– ETHICAL AND LEGAL ISSUES IN SUPERVISION (BY BARBARA HERLIHY)


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ETHICAL AND LEGAL ISSUES IN SUPERVISION (BY BARBARA HERLIHY)

As was emphasized throughout the introductory chapter, a key goal of supervision is to ensure that clients receive competent, ethical services. A number of ethical issues inevitably arise and must be dealt with in supervision. Some issues that pertain both to the relationship between supervisor and supervisee and the relationship between supervisee and client include securing informed consent, ensuring competence, and maintaining relationship boundaries. A supervisory function that has both legal and ethical implications is gatekeeping for the profession. Legal issues that cause concern among supervisors are vicarious liability and malpractice. These topics are examined in this chapter.


INFORMED CONSENT


Informed Consent for Supervisees


The rationale for informed consent in counseling can be stated in simple terms: Clients have a right to know what they are getting into when they come for counseling (Remley & Herlihy, 2005) . This same principle applies equally to the supervisory relationship. Supervisees have a right to be fully informed, at the outset, about what supervision will entail.

The right of supervisees to receive informed consent creates a responsibility on the part of the supervisor to provide supervisees with a great deal of information. No matter how thoroughly supervisees are prepared, supervision will inevitably hold some surprises for them. However, these surprises should be due to the learning process itself and the complexity of human functioning, not due to carelessness or omissions on the part of the supervisor (Bernard & Goodyear, 2004). Information that supervisors should discuss with supervisees during their initial meeting includes the following:

Purposes of supervision. All supervision shares the same general purpose of fostering the professional growth and enhancing the skills of the supervisee while protecting the client from harm. It is not unusual, however, for supervisees to embark on the supervisory process with a kind of tunnel vision that is focused on the end goal of completing a prescribed number of clock hours to fulfill an internship requirement or to obtain a license to practice. When a supervision relationship is undertaken with the intent of having the supervisor sign off on the required hours, there is little chance that supervision will be a growth-producing experience for the supervisee (Remley & Herlihy, 2005). Beginning the supervisory relationship with a discussion of the goals and purposes of supervision helps to establish that professional growth will be the focus of supervision.

Information about the supervisor. Supervisees need to know that their supervisors are qualified by training, experience, and credentials so that they will feel confident that the supervisory relationship will benefit them. Therefore, supervisors need to describe their qualifications. Because there are likely to be differences in perspective that need to be negotiated (particularly when the supervisor and supervisee are from different disciplines within the mental health field), supervisors should explain their theoretical orientations and supervisory styles and discuss any potential problems that could be created by differences that exist.

Expectations, roles, and responsibilities. Just as clients sometimes have very little notion of what to expect in counseling, supervisees may enter a supervisory relationship having given little thought to the specific responsibilities they will be expected to fulfill. The supervisor has a responsibility to explain the nature of the supervisory relationship, how evaluation will be conducted, and how boundaries will be managed. If the supervisor is providing administrative as well as clinical supervision to the supervisee, distinctions between the responsibilities of the two roles should be clarified.
Supervisors need to make their requirements clear regarding what they expect from their supervisees in terms of taking responsibility for their own learning. Does the supervisor want them to make and review tapes of their counseling sessions? Come to supervision sessions prepared with specific questions? Do outside reading and attend professional development seminars? Present cases for consultation? A crucial question to address is how the supervisee will be evaluated, including processes, procedures, and timing for ongoing and summative evaluation.

Some writers (Bernard & Goodyear, 2004; Remley & Herlihy, 2005) have recommended the use of a written supervision agreement that is reviewed and signed by both parties. This kind of contract can articