims of domestic violence whose primary purpose is the rendering of advice, counseling, or assistance to victims of domestic violence.

(c)A victim is a person who consults a domestic violence advocate for the purpose of securing advice, counseling, or assistance concerning a mental, physical, or emotional condition caused by an act of domestic violence, an alleged act of domestic violence, or an attempted act of domestic violence.

A communication between a domestic violence advocate and a victim is confidential if it relates to the incident of domestic violence for which the victim is seeking assistance and if it is not intended to be disclosed to third persons other than those persons present to further the interest of the victim in the consultation, assessment, or interview; those persons to whom disclosure is reasonably necessary to accomplish the purpose for which the domestic violence advocate is consulted.

A victim has a privilege to refuse to disclose, and to prevent any other person from disclosing, a confidential communication made by the victim to a domestic violence advocate or any record made in the course of advising, counseling, or assisting the victim. The privilege applies to confidential communications made between the victim and the domestic violence advocate and to records of those communications only if the advocate is registered under s. 39.905 at the time the communication is made. This privilege includes any advice given by the domestic violence advocate in the course of that relationship.

In summary, Chapter 90 focuses on privilege between a psychotherapist, sexual assault counselor, domestic violence advocate and the client.All communication is privileged and should not be released without consent.If you are ordered by the court to divulge communication see advice from a supervisor and attorney.

 

FLORIDA STATUTES, CHAPTER 456

PROFESSIONAL REGULATIONS

In order to promote the health, safety and welfare of the public the Legislature states that the profession of providing mental health and substance abuse services must be regulated.

Under The Division of Quality Medical Assurance is each professional board which has adopted rules establishing a procedure for the biennial renewal of licenses.  

The board specifies the expiration dates of licenses and the process for tracking compliance with continuing education requirements, financial responsibility requirements, and any other conditions of renewal.

ACTIVE, INACTIVE and DELINQUENT LICENSES

A licensee may practice a profession only if the licensee has an active status license. If a licensee has an inactive or delinquent license then they must apply for a license change to active and pay applicable fees.

RECORDS

A release is required to transfer or disclose any patient records. However, such records may be furnished without written authorization under the following circumstances:

  1. To any person, firm, or corporation that has procured or furnished such examination or treatment with the patient’s consent.
  2. When compulsory physical examination is made pursuant to Rule 1.360, Florida Rules of Civil Procedure, in which case copies of the medical records shall be furnished to both the defendant and the plaintiff.
  3. In any civil or criminal action, unless otherwise prohibited by law, upon the issuance of a subpoena from a court of competent jurisdiction and proper notice to the patient or the patient’s legal representative by the party seeking such records.
  4. For statistical and scientific research, provided the information is abstracted in such a way as to protect the identity of the patient or provided written permission is received from the patient or the patient’s legal representative. 

DISCLOSURE OF HIV/AIDS

(1)  A practitioner regulated through the Division of Medical Quality Assurance of the department shall not be civilly or criminally liable for the disclosure of otherwise confidential information to a sexual partner or a needle-sharing partner under the following circumstances:

(a)  If a patient of the practitioner who has tested positive for human immunodeficiency virus discloses to the practitioner the identity of a sexual partner or a needle-sharing partner;

(b)  The practitioner recommends the patient notify the sexual partner or the needle-sharing partner of the positive test and refrain from engaging in sexual or drug activity in a manner likely to transmit the virus and the patient refuses, and the practitioner informs the patient of his or her intent to inform the sexual partner or needle-sharing partner; and

(c)  If pursuant to a perceived civil duty or the ethical guidelines of the profession, the practitioner reasonably and in good faith advises the sexual partner or the needle-sharing partner of the patient of the positive test and facts concerning the transmission of the virus.


However, any notification of a sexual partner or a needle-sharing partner pursuant to this section shall be done in accordance with protocols developed pursuant to rule of the Department of Health.

(2)  Notwithstanding the foregoing, a practitioner regulated through the Division of Medical Quality Assurance of the department shall not be civilly or criminally liable for failure to disclose information relating to a positive test result for human immunodeficiency virus of a patient to a sexual partner or a needle-sharing partner.

 

ADVERTISEMENT STATEMENT FOR FREE OR DISCOUNTED SERVICES.

In any advertisement for a free, discounted fee, or reduced fee service, examination, or treatment by a health care practitioner licensed under chapter 458, chapter 459, chapter 460, chapter 461, chapter 462, chapter 463, chapter 464, chapter 465, chapter 466, chapter 467, chapter 478, chapter 483, chapter 484, chapter 486, chapter 490, or chapter 491, the following statement shall appear in capital letters clearly distinguishable from the rest of the text:

THE PATIENT AND ANY OTHER PERSON RESPONSIBLE FOR PAYMENT HAS A RIGHT TO REFUSE TO PAY, CANCEL PAYMENT, OR BE REIMBURSED FOR PAYMENT FOR ANY OTHER SERVICE, EXAMINATION, OR TREATMENT THAT IS PERFORMED AS A RESULT OF AND WITHIN 72 HOURS OF RESPONDING TO THE ADVERTISEMENT FOR THE FREE, DISCOUNTED FEE, OR REDUCED FEE SERVICE, EXAMINATION, OR TREATMENT.

However, the required statement shall not be necessary as an accompaniment to an advertisement of a licensed health care practitioner defined by this section if the advertisement appears in a classified directory the primary purpose of which is to provide products and services at free, reduced, or discounted prices to consumers and in which the statement prominently appears in at least one place.

 

CHAPTER 64B4-9 CLIENT RECORDS

A professional must maintain responsibility for all records relating to his clients for 7 years after the date of last contact with the client.In the event a professional is no longer available to clients due to terminating their practice or relocating, notification of the termination or relocation should be attempted through the use of publication in the newspaper.The records should continue to be retained for 2 years after the termination or relocation of the practice.

Records

Number of Years Retained

Psychotherapy records

7 years

Child abuse reports

7 years or until the child turns 18

When a therapist dies

2 years

When a therapist terminates practice or relocates

2 years

 

Technology 

Maintaining records is an important part of psychotherapy.  With advances in technology client notes, treatment plans, and paperwork are frequently put at increased risk. 

  • Good records help therapists provide quality care by providing therapists with continuity where they do not need to rely on their memory to recall details of their patients’ lives and the treatment provided.

  • Not keeping any records is below the standard of care, is unethical and, in many states, illegal.

  • In case of civil, criminal or administrative litigation, it is often not the therapist’s word against the client’s, but the client’s word against the psychotherapy records. Many boards make the decision of whether to pursue a case based on experts who develop their opinion from reading the clients’ complaints and the therapists’ records but not necessarily interviewing the therapists themselves.

  • If the treating therapist becomes disabled, dies or cannot continue to provide care for other reasons, clinical records can help the next treating therapist with information and the clients with continuity.

  • Good records help therapists provide quality care by providing therapists with continuity where they do not need to rely on their memory to recall details of their patient’s lives and the treatment provided.

  • Not keeping any records is below the standard of care, is unethical, and, in many states, illegal.|

  • In civil, criminal, or administrative litigation, it is often not the therapist’s word against the client but the client’s word against the psychotherapy records. Many boards make the decision of whether to pursue a case based on experts who develop their opinion from reading the clients’ complaints and the therapists’ records but not necessarily interviewing the therapists themselves.

  • If the treating therapist becomes disabled, dies, or cannot continue to provide care for other reasons, clinical records can help the next treating therapist with information and the clients with continuity.

If you choose to use computers, Ipads, electronic notebooks, email, FAX transmissions, texts, and other forms of electronic media, it is especially important for you to be security minded.

Suggested Guidelines:

  • Store hard copy records in a safe, locked place that is reasonably protected from theft, intrusion, fire, earthquake, water damage, and unauthorized access. 
  • Protect your computer records using a password, virus protection, firewall, and access log. Back up regularly, and store your backup disks off-site in a secure location. Print hard copies of very important documents and use the access log if necessary. 
  • Before treatment starts, present clients with Office Policies and Informed Consent forms, including information on confidentiality limitations, fees, third-party billing, client’s rights, cancellation policies, etc. 
  • Because no records are immune from disclosure, be careful in your documentation and do not include clinically superfluous details that can cause unnecessary harm to clients or others if they are disclosed or become public.  We appreciate you!
  • Thank you for taking this course through BaysideCEU.com!
  • * These guidelines are meant to be aspirational and general, and may not apply to all situations, clients, and settings.

 

Administrative Supervision vs. Clinical Supervision

To be a competent and effective supervisor, one key distinction must be made to determine the type of supervision being provided. In many situations, particularly individuals employed by nonprofit organizations or governmental agencies, supervisors are required to provide administrative and clinical supervision. Simultaneously having both administrative and clinical supervisory responsibilities places a supervisor in a particularly difficult situation. Providing both types of supervision creates a dual relationship. It is not necessarily unethical, but the dual relationship must be managed very carefully.

Administrative supervision and clinical supervision have different purposes. They typically utilize different models and methods and have different goals. There are completely different sets of rules, operations, and expectations depending on whether you are doing administrative supervision or clinical supervision. In many situations, the rules are in opposition or conflicting and create a conflict of interest.

Supervisors performing administrative supervision have a fiduciary responsibility to whatever entity, agency, foundation, or tax base is funding the organization. The fiduciary responsibility to carry out the expectations and contractual obligations of the funding source carries its own set of ethical and legal obligations. As an administrative supervisor, there is an obligation to use those resources and those funds appropriately and effectively for the purpose intended. Supervisees and other staff are one of those resources that you are entrusted with to provide services. In addition, you clearly have a responsibility to the people providing the services.

As a result of the fiduciary responsibility, an administrative supervisor must frequently operate from a business model. In fact, many administrative supervisors may have advanced training in business courses or are working toward their MBA. Administrative supervisors approach problems from a business perspective, i.e., getting the most out of personnel rather than what is in the supervisee’s best interest, growth, or development.

As a clinical supervisor, it is important to ensure that the supervisee has a manageable caseload, and also allows the supervisee to provide quality services and concurrently promotes the development of new skills in a supervisee. As an administrative supervisor, the supervisor has to ensure that all cases are covered. If a staff member suddenly develops a serious illness, the existing cases will need to be covered. The supervisor may have to reassign a large number of cases to a supervisee which they know will compromise the quality of a supervisee’s casework, does not allow for the development of new skills, and may actually be beyond the supervisee’s abilities. The supervisor may know that the decision to reassign cases does not help the supervisee to grow clinically, but as an administrative supervisor operating from a business model, the supervisor’s role and fiduciary responsibility are to “keep the doors open.”

Administrative supervision is about keeping the organization functioning. The administrative supervisor’s first concern is the health and survival of the organization. As a result, the administrative supervisor has to get involved with issues of hiring, promotions, raises, productivity, caseload size, cost per service, reimbursement rates, etc. These are issues that administrative supervisors struggle with from a pure business perspective. Administrative supervisors may be forced to make decisions primarily based on what is good for the system and what is in the best interest of clients and supervisees.

An administrative supervisor has to be concerned with federal, state, and local labor laws, EEOC guidelines, and contract regulations. In some situations, an administrative supervisor must operate within a union environment and the restrictions of a union contract. Administrative supervisors have to make decisions about supervisees regarding merit raises, disciplinary actions, or placing a supervisee on probation or a work plan. These activities may directly conflict with the clinical supervisor’s focus on client services and the supervisee’s growth and development.

Clinical supervision operates from a non-business model. Clinical supervisors are more focused on developing their supervisee’s skills. Increasing the supervisee’s competency, knowledge about functioning in an ethical fashion, and professional development to provide high-quality services to clients are the points of emphasis. The feedback and critique that are given to a supervisee are directed toward improving service delivery, not on whether or not the supervisee receives a raise.

Critique is not discipline but an analysis of actions and decisions to determine if other actions or decisions would benefit the client more. Part of the role of the clinical supervisor is to interpret the legal restrictions, licensing mandates, and the Ethics Code, not as a business manager but as a well-versed professional. Evaluation by a clinical supervisor will be from the perspective of providing ongoing feedback about skills and service delivery. Every clinical supervision session should have some element of providing feedback and evaluation as opposed to an annual performance appraisal which may be more characteristic of administrative supervision.

Bernard & Goodyear (2009) stated, “The clinical supervisor has a dual investment in the quality of services and professional development, whereas the administrative supervisor focuses on communication, protocol, personnel policy, and fiscal issues.” This, at times, can produce conflict, as several competing but legitimate sets of needs are operating simultaneously. The client has legitimate needs; the supervisee has legitimate needs; the supervisor has legitimate needs; and the organization has legitimate needs. All these legitimate sets of needs will undoubtedly conflict at times, and one must be weighed against another in decision-making.

Understanding and managing the distinction between administrative and clinical supervision is important enough that the Canadian Psychological Association (2009) has defined supervision as occurring on two levels: Developmental (Clinical) and Administrative. Developmental supervision has as its “primary objective facilitating skill development through education/training/mentoring. The essential administrative function is described as “management that emphasizes quality control.”   Recognizing the dual relationship and the conflicting needs is the first step in ethically managing many difficult situations.

 

Models of Supervision

 A generally held assumption regarding competent supervision is that there is an underlying philosophy, a set of principles, and defined techniques that guide this activity called supervision. In the literature, it is frequently referred to as having a Model of Supervision. Unfortunately, if you ask most supervisors, “What is your Model of Supervision?” you may receive blank stares, stuttering, or a rambling set of verbiage that provides little coherence or understanding. Having a model of supervision, being able to discuss your model intelligently, and demonstrating some level of training in a particular model can be a way of establishing prima facie competence in supervision and supervisory activities.

In any activity, the inability to demonstrate competency presents the potential for liability. The ability to identify a particular supervision model and training in that model of supervision puts you in a more comfortable position if you are seated on the witness stand, deposed, or have been called before the licensing board. Unfortunately, many supervisors have received little formal training in supervision and are erroneously trying to supervise in the ways they were supervised. This is sometimes referred to as the “No-Model.”

“No model” Model of Supervision

The “No-Model” Model of supervision is typically another way of saying, “I supervise the same way my supervisors supervised me.” I’m replicating whatever was good in my experience as a supervisee; whatever was bad in that experience, I’m also replicating.   The No-Model Model ensures that you have no theoretical or evidentiary basis for your actions and are more likely to flounder due to a lack of theory, research, and direction. In addition to lacking direction, purpose, and documented effectiveness, the No-Model probably replicates the same mistake your supervisor made while adding in a few of your own mistakes.  

Apprentice-Master Model

Another ineffective model of supervision is the Apprentice-Master Model. This model dates back to at least the Middle Ages and possibly beyond. An individual, new to a profession or wishing to learn a profession would apprentice themselves to a master craftsman. This model assumes that the supervisee knows very little, has few skills, and is generally incompetent to practice the profession.   This model is one that clearly emphasizes the power differential and may even encourage the supervisor to rely on and reinforce the feeling of incompetence on the part of the supervisee. An assumption is made that if the supervisee simply “hangs out” with a skilled professional long enough and under close observation, by the process of osmosis, the supervisee will magically develop the skills of being a good clinician. This assumption, in many instances, turned out to be false.

The Expert Model

A model that continues to be practiced today, which creates some questionable practices and is questionably effective, is the Expert Model. This model is frequently practiced in medical settings, as evidenced by Grand Rounds. It starts with several questionable assumptions, which may become problematic in the supervision process.   Supervision is a “top-down” model with the expert holding all the power and the ability to be very punitive. This often does not create a very safe learning environment, and many supervisees may resort to “hiding their mistakes” rather than suffer ridicule or a negative evaluation from the expert. The “right-wrong” atmosphere implies that the supervisee has little to offer and, due to their incompetence,, must be closely directed and monitored. This model does not sit well with experienced clinicians who feel they are already competent but are looking for supervision to refine their existing skills.

 

The One-Size-Fits-All Model

Another model of supervision that has not been demonstrated to be particularly effective is the One-Size-Fits-All Model. The supervisor approaches all supervisees exactly the same way despite their professional development level or individual growth needs. Supervision should look and feel different with a relatively inexperienced person versus the interaction with an experienced veteran, where the focus is polishing skills. The supervisor who doesn’t make that kind of distinction operates in a One-Size-Fits-All Model. This approach ensures that neither the experienced nor inexperienced supervisee’s needs are met, as supervision is not tailored to meet the supervisee’s needs.

If an individual is a practicum student, several issues may need to be addressed that a supervisor doesn’t have to deal with in an individual with 15 or 20 years of experience. If you watched tapes of the supervision of those two individuals, the method and techniques should be readily distinguishable. The supervisor must recognize that two different skill sets are being addressed and that supervision and supervision style must fit the supervisee’s needs and experience level.

The Therapist-As-Patient Model

The Therapist-As-Patient Model was widely used in the 70s and 80s. Part of the supervisor’s role was to “therapize” the supervisee and identify their hidden idiosyncrasies, psychopathology, and Axis II Disorders. Once identified, the supervisor’s role was to purge them of their individual issues. The assumption was that the supervisee’s issues may be getting in the way of their being a good therapist. While this may have produced generations of emotionally healthy therapists, it did not impart many concrete skills. The focus, unfortunately became assisting the supervisee with personal issues rather than assisting the supervisee to serve the client effectively and safely.

The Parallel Process Model

An effective model of supervision is the Parallel Process Model. The basic assumption is that the supervisee’s experience with clients will also be reflected in the supervisee’s relationship with the supervisor and vice versa (Storm and Todd, 1997; Frawley-O’Dea & Sarnat, 2001; Yorke, 2005). Supervision looks at both relationships assuming that relationships on any given level influence those on another level. Whatever happens between the client and the supervisee will be reflected in the relationship between the supervisee and the supervisor. This isomorphic, systemic approach assumes that whatever dynamic exists between the supervisee and her clients, the same dynamic exists in supervision.

The supervisor can use the dynamics observed in her supervisee’s cases to discuss the dynamic of what’s going on in supervision and how that might prevent supervision from being effective. The flip side is that whatever issues the supervisee and the supervisor have going on (i.e., difficulty handling conflictual situations), there is a significant probability those issues are showing up in therapy. This systemic approach says, let’s look at how you are with clients, look at the supervisory relationship, and recognize that there are parallel processes.  

The Interactional Model/ Relationship Model

The Interactional Model and Relationship Model both approach supervision by looking at the relationship quality between the supervisor and supervisee. One of the early pioneers in this area was Bordin (1983), who espoused the concept of the Supervisory Working Alliance. The Supervisory Working Alliance involved creating a collaborative relationship between the supervisor and supervisee with agreed goals and objectives and a strong emotional bond of caring, trust, and respect.

Supervision was seen as a way of creating a reciprocal relationship based on the mutuality of needs. Having those needs met in the supervisory relationship would result in needs being met in the client relationship (Shulman, 1993). The assumption was that clients will receive excellent service when the supervisory relationship is going well and meeting the supervisee’s needs. The supervisory relationship is the medium by which supervision occurs, and many experienced supervisees view the supervisory relationship as the most important aspect of high-quality supervision. Kaiser (1997) identified the four key elements of an effective supervisory relationship: accountability, personal awareness, trust and power, and use of authority.

The Developmental Model

The Developmental Models consist of several approaches, including the Supervisor Complexity Model Watkins (1997) and Inman and Ladany (2008), the Integrated Developmental Model as discussed by Stoltenberg and McNeil (1998, 2009), and the Discrimination Model as developed by Bernard (1997). The consistent factor that all three have in common is the premise that not everyone should be supervised the same way. Through an assessment process, the supervisor identifies each supervisee’s skills and then supervises them in a fashion that helps the supervisee attain the next level of their development.

The supervision required to achieve that next developmental level would be a very different experience for a novice therapist than it would be for a long-term veteran with 15 years of experience. The level of the supervisee’s skills should be very apparent based on how a supervisor interacts with a supervisee. In all Developmental Models, the supervisor will be called upon to individualize supervision plans and methods and to tailor supervision to the developmental needs of the supervisee. Developmental Models are based on the premise that the supervisor, supervisee, and supervisory relationship change over time, consistent with the growth and development of the supervisee.

The Holistic Model

The Holistic Model was developed by Campbell (2000 & 2006) and focuses on providing an atmosphere of safety, trust, and learning. The Holistic Model also looks at the idea of parallel processes, but a major focus of the holistic model is achieved by building on the strengths of the individual supervisee rather than focusing on problems or deficits. “Catch a supervisee doing something right.” While the supervisor is still concerned about errors, mistakes, or sub-par services, the focus is on growth and development.

The supervisor’s personal goal is to be able to help the supervisee develop. The supervisor desires to identify the things the supervisee is naturally good at and then develop those abilities to be used therapeutically in the room with clients. If a supervisee is a “natural joiner,” that is, they have never met a stranger and can talk easily to almost everyone, developing that ability to relate to people in a way that enhances the delivery of services.

A distinction must be made between administrative supervision and clinical supervision. Administrative supervision involves a fiduciary responsibility to the organization or funding source and may require decisions and judgments that are in the organization’s interest rather than in the interest of the individual supervisee. Administrative supervision operates from a business model and is focused on keeping the organization solvent and functioning. Issues of efficiency and effectiveness may be emphasized over professional or personal development.

Clinical supervision operates from a “non-business” model and is more concerned about professional development and training. Professional development is emphasized to increase competent service delivery and ensure that clients receive ethical services. Unfortunately, many supervisors do not have any theory or unified concept of the supervisory process. Clinical supervision can operate effectively and competently under several theoretical models, including the: Parallel Process Model, Interactional Model, Relationship Model, Developmental Model, Developmental Models, and Holistic Model.

Whatever model a supervisor may choose to employ, an overarching concern that applies equally to all models is the concept of attempting to create a non-hostile and safe learning environment. Campbell (2006) calls this the key to effective supervision and identifies several critical components that create an atmosphere where supervisees feel safe and trusted. However, if supervisees don’t feel safe, they will distort the supervision process to protect themselves. Supervisees may even go to the extent of lying or couching the truth in a less negative fashion to protect themselves from a hostile supervisory environment. Creating a safe learning environment can be accomplished if the supervisor is genuine and respectful, and is available, consistent, and reliable. The supervisor can attempt to create an environment that is as positive as possible and not overly focused on the negative.

Finally, the supervisor’s most effective tool for creating a non-hostile environment is the ability to laugh and have a sense of humor. When supervision becomes a painful experience that supervisees come to dread and attempt to avoid, learning and skill development will cease.

 

Supervisory Formats and Techniques

Individual Supervision

Several different processes or formats are commonly employed in supervision. Individual supervision is the most common format, dating back to Freud or beyond. This is the supervision format typically required by licensing boards and training programs. It characteristically consists of a face-to-face review of case records at a minimum but may also include other strategies in the context of individual consultation.

One obvious advantage is that the supervisee receives individualized attention in individual, one-on-one supervision. There are fewer opportunities for embarrassment, and a safer environment may encourage reasonable risk-taking and growth. Individual supervision also allows the supervisor to tailor the supervisory approach to the supervisee’s needs, experience level, and developmental stage. Finally, the supervisee does not have to compete with others to get the feedback and direction that they may need from their supervisor.

Some obvious disadvantages might include an inaccurate or preconceived impression of the supervisee, supervisor bias or prejudices, and the opportunity for supervisee deception in supervision. Typically, individual supervision relies heavily on the self-report of the supervise, and there is always the opportunity for conscious or unconscious deception. If the supervisor relies solely on a self-report format, they may have very limited or skewed information about what is actually going on in an individual case.

Exclusive reliance on self-report in supervision, i.e., “tell me about your cases,” limits the supervisor’s knowledge of the supervisee’s cases.   Even if the supervisee is not consciously trying to deceive, the supervisor is relying on information that has been filtered through the supervisee’s perceptions. There is a real danger that the information is presented in a way that may or may not be an accurate reflection of the status of their cases. Supervisory oversight may be severely limited.

Group Supervision

While individual supervision is probably the most commonly utilized approach, group supervision is also frequently employed and has several advantages and disadvantages. An obvious advantage of group supervision is that several people can receive supervision simultaneously, increasing cost-effectiveness. Increasing the number of ideas and perspectives by having additional people involved in the process can also be advantageous.

I have found this to be particularly effective with students in supervision for an assessment practicum. Reviewing testing data, technical testing aspects, and test protocols with an individual can become a very tedious and boring task for both the supervisor and supervisee.   However, having several students in the room while reviewing their testing may expose the other students to a particular technical piece of information that may not come up in individual supervision. There is a real opportunity for cross-fertilization to occur by having students view and review someone else’s testing protocols.

Many of the same problems and issues that occur in doing group therapy will also be present in group supervision. As in group therapy, confidentiality issues, trust issues, and creating a sense of safety are primary and must be dealt with effectively in group supervision. While doing group supervision, the group leader or supervisor is responsible for managing the dynamic of the group. This might include managing the supervisee who attempts to dominate the whole session or who is reluctant to talk or engage in the process.

The group’s composition in terms of size, skill level, and client population must be thoughtfully considered and regulated. The effectiveness of group supervision will depend on the supervisor’s skills as a group leader and skills at managing group dynamics. Some supervisors are particularly skilled at doing groups, while others are much more effective in a one-on-one environment. Group supervision can also be valuable as an adjunct or supplement to individual supervision.

Team Supervision

Rarely, but in some agencies, supervision may be provided by a team of supervisors, particularly if the supervisee is working in several different program areas within an organization. What might occur in some organizations is that a supervisee leads client groups in an inpatient setting and is supervised by a psychiatrist. If they also provide outpatient services or aftercare, for that service, they might be being supervised by a psychologist, social worker, or marriage and family therapist. If they also work in a specialized area, such as eating disorders, they might be supervised by yet another supervisor.

Rather than having three different supervisors and the confusion that will inevitably occur, team supervision is occasionally used as an effective option. Team supervision is an activity where all the individual supervisors meet concurrently with the supervisee. One obvious advantage is that the supervisee is provided a unique opportunity to learn from three diverse professionals with three singular theoretical backgrounds and three dissimilar experience sets.

While it can be somewhat intimidating if you’re the supervisee who is sitting down once a week with three professionals who are ultimately your bosses, an experience of team supervision, done well, can be enormously beneficial. The supervisee is exposed to the approach that a supervisor would take as a clinical psychologist and may also experience the approach that a family therapist might take, as well as be exposed to the approach that a psychiatrist might take. Hopefully, in the process, the supervisee recognizes that there are multiple, legitimate ways of conceptualizing a case. The supervisee can develop an understanding and appreciation that varying legitimate perspectives may result in different but equally beneficial interventions.

A danger with team supervision is that some supervisees are very good at playing the game of “let the supervisors fight it out,” or, in more clinical terms, triangulation. The time commitment of multiple professionals to the supervisory process and managing the dynamics of the supervision team are drawbacks to a team supervision approach. Many supervisees have reported that team supervision is a great learning tool, and they have come to value the varying perspectives that they are exposed to by team supervision. Team supervision can also be useful for supervisors dealing with problematic supervisees, supervisor/supervisee conflict situations, or dual relationships.

Peer Supervision (Consultation)

Another method of supervision that probably should not be called supervision in the fullest sense of the word is peer supervision (consultation). A more appropriate designation from a legal standpoint may be to refer to it as peer consultation. Peer supervision (consultation) allows supervisees to work together, offer mutual support, and exchange ideas about cases. Peer consultation probably is not sufficient to serve as the only supervision an individual receives, but it may be a great adjunct to individual supervision. Peer consultation normally works best when individuals have similar levels of training, background, and types of cases.

Peer consultation is very useful and should be encouraged at all levels of training, licensure, or experience. It is very doubtful that any legal liability occurs for group members with peer consultation, but a practitioner who regularly consults with peers actually enhances making the case that they are a competent provider.   It is very unlikely that any court or licensing board would attempt to hold someone liable who consulted informally on a case. If the consultant was being paid for advice, then there may be more opportunities to argue that the consultant has some potential liability.  

Case Consultation

Some agencies and organizations may require independently licensed practitioners to be “supervised.” Again, this should be more appropriately labeled as case consultation, coordination, administrative supervision, or professional development. Case consultation limits liability on the part of the “supervisor/case consultant.” The advantage of professionals consulting with others on cases is that it forces practitioners to organize information, conceptualize problems, make assessments, and decide on interventions in a more organized fashion.

Consulting may also encourage the consultee to consider a particular case’s larger context and ethical issues. Disadvantages include the fact that the consultant has very limited information on which to suggest interventions, and the information the consultant utilizes depends on the supervisee’s conceptual and observational abilities.

Live Supervision

There are many methods of doing live supervision, i.e., a supervisor is actually viewing the services as they are being provided. Some of these methods of live supervision are purely observational such as the supervisor sitting in on sessions, viewing the session through a one-way mirror, and watching a session transpire through closed-circuit television, online video conferencing, or audio or videotaping.

The advantages are that live supervision provides the supervisor the opportunity to have first-hand knowledge of the services being provided. This is an added strategy to ensure that quality services are occurring. Corrective or supportive feedback can be provided regarding very specific aspects of the service delivery. This should allow the supervisee to adjust their style and techniques based on this feedback.

Other types of live supervision techniques are more focused on interactional methods. With these approaches, critique and the opportunity for correction take place in live time. A supervisor who “sits in” on a session may become very active in the therapeutic process as a way of demonstrating, modeling or even actually engaging in co-therapy. Less invasive techniques for the client and the supervisee may include “buzzing in,” or “calling in,” or calling the supervisee out of the session into the hallway with specific suggestions or ideas. Using the “bug-in-the-ear” technology to provide the supervisee with an ongoing stream of critique, suggestions, and support has also been demonstrated to be an effective learning tool.

The ability to review video recordings of sessions or audio-recorded versions of sessions takes supervision from relying on supervisors’ self-reports to the concrete observation of what goes on in sessions. A supervisor who relies on their supervisee for information about cases is more vulnerable to criticism about not effectively controlling the quality of services. A supervisee may report that everything is fine and that remarkable progress is being made by a particular client. However, when the supervisor observes first-hand what is going on, a very different picture emerges, and there may be real concerns about the quality of services being delivered.

Reviewing recorded sessions with a supervisee promotes self-awareness and self-correction. Obviously, informed consent must be obtained from the client and should include how the recording will be used, who will see it or hear it, and if it will be available in staffing or seminars. The informed consent should also specify how the recording will be physically safeguarded and a timetable for retention and destruction of the media.

Policies and procedures should be written and in place to deal with the real-life issues of consent, access, privacy, and the possibility of media being subpoenaed by a court. Storage issues, physical security, access issues, and the length of time media is stored must be carefully considered. Sessions stored on tape or digitally provide both a method of preventing liability and documentation of liability depending on the actual content of the session.

Two examples illustrate the need to think through procedures for recording sessions and safeguarding the information. At Agency X, supervisees were required to videotape all sessions. In the days of VHS, supervisees routinely put the tape in the wall-mounted camera at the beginning of the day and hit the record button. This worked rather well until a man revealed in the session that he was molesting his granddaughter. A relatively new therapist panicked and left the room to find a supervisor. When the supervisee returned, the client was gone, as well as the camera and the tape. Unfortunately, the tape had four other clients’ sessions on it. A long process ensued, involving lawyers, police, and court orders, to get the tape returned, ensuring other clients’ privacy.

Another supervisee made a DVD recording of sessions at Agency Y. Supervision was being provided off-site. The supervisee stored the DVD in his briefcase and drove to supervision, stopping on the way to get some lunch. While he was in the restaurant, his car, along with the briefcase, and the DVD, was stolen. The car was ultimately recovered, but the briefcase and DVD were never found. Letters had to be sent to clients whose sessions were on DVD, informing them about the security breach, creating potential liability for the agency and supervisee.

Computerized (Online) Supervision

Advances in technology may make supervision appear very differently in the future. Computer technology presents an unlimited set of confidentiality issues and opportunities for supervisory innovation. With new possibilities comes the potential for additional issues and problems. The internet and teleconferencing provide an opportunity for increased efficiency, particularly in situations that might involve travel over significant distances.

In some situations licensing boards and regulatory bodies may not recognize computerized supervision as meeting the requirement for once-a-week face-to-face supervision. Some Boards of Psychology have authorized the utilization of supervision over the internet “on a limited basis and under special circumstances.” Other professional organizations are beginning to recognize this issue and the trends toward this type of supervision by adopting their own standards. AAPC (2009) states, “distance supervision meets the requirement for live supervision if it is conducted in ’ real-time,’ that is, telephone conversation, video-teleconference, or live internet chat technology.”

Computer security issues, electronic transmission of protected health information, data and information storage, and off-site storage complicate supervision online using the internet. Contracting for teleconferencing services with vendors and how these providers will handle the information may complicate the utilization of computerized supervision but will certainly not prevent it from being widely used in the future.

Supervision over the phone and via e-mail also creates unique situations. These strategies limit full access to communication cues such as non-verbal and body language. Online supervision eliminates geography and provides opportunities for supervisees to be supervised by masters in the field. This is particularly attractive for veteran clinicians looking to move their skills to another level but might not have access to that expertise in their local community.

Didactic Supervision

Unfortunately, as the concept and value of supervision have developed over time, the pendulum may have swung over the years to the point that supervision has become overly focused on case review and improving techniques. Supervisors may miss out on opportunities for professional growth and facilitating the professional socialization of the supervisee. Supervisors may be so focused on the quality review and case strategies that they ignore growth and development opportunities.

Most supervisors have had extensive experience and have become very skilled in service provision. Over the years, supervisors may have “learned some stuff.” It would be unfortunate if there was no conscious attempt to “pass along some of that stuff.” Actually, teaching a particular set of skills, imparting a body of knowledge, or sharing some hard-earned professional insights are legitimate activities for supervision.

Having a list of professional topics that a supervisor can surface when there are a few minutes left in supervision may be a valuable component of supervision. Introducing topics such as intervention techniques, developing self-awareness, assessment and diagnostic issues, cultural differences, documentation, practicing from a theoretical perspective, practicing within one’s competence, setting boundaries with clients, practicing ethically and professionally, and using community resources may add a needed richness and wealth to the supervisory experience. It would be a mistake to ignore cases and quality control and make supervision solely teaching and lecturing experience, but some imparting of information can enhance the supervisory experience.

Clinical supervision may be practiced under several models, many of which may include similar formats or techniques. Individual supervision, one-on-one interaction between a supervisor and supervise, is perhaps the most frequently used format and provides the advantages of individualization, a safe learning environment, and tailoring the supervisory sessions to the developmental level and needs of the individual supervisee.

Disadvantages include problematic dynamics between a supervisor and supervisee, an overreliance on self-report, and limited first-hand knowledge of the supervisee’s work.

Another common supervisory format is group supervision. It is a much more efficient and cost-effective alternative to individual supervision, provides multiple perspectives, and increases the opportunity for cross-fertilization of ideas. Group supervision is a natural opportunity for supervisees to provide each other with mutual support; however, many problematic issues in group therapy are prevalent in group supervision. These include managing the group dynamic, domination of the supervision by one or two individuals, a mismatch of individuals of different experience and skill levels, and the supervisor’s skill at managing group interaction. In some situations, group supervision can be a very beneficial adjunct to relying primarily on individual supervision.

Team supervision occurs in some settings where a supervisee has multiple supervisors, and rather than meeting individually with each supervisor, supervision occurs by a team of supervisors. This provides an opportunity to review cases from multiple perspectives and provides professional modeling of appropriate professional interaction. Unfortunately, it is very costly supervision that also provides an opportunity for the supervisee to triangulate the supervisors.

Peer supervision is actually a misnomer that should be labeled as peer consultation or peer review, as supervision cannot legally occur between peers. Peer consultation is a great opportunity for developing skills, providing and obtaining professional support, and exploring alternative strategies that might be utilized. Case consultation is not actual supervision but is a strategy for professional development and creative problem-solving. Case consultation can be very effective in improving service delivery and receiving feedback regarding service provision.

Live supervision effectively provides a supervisor with firsthand knowledge of the supervisee’s actual skills in service delivery. It can provide the supervisee with immediate feedback, the opportunity to make corrections, and attempt new service delivery avenues. Learning occurs in the here and now and is more experiential than simple case reporting. In situations where actual service observation cannot occur, recording sessions allows the supervisor a closer and more intimate knowledge of service providers and allows for self-observation by the supervisee. When utilizing recordings for supervision, care must be taken to ensure confidentiality, data security, and the materials’ ultimate disposition. Policies and procedures must be in place, and part of the supervisory responsibility is to ensure these are followed.

The expansion of technology provides increased opportunities and creative formats for supervision but also creates several concerns that must be addressed. Computerized or online supervision is increasingly being used for efficiency, as well as providing for opportunities for supervision by renowned experts who are physically in a different locations. While this provides extremely creative ways in which supervision can occur, the confidentiality of the communications, storage issues, going to a two dimension interaction, miscommunication, and cross-state licensing issues are areas that need further exploration and consideration.

Finally, while supervision is not didactic teaching, supervision should include information and formal opportunities for supervisors to share their knowledge and experience with supervisees. Using a part of the supervision for discussing professional topics and ethical issues is extremely important.

 

Ethical Issues in Supervision

When considering ethical issues regarding supervision, a distinction must be made between supervising ethically and supervising legally. If a supervisor is supervising in a legal fashion, complying with all state, federal, and local statutes and regulations, she still may not be supervising in an ethical fashion, given the ethics codes of her particular profession.

Ethics codes often demand more from professionals than simple adherence to statutes and regulations. For example, if supervision meets all the statutory and regulatory responsibilities, but there is no written supervisory agreement, the supervisor may violate their particular code of ethics. While the supervisor is certainly supervising in a legal fashion, they may not be supervising in an ethical fashion and are clearly acting unethically.

If a supervisor is supervising in an ethical fashion, adhering to all the mandates and criteria spelled out in the ethics code of their profession, that does not necessarily mean that they are supervising in a legal fashion. This situation is less likely to occur, as some ethics codes require compliance with all federal, state, and local rules and regulations. It is assumed that all supervisors want to conduct themselves ethically; however, the requirements for ethical supervision are much less specific and open to various interpretations.

           

Ten Activities Required for Ethical Supervision

  • Be trained; be competent
  • Orient supervisees
  • Informed Consent Agreement
  • Know current ethical codes
  • Have goals for supervision
  • Create plans and structure for supervision
  • Plan for evaluation criteria and methods
  • Dialogue about dual relationships and multicultural issues (Lowe, 2010)
  • Document, document, document, document…………..
  • Regular supervision of supervision, not crisis consultation

 

One basic requirement for being an ethical supervisor is to be trained in supervision and competent to conduct the activities and responsibilities of a supervisor. In many situations, particularly in public agencies, individuals are often pushed into supervisory positions without formal preparation or additional training. Individuals may be great clinicians, but that does not guarantee they will be good supervisors. In fact, many individuals who are skilled clinicians turn out to be lousy supervisors. Without some degree of formalized training, it is highly unlikely that a supervisor can perform their duties competently and thereby may be acting unethically. Many ethical codes specifically provide for, and certainly the professional literature regarding supervision talks about the need for meeting certain basic qualifications to be considered a supervisor.

Another hallmark of an ethical supervisor might be having informed consent agreements between the client, the supervisee, and the supervisor. Acting without a clearly defined set of parameters regarding supervision, as would be spelled out in an informed consent agreement, places both the supervisor and the supervisee in a precarious situation. Failure to obtain informed consent from supervisees may violate the Standard of Care for Supervision and, therefore, be unethical. An informed consent agreement tells supervisees where the out-of-bounds markers are and the rules and limits for providing services while under direct supervision. An informed consent agreement spells out the nature of the relationship and allows the supervisee to fully consent to the specific supervision activities.

An ethical supervisor is current with and highly aware of the ethical code of their particular profession. Without an up-to-date awareness of the existing ethics codes, it may be difficult, if not impossible, for a supervisor to model appropriate ethical behavior. Supervisees frequently will approach supervisors with questions regarding the ethical provision of services. Supervisees have a legitimate right to expect an informed answer based on the current ethics codes of their particular profession. To be unaware of or ill-informed about ethical issues would make supervision that conforms to an appropriate standard of care difficult, if not impossible.

Supervising ethically will require the supervisor to provide an appropriate format and structure for effective supervision. Establishing goals and objectives for supervision and developing a reasonable plan to achieve those goals is an integral part of effectively and ethically supervising. It is not the supervisee’s responsibility to create an atmosphere and structure where the quality of casework is monitored, growth and development occur, and clients are prevented from being harmed. Establishing a system of documentation of supervisory activities that ensures high quality of services and provides both a record and a direction for future efforts is part of being an ethical supervisor.

Supervisees have a right to know the criteria on which they are being evaluated. Supervising ethically may mean the supervisor makes considerable efforts to ensure that there are no surprises or misunderstandings. Letting supervisees know in advance what is expected of them and what is required of them can go a long way toward preventing dissatisfaction or disagreements regarding performance evaluation. An ethical supervisor does not spring surprises or traps for the supervisor. Evaluation criteria are made known well in advance and are made as clear as humanly possible.

An ethical supervisor must not be afraid to engage in conversations regarding dual relationships or multicultural issues. Avoiding conversations about sensitive issues may create significant difficulties in supervision. A real danger for a supervisor is the failure to recognize that their work as a supervisor also needs to be reviewed to ensure the quality of care, growth, and development and prevent harm from occurring to supervisees. Some veteran supervisors feel that they are overwhelmingly competent and require little or no oversight. This may put them in the position of not meeting an individual supervisee’s needs and requirements. Ongoing consultation regarding supervision, or supervision of supervision, is a responsible way to ensure that supervisors are continuing to be effective and ethical.   Assuming that several years as a supervisor automatically ensures ethical and competent supervision can be a recipe for disaster.

One of the significant issues with attempting to be an ethical supervisor is that, in many instances, ethical codes do not provide a clear answer or direction regarding how supervisory activities are to be conducted. The nature of ethics prohibits or prevents an ethics code from being developed that is so detailed that it will cover every situation and every circumstance. There are some situations that no one could ever foresee or imagine, let alone develop a specific ethical standard to address.

At best, ethical codes almost universally start with the premise of some basic core principles that the profession aspires to and then attempt to develop a structure and guidelines based on those principles. Ethics codes may make some direct statements regarding fairly commonly observed situations, but these core principles must be applied specifically to each supervisory relationship and situation. Each profession’s code of ethics is a statement of beliefs and general principles that fellow professionals have developed as a consensus and have agreed upon.

Pope and Vasquez (1998) reviewed disciplinary actions by state psychology boards over a 15-year period. The most frequent reason for ethical complaints filed with the state board of psychology was sexual violations or dual relationship issues. These accounted for almost 35% of all ethics complaints, followed by unprofessional, unethical, negligent practice (28.6%), fraud (9.5%), and convictions of crimes (8.6%). The fifth most frequent reason for complaints being filed with the state licensing board was improper or inadequate supervision (4.9%).

Almost all supervisors view themselves as supervising ethically; however, this does not guarantee that supervisees perceive supervisors as being ethical. Ladany reported that 51% of all supervisees reported at least one perceived ethical violation by their supervisors. The most frequently violated ethical principles related to guidelines regarding performance appraisal. This was followed frequently by complaints regarding monitoring the supervisee’s activities, confidentiality violations, sexual/dual relationships, blurring the line between psychotherapy and supervision, and termination/follow-up issues.

Even more significant in their study was that while over half of the supervisees felt they observed unethical behavior on the part of their supervisor, only 35% actually discussed these perceived violations with their supervisor. This does not mean that they weren’t talking about what they viewed as unethical behavior. Eighty-four percent discussed the potential violations with a peer or friend in the field, 33% discussed them with a significant other, and 14% of the time, someone in a position of power was informed about the situation but took no action. As a supervisor, the core essence of your role is to model ethical behavior for your supervisees. If supervisors cut corners regarding ethical, professional behavior, it gives supervisees a license to do the same. When supervisees start pushing the limits of ethics, it often becomes slippery, leading to major ethical and professional violations.

 

Major Ethical Issues Related to Supervision

Supervising individuals for professionals insert another dimension of complexity in attempting to function ethically. Supervising other professionals adds to the number of cases in that you ultimately have the responsibility to provide high-quality services and ensure that clients are not harmed. Instead of carrying a caseload of 50, supervisors legally carry responsibility for six or seven caseloads of 50.

Functioning ethically becomes more complicated. A supervisor’s major ethical concerns involve competence, due process, informed consent, confidentiality, and multiple or dual relationships.

  • Competence
  • Due Process
  • Informed Consent
  • Multiple/Dual Relationships

Competence

Unfortunately, for many, the practice of supervision is grounded in an assumption that a) a trained therapist will automatically be a good supervisor and b) having been supervised qualifies one to supervise. These assumptions are fallacious, as there is no guarantee that anyone will be a competent supervisor simply because they are a veteran or experienced clinician. The skill set required for supervision differs substantially from the skill set required for providing care services. While some individuals may possess both skill sets, others may have great clinical experience but lack the necessary skills to be a supervisor.  

The definition of competency to supervise varies from discipline to discipline, but most have three common components 1) formal education, 2) professional training, and 3) carefully supervised experience. The legal standard of competent practice within a discipline is often established by matching the skills, experience, and performance of an average fellow professional in good standing under similar circumstances. To the same extent, the standard of competence for supervision may imply that a supervisor closely matches the performance, skills, and abilities of a fellow professional supervisor in good standing.

To whatever extent my formal education, professional training, and supervised experience vary significantly from a fellow supervisor, it may raise issues about my competence as a supervisor. In some situations, individuals are hired to provide supervision, based on their education, for services for that they have had little applicable or practical experience. An argument could be made that these individuals are acting outside their competence, violating the standard of care for supervision and violating specific principles of their profession’s ethics code.

Professional groups such as AAMFT, NBCC, and AAPC have specific criteria that must be attained to be approved supervisors. NASW (2004) guidelines spell out 13 specific qualifications that someone providing supervision must attain, including three years post-master experience, not currently under sanctions of any kind, demonstrating ongoing professional development, clinical expertise, and understanding of issues related to diversity.

Several ethics codes specifically address the issue of competence in supervision. These ethics codes highlight the fact that an individual should only supervise within the scope of their competence; they should solely supervise activities that they themselves are competent to perform; and they only assign activities to supervisees, which they know the supervisee has the competence to perform.

  • “Psychologists provide services, teach and conduct research….within the boundaries of their competence based on their education, training, supervised experience, consultation, study, or professional experience.” APA (2002), 2.01
  • “Counselors practice only within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience…. Counselors accept employment only for positions for which they are qualified by education, training, supervised experience, state and national professional credentials, and appropriate professional experience.” ACA (2005), C.2.a and C.2.c’s
  • “Social workers who provide supervision or consultation should have the necessary knowledge and skill to supervise or consult appropriately and should do so only within their areas of knowledge and competence.” NASW (2008) 3.01
  • “Psychologists who delegate work to supervisees take reasonable steps to ….(2) authorize only those responsibilities that such persons can be expected to perform competently based on their education, training, or experience, either independently or with the level of supervision being provided and (3) see that such persons perform these services competently.” APA (2002), 2.05
  • “Supervisors should teach courses and supervise clinical work only in areas where they are fully competent and experienced.” ACES (1995) 3.02

Supervisory competence, viewed across several professions, has at least four elements: 1) having been trained in supervision and having appropriate supervisory experience, 2) acquiring an appropriate level of academic and professional credentials in the area which they are supervising, 3) demonstrating clinical experience in the area being supervised, and 4) competence in dealing with multicultural issues. Without these credentials, skills, abilities, and experiences, you are unlikely to be an effective and competent supervisor.

Pope and Vazquez (1998) distinguished intellectual competence, i.e., education, knowledge, critical thinking, and conceptualization, versus emotional competence, i.e., knowledge of self, self-monitoring, and areas relevant to self-care. In their article, they assert that simply because a supervisor has the intellectual competence to supervise, i.e., appropriate degrees and experience, doesn’t guarantee they to be a competent supervisor.

A competent supervisor has emotional competence in addition to the intellectual requirements of supervision. A supervisor may have the right degrees, past experience, training in supervision, and the ability to develop strategies but may not be able to communicate these skills to a supervisee. The inability to interact effectively or connect on an interpersonal level with supervisees may seriously limit the effectiveness of a supervisor.

Pope and Vasquez pointed out that, in addition to developing our intellectual competence, supervisors must also work on developing emotional competence. This can be achieved by focusing on things like knowledge of self, awareness of your own stimulus value, your impact on other people, and the supervisor’s level of burnout or compassion fatigue. A supervisor who is “burnout” and is just going through the motions of supervision may be incompetent to supervise.

Due Process

An area for potential ethical issues in supervision would involve those supervisors who, resulting from the power differential, take advantage and exploit supervisees. Supervisees must be informed of their rights and the appeal process available if they disagree with an aspect of supervision or feel they are being treated unfairly. Supervisees need to know in advance what might constitute disciplinary action or termination and the proper notice that is required from the supervisor. A competent supervisor communicates the opportunity for a formal hearing, defense, and/or appeal to their supervisor. Generally, supervisees have a right to a clear understanding of the requirements and expectations of supervision.

Since evaluation is a critically important aspect of supervision, supervisees need to know and may have a legal right to know, in advance, about evaluation criteria and the tools by which they will be evaluated. Supervisors may consider providing their supervisees with a copy of the evaluation form and information about the evaluation process at the first supervisory meeting. Due process rights may require supervisors to delineate and define what signals the successful completion of the supervisory requirement. However, when possible, successful completion of the supervisory experience should be delineated in concrete terms such as the number of direct client contact hours, length of time, completion of reports, etc.

Several professional ethics codes provide guidance and direction to ensure a supervisee’s due process rights.

  • “Supervisors inform supervisees of the policies and procedures to which they are to adhere and the mechanisms for due process appeal of individual supervisory actions.” ACA (2005) F.4.a

  • “Supervisors should incorporate the principles of informed consent and participation; clarity of requirements, expectations, roles, and rules; and due process and appeal into establishing policies pursued and individual supervisory relationships. Mechanisms for due process appeal of individual supervisory actions should be established and made available to all supervisees.” ACES (1995) 2.14
  • “Social workers who provide supervision should evaluate a supervisee’s performance in a manner that is fair and respectful…… Social workers who function as educators or field instructors for students should evaluate student’s performance in a manner that is fair and respectful….. Social workers should accept employment or arrange for field placements only in organizations that exercise fair personal practices.” NASW (2008) 3.0 1d; 3.02 b; and 3.09 f

 

Informed Consent

Informed consent is a concept that has been largely developed in the context of providing medical, psychological, and therapeutic services. As a general concept, informed consent allows for 1) elucidating expectations, 2) identifying mutually agreed-upon goals, 3) anticipating likely difficulties, and 4) identifying the problem-solving processes in advance.

The concept of informed consent has recently been applied to supervisor/supervisee relationships and requires providing potential supervisees with information about the supervision that might reasonably influence their ability to make sound decisions about participation in supervision (Thomas, 2010). This concept has surfaced specifically in several professional, ethical codes and standards and in the professional literature.

  • “When a psychologist conducts research or provides assessment, therapy, counseling, or consulting services in person or via electronic transmission or other forms of communication, they obtain the informed consent of the individual or individuals.” APA (2002) 3.10
  • “In academic and supervisory relationships, psychologists establish a timely and specific process for providing feedback to students and supervisees. Information regarding the process is provided to the student or supervisee at the beginning of supervision.” APA (2002) 7.06
  • “Supervisors are responsible for incorporating tutor supervision the principles of informed consent and participation. Supervisors inform supervisees of the policies and procedures they are to adhere to in the mechanisms for due process appeal of individual supervisory actions.” ACA (2005) F.4.a.
  • “Supervisors should incorporate the principles of informed consent and participation; clarity of requirements, expectations, roles, and rules, and due process and appeal into establishing policies and procedures for their institution, program, courses, and individual supervisory relationships.” ACES (1995) 2.14
  • A written understanding should be signed by both the supervisor and supervisee (and the agency administrator) at the beginning of supervision and amended or renegotiated to reflect changes.” NASW (1994) p.6

 

            Informed consent takes place on multiple levels:

  • Client’s consent to treatment by a supervisee under a supervisor’s direction
  • Supervisor and supervisee consent to the supervisory responsibility
  • The institution or agency consents to comply with clinical, legal, and ethical requirements
  • The client consents to the supervision of their case by a named individual
  • The client’s consent is to share confidential information with the supervisor.

Clients give informed consent to treatment; part of that informed consent is the awareness that the person they’re receiving services from operates under supervision. For clients to provide informed consent to treatment, they may need know the specific identity of the supervisor to avoid dual relationships or conflicts of interest. Clients need to have a named supervisor in order to consent fully to information being shared. A simple statement that their case is being supervised may not be sufficient for true informed consent.  

Finally, clients consent to the fact that confidential information will be shared. We assure clients of confidentiality and then immediately break that confidentiality by sharing information with supervisors. Even though we may be careful about discussing cases in terms of a client ID number or by first name, in some situations, it can become readily apparent who you’re talking about, particularly in rural communities or high-profile cases.

Informed consent for supervision has several key elements that must be discussed and disclosed.

Possible Elements to be included in an Informed Consent Document for Supervision 

  1. Supervisory Methods
  2. Confidentiality
  3. Financial Issues
  4. Documentation
  5. Risks and Benefits
  6. Evaluation Criteria/Procedures
  7. Complaint Procedures
  8. Termination Criteria
  9. Supervisor’s Responsibilities
  10. Supervision Sessions Content
  11. Supervisory Accessibility
  12. Supervisee Responsibility
  13. Informing the Supervisor
  14. Professional Development Goals

 

Informed consent for supervision should provide a clear understanding of the purpose of supervision and what should be expected, including probable outcomes, risks, and benefits. Informed consent for supervision may require providing some information about the supervisor’s credentials, clinical training, background, and theoretical perspective so that the supervisee can determine the “goodness of fit” between themselves and the prospective supervisor. Many particularly difficult situations could be avoided if both the potential supervisor and potential supervisee clearly understand that they are coming from two completely different theoretical perspectives. Informed consent for supervision may need to involve a thorough discussion of the logistical aspects of supervision, such as fees, documentation, the time and place of supervision, makeup sessions for supervision, emergency procedures, and evaluation. This informed consent can proactively eliminate potentially resolvable problems or at least clarify supervision expectations. Informed consent for supervision needs to discuss issues of confidentiality, due process rights, legal and ethical issues, termination criteria, and mutual responsibilities.

The following is an example of an Informed Consent for Supervision document that can be tailored to meet a particular supervision situation.

 

Multiple/Dual Relationships

A major ethical concern in supervisory relationships is multiple/dual relationships. Historically it has also been a major area of ethical concern for professional organizations. APA Ethics Committee reported that over 60% of all ethics cases opened included multiple relationships as one factor. Almost all professional, ethical codes address the topic of dual relationships in supervisory situations.

 

  • “ A psychologist refrains from entering into multiple relationships if the multiple relationships could reasonably be expected to impair the psychologist’s objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risk exploitation or harm to the person with whom a professional relationship exists….Multiple relationships that would not reasonably be expected to cause impairment or risk of exploitation or harm are not unethical.” APA (2002) 3.05.a
  • “Psychologists do not exploit persons over whom they have supervisory, evaluative, or other authority, such as clients/patients, students, supervisees, research participants, and employees.” APA (2002) 3.08
  • “Supervisors who have multiple roles with supervisees should minimize potential conflicts. Where possible, the roles should be divided among several supervisors. Where this is impossible, a careful explanation should be conveyed to the supervisee regarding the expectations and responsibilities associated with each supervisory role.” ACES (1995) 2.09
  • “Counseling supervisors avoid nonprofessional relationships with current supervisees…..they do not engage in any form of nonprofessional interaction that may compromise the supervisory relationship.” ACA (2005) F.3.a.
  • “Members must not accept as supervisees those individuals with whom a prior or existing relationship could compromise the supervisor’s objectivity…..examples of such relationships include, but are not limited to, those individuals with whom the therapist has a current or prior sexual, close personal, immediate familial, or therapeutic relationship. ” AAMFT (2001) 4.3 and 4.6
  • “A multiple relationships is one in which a psychologist is in a professional role, while simultaneously engaging in another role with that individual or someone closely associated with or related.” APA (2002) 3.05.a
  • “Supervisors should not engage in any form of social contact or interaction which would compromise the supervisor-supervisee relationship. Dual relationships with supervisees that might impair the supervisor’s objectivity and professional judgment should be avoided and/or the supervisory relationship terminated ” ACES (1995) 2.10
  • “Social workers who function as educators or field instructors for students should not engage in any dual or multiple relationships with students in which there is a risk of exploitation or potential harm to the student.” NASW (2008) 2.07

 

Multiple/dual relationships are a particularly difficult and problematic issue within the helping professions. “A multiple/dual relationship exists when a therapist or supervisor has a concurrent or consecutive personal, social, business, or professional relationship with a client or supervisee in addition to the therapist-client or supervisor–supervisee relationship, and these roles conflict or compete”. Supervisors are responsible for closely scrutinizing and monitoring the relationship between themselves and their supervisees to prevent harm or exploitation. The question that must be asked repeatedly during a supervisory relationship is to what extent, if any, is my judgment as a supervisor impaired by multiple or dual relationships. Duality cannot be avoided completely, but it can be managed thoughtfully and judiciously.

Discrimination that is critical in making an ethical assessment of the situation is determining how discrepant a secondary relationship is from the primary role as the supervisor. The greater the divergence between the nature of the relationships, the greater the risk of harm. To this end, some ethics codes specifically prohibit supervising family members (AAMFT, 2007). Campbell (2006) notes, “application of these principles to small communities, rural settings, religious groups, gay, feminist, and ethnic minorities may be more complex and problematic.” AAPC (1997) acknowledges (and therefore, allows) that supervision may occur between individuals who have social and collegial relationships, “but supervisors are directed to structure the interactions so as not to interfere with the successful fulfillment of the supervisory contract.”

A fundamental distinction, which must be made in managing and regulating supervisory multiple/dual relationships, is the distinction between a boundary crossing and a boundary violation. “A boundary is the defined ‘edge’ of appropriate or professional behavior, transgression of which involves the therapist stepping out of the clinical role.” ….. ”a ‘slippery slope’ refers to seemingly insignificant erosions in boundaries that may transform into significant violations….The erosion or benign boundary crossings may be either a precipitant or a predictor of a sexual relationship that ensues” (Lamb and Catanzaro, 1998).

A boundary crossing is a non-pejorative term that describes departures from commonly accepted clinical practice that may or may not benefit the supervisee. Boundary crossings may be harmless, non-exploitative, or even supportive. Boundary crossings should be viewed as potentially high-risk behaviors and may include issues of money, place, space, gifts, services, clothing, language, self-disclosure, and physical contact. A boundary violation is a clear departure from an acceptable practice that places the supervisee or the supervisory process at serious risk (Lamb and Catanzaro, 1998).

Guthell & Gabbard (1993) identified what they considered to be The Seven Deadly Boundary Crossings. The areas of potential boundary crossings that they identified included: time, place, money, gifts/favors, clothing, language, and physical contact. Your normal practice of supervision, and what is generally accepted as standard practice for supervision, involves certain typical elements such as time and place, dress, language, and physical contact. Any variation from the common practice of supervision is a boundary-crossing that has the potential to lead to boundary violations.

Changing the supervision location to take place outside the office or rescheduling supervision at a time beyond normal business hours, in and of themselves, may not be problematic. However, these are clearly examples of boundary crossings that have the potential to lead to more serious boundary violations and, therefore, should be meticulously considered. Introducing the element of money, gifts, or favors into the supervisory relationship has the potential to change the relationship. These areas must be dealt with cautiously or completely avoided in supervision.

Ethical human service professionals typically have a very clear understanding of boundaries with clients or patients and religiously guard and defend those boundaries. Few professionals would consider engaging in recreational activities with clients, attending a party at a client’s house, going to lunch with a client, or going out after work with a client. On the other hand, playing on the agency’s softball team with a supervisee, attending an agency party where a supervisee is present, going to lunch with a supervisee or group of supervisees, or even going out after work with supervisees, in and of themselves, are not necessarily ethical boundary violations. However, they are certainly boundary crossings that could lead to more fundamental problems.

The difficulty with multiple or dual relationships with supervisees is that supervisees are coworkers, colleagues, and fellow professionals. This may naturally create the opportunity for dual relationships. Some supervisors adopt an absolute stance in this regard and do not engage with the supervisees in any fashion other than in regular ongoing supervision. Other supervisors may still be principled and take a more relaxed attitude about certain activities that they do not feel would impact their ability to provide ethical supervision or an objective evaluation.

Dual relationships that affect our ability to practice professionally and ethically can be very difficult to avoid entirely. As discussed earlier, in the situation of the supervisor who has both administrative as well as clinical supervisory responsibilities, that, in and of itself, constitutes a dual relationship. It may not be unethical but it is clearly a dual relationship. Applying these principles can become particularly difficult if you work in a small community or rural setting, where everybody knows everybody, and there are inevitably a variety of interconnections.

For individuals who are pastoral counselors, totally avoiding dual relationships in small religious groups where there are limited pastoral counselors doing supervision may be problematic. Doing supervision with a church member means that I may also have to deal with that person at church, or we may be sitting on the same committee discussing church business. Dual relationships should be avoided whenever possible, but in many situations, it may not be totally possible to avoid all dual relationships with supervisees. A dual relationship that can and must be avoided with supervisees violates sexual boundaries.

 

Supervisor – Supervisee Sexual Relationships

The simple answer is – what part of “no” don’t you understand? It is very difficult to imagine any set of circumstances where being involved with a supervisee in a romantic or sexual relationship could be justified. Ethics codes have specific prohibitions regarding sexual contact with supervisees and students (AAPC, ACA, APA, ASPPB, CPA, AAMFT, and NASW) and do not allow exceptions. The American Psychiatric Association (2009) is the one professional organization allowing for exceptions and states that “sexual contact between a supervisor and a trainee or student may be unethical.”

“Sexual or romantic interactions or relationships with current supervisees are prohibited….. Counseling Supervisors avoid accepting close relatives, romantic partners, or friends of supervisees.” ACA (2005) F.3 b/c.

“Supervisors do not participate in any form of sexual contact with supervisees.” ACES (1995)

“Social workers who function as supervisors or educators should not engage in sexual activities or contact with supervisees, students, trainees, or other colleagues over whom they exercise professional authority…….. Social workers should not sexually harass supervisees, students, trainees, or colleagues. Sexual harassment includes sexual advances, sexual solicitation, requests for sexual favors, and other verbal or physical conduct of a sexual nature.”   NASW (2008) 2.07

“Marriage and family therapists do not engage in sexual intimacy with students or supervisees during the evaluative or training relationship between the therapist and the student or supervisor. Should a supervisor engage in sexual activity with a former supervisee, the burden of proof shifts to the supervisor to demonstrate that there has been no exploitation or injury to the supervisee?” AAMFT (2001) 4.3

“Psychologists do not engage in sexual relationships with students or supervisees in their department, agency, or training center or over whom psychologists have or are likely to have evaluative authority.” APA (2002) 7.07

Many supervisors and supervisees would prefer to minimize the issue of sexual intimacy between supervisors and supervisees, almost to the point of denial. The seminal study on the issue was conducted by Glaser and Thorpe (1986) in which they surveyed female members of APA Division 12, Clinical Psychology. Their survey indicated that 17% of respondents reported having had sexual contact with psychology educators/supervisors as graduate students. In addition, 31% reported having experienced seductive behavior with educators/supervisors while they were in professional training.

A replication of the study by Hammel, Olkin, and Taube (1996) reported that rates of supervisor-supervisee sexual relationships had dropped to 10%, and this rate was sustained in a more recent study (Lamb and Catanzaro, 2003). A variety of studies have since reported rates of supervisor-supervisee sexual relationships to be consistently between 1.5 to 4 %. Lamb and Catanzaro (1998) place the rate of supervisor–supervisee sexual contact between 3% and 8%. A more recent study by Zakrewski (2006) reported rates of 2%, but the sample included male and female students. In that study, women were 2.5 times more likely to have had sexual contact with a supervisor than men.

The impact of a sexual or dual relationship on the supervisory process should not be underestimated. Due to the dual relationship, the supervisee is no longer as comfortable confronting or disagreeing with the supervisor. The supervisor’s ability to evaluate the supervisee objectively is severely compromised by the nature of the dual relationship. A dual or sexual relationship places the supervisor in legal jeopardy to accusations of inadequate supervision or the accusation of unfairness in evaluation. Supervisees involved in a dual relationship with their supervisor run the risk of isolation from the work group by peers, perceived preferential treatment, and questioning of professional judgment (Zakrewski, 2006). Supervisors may consciously or unconsciously over-accommodate or show favoritism to supervisees with whom they have a dual relationship.

Some authors would argue that a sexual relationship between two consenting adults, who happen to be supervisors and supervisees, is not necessarily problematic (Lazarus and Zur, 2002). Celenza (2007) and other authors make very strong arguments to the contrary. “Because of the power differential and the supervisee’s vulnerability implicit in supervisee/supervisor sexual relationships, completely voluntary consent may be impossible in supervisee/supervisor sexual relationships. Thus, to argue that such a relationship is consensual may be fallacious.” (Koocher & Keith-Spiegel, 1998). “The power differential in a supervisory dyad can create unique vulnerabilities for supervisees” (Gottlieb, Robinson, & Younggren, 2007).

In many situations, what started out as “consensual” often takes on a different feeling when the relationship ends or goes sour. Glaser and Thorpe (1986) reported that 28% of those involved in a sexual relationship with the supervisor felt some coercion at the time, but in retrospect, 51% reported feeling that they were coerced into a relationship. More tragically, supervisees who were sexually involved with supervisors are more likely to become offenders themselves (Bartell and Rubin, 1990 Pope et al., 1979).

Legal Issues in Clinical Supervision

DISCLAIMER – Legal issues related to supervision vary significantly from jurisdiction to jurisdiction and from profession to profession. In dealing with specific questions regarding legal issues in supervision, it may be necessary to consult with an attorney licensed in your particular jurisdiction. The following discussion attempts to provide basic information regarding the nature of legal issues that are frequently observed across jurisdictions and across professions. These may serve as a general guide and provide a conceptual understanding of these issues; however, specific situations may require more in-depth analysis by a legal professional.

Many seminars I have attended about legal and ethical issues of supervision seemed to focus on attempting to scare people about the legal and ethical issues of supervision. It is true that you have assumed additional legal and ethical risks once you take on the task of supervision, but this should not create an atmosphere of fear. It is not my intent to scare supervisors or potential supervisors but to provide sufficient information to make suitable decisions that reflect an understanding of supervision’s legal and ethical issues. I hope to inform you of the legal and ethical issues so that you will attempt to “clean up some of the loose ends” and institute appropriate risk management strategies. Supervisors need to be realistic about the reality of the fact that the moment they assumed supervisory responsibilities, they assumed a greater risk of liability and potential ethical violations.

Part of that reality is that as soon as you become a supervisor, you increased the risk that you may be sitting in a chair in the state office building answering questions by a licensing board. By becoming a supervisor, you increased the risks of defending yourself and/or your supervisee’s actions in a circuit court hearing. Due to the increased statistical risks, it is important that supervisors understand some basic legal principles and the impact those principles have on the practice of supervision.  

 Five general legal principles that must be understood to guide you to practice effective risk management:

Standard of CareThe normative or expected practice performed in a given situation by a given group of professionals.

Statutory LiabilitySpecific written standards with penalties imposed, written directly into the law.

NegligenceWhen one fails to observe the proper standard of care.

Direct LiabilityBeing responsible for your own actions or authority and control over others.

Vicarious LiabilityBeing responsible for the actions of others based on being in a position of authority and control.

The standard of care is a rather loosely defined, constantly changing, and gradually emerging principle regarding the practice of a profession that the general public should be able to rely upon. A more concrete example may provide some focus and clarity. When seeking services from any professional licensed, the public has a right to expect certain things and practices. In dentistry, for example, current expectations are very different than the practice of dentistry in the 1860s and have evolved over time. The standard of care has also changed as technology and materials have advanced over time. Individuals have a right to receive dental care consistent with current practices, technology, and knowledge regarding dentistry.

If you seek services from a licensed dentist, and three months later, you find out that your dentist had this crazy idea that to preserve water and energy, she was only going to sterilize instruments every six months. That clearly violates the standard of care for dentistry. If you later develop a blood born disease, you will likely be able to hold the dentist liable, as she certainly violated the standard of care for her profession. There is a standard of care for providing mental health or educational services to clients, and there is an emerging standard for supervision.  

Statutory liability is the principle that certain requirements exist to practice your profession, which is spelled out in statutes or administrative regulations. If you choose to ignore or violate the requirements spelled out in the statutes, you will likely be found criminally or civilly liable. Almost all states have mandatory child abuse reporting laws. If you fail to report, or choose not to report child abuse, you could be held accountable and fined or even imprisoned.  

Negligence, or when a professional fails to observe the standard of care, is an important legal concept that, as a supervisor, you must understand. You can be negligent as a supervisor by failing to observe, either intentionally or even unintentionally, the appropriate standard of care as it relates to the supervision. There are reasonable expectations about supervision, not the least of which is that supervision actually takes place. In a court setting or a board complaint, a supervisee may produce documentation that during the 52 weeks of supervision, the supervisor canceled supervision 26 times. This is a clear indication of failure on the supervisor’s part to meet the duties and responsibilities of supervision and is possible negligence. The failure to supervise consistently and in a timely fashion may have caused injury to a client or at a minimum, may not have provided adequate quality control or allowed for the growth and development of the supervisee.

An important legal distinction involves two other legal concepts: direct liability and vicarious liability. In direct liability, if I do something that damages someone or something, I can be held directly liable. If I am driving while texting, putting on my make-up, eating my breakfast, and running into a car, I may be liable for the damages involved.

In addition, there is also the concept of vicarious liability, which is particularly relevant as it relates to supervision. Vicarious liability is being legally responsible for the actions of others based on the fact that I, as the supervisor, was in a position of authority and control. My position of authority makes me accountable and liable for the actions of those I am directing.

Standard of Care

The standard of care is a legal concept that has emerged from specific case law, ethics codes, professional standards, and the current status of the profession. The standard of care has emerged over time as a part of the commonly accepted practice of a profession. At its core, the standard of care involves an element of competency. People seeking services from professionals, particularly licensed and regulated professionals, have the right to expect that when they seek services that, the professional is competent to provide those services. If an individual is providing services without appropriate credentials or under falsified credentials, they are violating the standard of care, and you may have a claim against them if some damages occur.

Part of the standard of care may relate to confidentiality. Within certain limitations, individuals seeking service have an expectation of confidentiality. If a professional violates that confidentiality and damages occur, the individual may have a legitimate claim of liability and an expectation of compensation for damages. The standard of care also has implications for dual relationships. Seeking services from a professional doesn’t mean that I am consenting to subject myself to a sales pitch about cleaning products or about the value of investing in vacation properties. Saccuzzo (1997) identified five major principles that were repeatedly found in statutes, case law, ethical codes, and professional literature related to the standard of care: 1) Competence, 2) Confidentiality, 3) Dual Relationships, 4) Welfare of Consumer, and 5) Informed Consent.

Fallendar and Shafranske (2004) stated that the Standards of Care for Supervision can be extracted from case law, ethics, statutes, and clinical practice. These included:

  • Supervising only within your area of competence
  • Providing appropriate feedback and evaluation
  • Consistent monitoring and controlling of supervised activities
  • Accurately documenting supervisory activities
  • Providing consistent and timely supervision.

 

The Standard of Care for Supervision is an emerging and changing concept that has evolved over time. It comprises case law, statutes, administrative regulations, ethics codes, and the current professional literature. A major accepted part of the standard of care for supervision is that supervisors only supervise activities within their area of competence. If I have no experience in treating eating disorders, and it just so happens that one of my supervisees is assigned a case involving an eating-disordered client, the Standard of Care for Supervision may require reassigning the case, bringing in another supervisor as a consultant, or that another supervisor assumes responsibility for supervising that case.

To allow a supervisee to provide services involving techniques or a diagnosis that the supervisor has no familiarity with is very likely a violation of the Standard of Care for Supervision. How can the supervisor be monitoring and control activities of which they have no familiarity or competence? Supervising outside my area of competence may involve ethical and legal liability.

Another reasonable expectation of the supervision activity that could be considered part of the standard of care is that the supervisor will provide the supervisee with feedback and evaluation. This is essential so the supervisee can correct errors, improve skills, and develop to their maximum potential as a clinician. Many laissez-faire supervisors who approach supervision casually or with an attitude of “let’s get this over with” may not make the effort to provide their supervisees with accurate and timely feedback so that adjustments in care can be provided. Some supervisors would rather spend hours of supervision discussing the latest agency gossip and sports scores or regaling the supervisee with “war stories” of their therapeutic exploits. While the stories and gossip may be interesting, they do little to improve the quality of care that a specific client receives from their caseworker.

Part of the Standard of Care for Supervision is the expectation that supervisors consistently monitor and control case activity.   As the supervisor, one of your functions is monitoring the supervisee’s work to ensure quality and protect clients. A basic familiarity with the supervisee’s cases and an awareness of what the supervisee is doing or attempting to accomplish with those cases is essential. Failure to be knowledgeable about the supervised cases is an obvious impairment of the supervisory responsibility to monitor and control the supervisee’s work activity.

Some of the activities that a supervisor might be engaged in to be knowledgeable about cases and conscientiously monitor and control a supervisee’s activity would include: reviewing work samples, viewing videotapes, listening to audiotapes sitting in on cases with a supervisee, a joint home visit, reviewing treatment plans, and signing off on progress notes. Failure to engage in these or similar activities may make it difficult to present a credible argument that you are effectively monitoring and controlling a supervisee’s activity.  

Another part of the Standard of Care for Supervision is documenting supervisory activities. Doing supervision without some form of written documentation is roughly the equivalent of providing services without keeping a case record. That would be both ethically and possibly legally disastrous. The old legal adage “if it isn’t in writing, it didn’t happen” probably applies when you were providing adequate supervision, but there is no actual record of it occurring.

Some supervisors, particularly if you are dealing with a veteran staff, may have a more casual attitude about supervision and do not feel that documenting supervisory activity is necessary. This is like “working without a net” and assuming that nothing could go wrong. Well, it can. Not keeping supervision documentation is a prima facie case of inadequate, unethical supervision and a clear departure from the Standard of Care for supervision. In situations where something goes wrong, what is likely to prevent liability from being assessed is that you can point to documentation of specific instructions to a supervisee or a specific discussion with a supervisee. Being able to present supervisory notes that indicate your awareness of and attempts to provide appropriate feedback and monitor the quality of services being delivered is clear evidence that you were attempting to practice within the Supervisory Standard of Care.

Finally, failure to provide supervisees with consistent and timely supervision is one of the most frequent reasons cited as a violation of the Standard of Care for Supervision. A large number of complaints about supervisors heard by licensing boards, and professional associations are for failure to provide consistent and timely supervision. A variety of ethical codes specifically address the concept of providing consistent and timely supervision.

The supervisor who fails to show up for supervision cancels supervision regularly, does not devote the required time for supervision, or always has another higher priority meeting or client crisis is not providing supervision on a consistent and timely basis. Allowing great periods of time to pass without meeting with a supervisee may put clients directly at risk because a supervisee was relying on having access to their supervisor to go over a complication in a case. Often when supervision was canceled or not held, supervisees were left to handle a potentially risky situation on their own.

Negligence/Malpractice

Malpractice is professional negligence and is, therefore, a tort. A tort is a wrong that involves a breach of a civil duty owed to someone else. A person who suffers a tortuous injury is entitled to receive “damages,” usually monetary compensation, from the person or people responsible — or liable — for those injuries. The most prominent tort liability is negligence. If the injured party can prove that the person believed to have caused the injury acted negligently – that is, without taking reasonable care to avoid injuring others – tort law will allow for compensation. A successful malpractice suit must demonstrate the “four D’s” Dereliction of a Duty Directly causing Damages. (Bennie et al., 1998)

To establish that a supervisor has acted negligently, four legal criteria must be established:

  1. There was a duty to perform an action as established by the nature of the relationship or by statute.
  2. There was a breach of the established duty, a violation of a standard of care that was foreseeable and unreasonable.
  3. There is direct causation – breach of duty or care that was the direct or proximate cause of the injury.
  4. Damages occurred as a result of the supervisor’s action or lack of action, i.e., physical, financial, or emotional injury or damages.

Bennett et al. (1990) and Guest and Dooley (1999) expanded these concepts in the context of supervision:

  • A professional relationship was formed between the supervisor and supervisee.
  • There is a demonstrable standard of care for supervision, and the supervisor beached that standard.
  • The supervisee or client suffered demonstrable harm or injury.
  • The supervisor’s breach of duty to practice within the standard of care was the proximate cause (reasonably foreseeable) of the supervisee’s or client’s injury.

When a supervisor enters a supervisory relationship, that supervisee and indirectly all of their clients have a right to expect that the supervisor will engage in certain activities to monitor the quality of the service and direct the supervisee’s activities. A breach in that relationship and obligation is when the supervisor does something to violate that standard of care, like not showing up for 50 percent of the supervision sessions. In that situation, the supervisor has probably breached their duty to perform and, therefore may be negligent in that regard.

Another part of supervisory negligence that must be proven is to show causation.   A major part of negligence is that there has to be demonstrable proof of causation of damages. If breaching the duty as a supervisor can be demonstrated to be the cause of damages taking place to a client or a supervisee, then negligence or malpractice may have occurred, and damages could be awarded.

Finally, as a part of negligence, there must be demonstrable damages. Supervisors are not negligent if they do something the supervisee does not like or disagree with. A plaintiff or supervisee must demonstrate that financial, physical, or emotional damages have occurred, and they have a right to be made whole. A supervisee might claim that a supervisor gave them a biased or unfair evaluation due to failing to properly execute their supervisory responsibilities. Pursuant to that evaluation, the supervisee might have been unable to be licensed, and therefore, they could not make a living or suffered a loss of income. A supervisor could be found negligent and held liable for the loss of income that the supervisee suffered due to the supervisor’s negligence.

Supervisory malpractice involves lawsuits filed by a supervisee or a client against a supervisor who has allegedly violated professional supervision practice standards. Failure to adequately supervise students or assistants is one of the ten most common causes of malpractice lawsuits (Stromberg and Dellinger, 1993). State Psychology Licensing Boards reported that inadequate or improper supervision ranked fifth in frequency among violations (Reaves, 1998). Harris (2003) identified supervisors as being at high risk of experiencing licensing board complaints due to the nature of the supervisory relationship.

Direct versus Vicarious Liability

As a supervisor, you have legal responsibility for the actions of your supervisees. “The supervisee is legally an agent of the supervising psychologist” (Knapp & Vandecreek, 2006). Legal liability (Johnson, 1995; Saccuzo, 2002) permeates all areas of supervisory responsibility, particularly issues related to client welfare, professional development, and gatekeeping.

For those individuals supervising, a key legal distinction that must be understood is the distinction between direct liability and vicarious liability. Direct liability is based on erroneous, improper, or unethical actions or omissions on the supervisor’s part. In the case of direct liability, if an individual takes some kind of action or fails to act, and as a result, another individual is damaged in some way, direct liability accrues.   If a supervisor does something and causes damages to an individual, the supervisor may have liability and an obligation to make the person whole by paying damages.

Harrar, VandeCreek, and Knapp (1990) summarized direct liability as including any action or lack of action that is a dereliction in carrying out the responsibility to adequately supervise a supervisee’s work. This could include not supervising consistently or in a timely basis, not adequately monitoring a supervisee’s caseload, failing to provide emergency coverage or crisis procedures, or not providing clear expectations or a supervisory contract. Giving a supervisee an inappropriate treatment recommendation that the supervisee implements to the client’s detriment may result in direct liability on the supervisor’s part.

Other examples of situations where the supervisor might incur direct liability are: 1) assigning tasks to the supervisee that the supervisor knew, or should have known, the supervisee was inadequately trained to handle, 2) allowing a supervisee to practice outside his/her scope of practice, 3) failure to assess the supervisee’s skills and abilities, and 4) failure to listen carefully to a supervisee’s comments and therefore, failing to comprehend the client’s needs. Lack of consistent feedback before the evaluation, a biased or unfair evaluation, or violating professional boundaries are obvious direct failings on the part of a supervisor for which they can be held directly liable.

In addition to having direct liability for my actions as a supervisor, the concept of vicarious liability means that the supervisor may also be liable for the actions of those individuals they supervise. Vicarious liability holds that supervisors are liable for their supervisee’s actions because a) they are in a position of responsibility and authority, b) the supervisee was under the direct control of the supervisor, and c) the supervisor or supervisor’s agency or organization, may profit from the actions of their supervisees (Behnke et al., 1998). As a supervisor, even though I did nothing wrong, if my supervisee caused damages, the supervisor may hold some accountability for the actions of their supervisees. Saccuzzo stated that “supervisors can be liable not only for their own negligence in failing to supervise adequately but also for the actions of their supervisee.”

Vicarious Liability is based on the concepts of respondeat superior, borrowed servant rule, or enterprise liability (Falvey, 2001).

Respondeat Superior – liability attaches to a supervisee’s actions because the supervisor has the authority and control, even if they lack specific knowledge about the situation. Liability attaches to whether or not the supervisor personally breached a duty. “One who occupies a position of authority or direct control over another (such as a master and servant, employer and employee, or supervisor and supervisee) can be held legally liable for the damages another suffered as a result of the negligence of the subordinate” (Disney and Stephens, 1994). To whatever extent a supervisor has the ability and responsibility to control the activities of a supervisee, the supervisor has responsibility and liability for their supervisee’s actions.

Borrowed Servant – liability attaches to the person who had control of the supervisee at the time of the negligent act. Liability may attach to the actions of my agents, representatives, or employees if they were acting on my behalf. This can become clouded when a supervisee is assigned or on loan from another entity, such as a student assigned to an agency for practicum or internships. Essential in determining supervisory liability is whether a person is subject to another’s control regarding the work to be conducted and the manner of performing that work (Sacuzzo, 1997).

Enterprise Liability – liability attaches to the extent that the supervisor or organization benefits or profits from the supervisee’s work. If a supervisor, or their organization, profits from the activities of a supervisor, the liability for the supervisor’s actions and activity increases. The possibility to gain from a supervisory relationship changes the nature of the relationship. The nature of the relationship creates additional liability and may create a dual relationship. The California Board of Psychology (2008) prohibits supervision for the pay of prospective licensees. ASPPB (2003) spells out the differing nature of a supervisory relationship to the extent that “payment for supervision by a pre-doctoral supervisee is not acceptable.”

 

Disney and Stephens (1994) clarified factors that aid in determining whether the supervisee’s negligence implicated the supervisor, resulting in vicarious liability. These factors included the supervisor’s power to control the supervisee and the supervisee’s duty to perform the act. Was the supervisee acting in a fashion consistent with their duties and obligations? Other factors that might mitigate vicarious liability for the supervisor included the time, place, and purpose of the act, the motivation of the supervisee for engaging in the act, and finally, whether the supervisor could have reasonably expected that the supervisee might commit the act. Some behaviors that a supervisee might engage in are inappropriate but so far beyond a reasonable possibility that it would not be rational for a supervisor to monitor and control that activity.

Due to their supervisee’s inappropriate actions, vicarious liability becomes a concern to supervisors. A substantial body of case law would indicate that supervisors can be liable for what they knew and if their negligence created a situation where they should have known a supervisee was acting inappropriately. Simmons v. United States (1986) held that supervisors assume direct responsibility for their response to supervisee sexual transgressions with clients. Supervisors oversee the counseling relationship between the supervisee and client and should know what is happening.

In Simmons v. United States (1986), a social worker who was being supervised initiated a sexual relationship with a client. A Tribal Chairwoman approached the supervisor and expressed concern about the relationship. The supervisor did not investigate the improper counseling relationship or remove the social worker from the case. The client ultimately attempted suicide when the relationship ended. The Court found that negligence is imposed on one who should have known of the negligent acts of a subordinate, and the supervisor should have supervised the worker more closely so that he would have been aware of the situation at a much earlier date.

As a supervisor, you may be legally vulnerable if you fail to take appropriate actions (Andrews v. United States, 1984, cited in Falendar and Shafranske, 2004). A supervisor failed to investigate a report that an intern was having a sexual relationship with a client. By not speaking with the patient, conducting an investigation, or filing a written report, the supervisor was found liable since he negligently failed to respond appropriately to a complaint of sexual misconduct.

Many currently supervise individuals operate under a fairly naïve and false presumption that they are immune to adverse legal problems due to their experience and professionalism. Pope and Tabachnick (1993) found that 11.6 % of respondents reported at least one malpractice lawsuit or board complaint. Miller (2002) stated that the possibility of an adverse disciplinary event during a 15-year career is 10 to 15%.

It is statistically unlikely that many supervisors will be named in a lawsuit or criminal action. However, supervisors may find themselves more frequently facing a licensing board complaint. In many instances, it may be better to face a civil action than a licensing board complaint. The legal system offers built-in protections, such as rules of evidence and a standard of proof. If an individual is charged with a capital offense, they must be found guilty “beyond a reasonable doubt,” or in more common parlance, at a level of about 95% certainty. If an individual is charged with a felony complaint, the standard of proof in most legal systems is a “clear and convincing” or about 75% proof. In a civil action, the standard of proof is only a “preponderance of the evidence” or greater than 51%.

Many licensing boards have not established standards of proof and often utilize whatever criteria they feel are appropriate given the circumstances to protect the public from unscrupulous or incompetent practitioners. In a court, there are also specific requirements regarding hearsay testimony, third-party testimony, and admission of prior acts. These rules may or may not apply in a licensing board hearing.

Supervision is an activity that has major legal implications and risk as an inherent part of the activity. Several legal principles directly apply to the supervision process, including standard of care, statutory liability, negligence, and direct and vicarious liability. The standard of care is loosely defined as the norm or expected practice performed in a given situation by a given group of professionals. The standard of care would require supervisors to only supervise within their area of competence and provide appropriate feedback and evaluations of a supervisee’s activity. The standard of care for supervision would also include consistently monitoring and controlling a supervisee’s activity, documenting supervisory activities, and providing consistent and timely supervision.

Malpractice is professional negligence. Supervisory malpractice or negligence implies that a supervisor had a duty to adequately supervise a supervisee’s activity and failed to complete that duty. If a client or the supervisee was damaged somehow by the supervisor’s failure to perform adequately, then the supervisor was negligent. Depending on individual state statutes, there may also be other mandated activities and responsibilities that the supervisor is obligated to perform. Failure to perform these activities may carry specific legal penalties and fines.

If a supervisor fails to perform an appropriate supervisory activity, she can have direct liability in the event that a supervisee or client is damaged. This could include failing to adequately monitor or supervise a supervisee’s activity, giving an inappropriate treatment directive, allowing a supervisee to operate outside her scope of practice, failure to listen carefully to a supervisee, or a biased or unfair evaluation.

 

Even if a supervisor performs competently, they may be liable if damages occur to a client at the hands of one of their supervisees through vicarious liability. Numerous court cases have established the obligation and liability of supervisors to perform appropriately.

 

Evaluation

Supervisors are ethically bound to provide an impartial, objective, and accurate evaluation of supervisees. Supervisees are legally entitled to receive an unbiased and objective evaluation of their skills and performance. The supervisor’s lack of understanding of the significance of their role as an evaluator can often lead to formal complaints on the part of supervisees. The lack of timely feedback has become the most common basis for a formal ethics complaint regarding supervision (Koocher and Keith-Speigel, 1998).

A supervisor’s reluctance to deal with uncomfortable evaluation issues has potential legal implications, as it may relate to a supervisee’s ability to obtain employment or licensure. Supervisors must understand that evaluation is an ongoing process, not an event, i.e., a once-a-year performance appraisal. Supervisors’ continuous evaluation allows supervisees to remediate particular skill deficits or improve specific aspects of performance. How the evaluation/feedback is handled is the core of a positive or negative supervisory experience (Lehrman and Ladany, 2001).

Evaluation is a four-step process that begins long before the supervisor sits down with a rating form to prepare a formal appraisal. The initial step in the evaluation process should take place at the first meeting of a supervisor and supervisee.  Establishing goals and objectives for supervision, as well as spelling out specific criteria on which the supervisee will be evaluated, should occur at the beginning of the supervisory process, and preferably in writing.

Supervisors should receive ongoing feedback on how they perform on these criteria as a regular part of the supervisory sessions. Providing more formal feedback at set intervals, such as once a quarter or at the end of each semester, ensures and documents that the supervisee has been made aware of their performance level. This may be particularly essential in those situations where the final evaluation, which formalizes performance for a specific time period, is going to be negative or critical. Providing more formal evaluation at definite time intervals puts the supervisee on notice and eliminates any “surprises” in the evaluation.

It may be worth the supervisor’s time to examine and reflect on their own experiences of being evaluated. What factors or circumstances might have kept the evaluation from being a constructive experience? Identifying the format and the evaluation process at the time of orientation provides understandable expectations and transparent criteria for acceptable service provision. The format, methods, and techniques that will be a part of the evaluation process should be known in advance by all parties.

 

In some situations, clarifying who will be involved in the evaluation may be advisable, particularly if the information is to be solicited from another staff member or other supervisors. Attempting to be as clear and concrete as possible and describing in behavioral terms exactly what the supervisee will be evaluated on can go a long way towards eliminating difficulties in evaluation. The focus of the evaluation needs to be on behaviors, not on personality factors or on the personal preferences of the supervisor.

Falendar (2004) makes a distinction between Formative Feedback and Summative Assessment. Formative Feedback has, as its purpose, the focus of attempting to assist in skill development. This is done primarily by identifying issues that impede clinical practice with clients or impede the supervisee’s growth and development. Formative Feedback is offered by the supervisor as a means to take corrective action to improve service delivery quality and promote skill development.

Freeman (1985) identifies several characteristics of Formative Feedback, including the fact that it is ongoing and occurs throughout the period of supervision. It is typically informal and not documented in personnel files or as a part of a formal evaluation. Formative Feedback should be consistent, objective, reliable, and timely, provided in close proximity to the actual event. The information in Formative Feedback should be clear, descriptive, constructive, and developmentally appropriate for the supervisee’s experience level.

Conversely, Summative Evaluation is an objective measure of the competence level of a supervisee and typically covers a pre-designated time period (Falendar, 2004). Normally, Summative Evaluation is a quantifiable rating on specific goals and objectives of performance. Summative Feedback or Evaluation increases liability issues, as these documents are often the basis for employment, promotion, tenure, or credentialing. Since Summative Evaluation can have employment and career implications, formal evaluations incur ethical and legal liability for supervisors. This is particularly true if it can be established that the evaluation was handled improperly and directly caused damages to the supervisee.

Summative Evaluations can be particularly difficult if they result in an overall negative appraisal. It is incumbent on the supervisor to be sure that they have defined the criteria for success clearly and in advance and that they have documented frequent formative feedback and assistance in problem areas. Utilizing multiple evaluation methods and having data other than simply self-report and case consultation can minimize the potential problems of an adverse evaluation.

If a Summative Evaluation is going to be negative, it is always advisable to consult with another supervisotr. Finally, be prepared for a negative reaction from the supervisee, particularly in terminations. It is important to gauge your reactions and limit your comments. Always ask yourself the question. How would the particular comment I am about to make sound in court or before a licensing board?

A key component of supervision is the evaluative component that must inevitably occur. Supervisees are entitled to a fair, unbiased, and objective evaluation based on clearly established criteria. Failure to provide an accurate evaluation opens the supervisor to potential liability. Formative evaluation is an integral part of the ongoing supervisory process. The summative evaluation covers a specific period of time and is a quantifiable rating on specific goals and objectives of performance. Summative evaluation increases liability issues, as these documents are often the basis for employment, promotion, tenure, or credentialing.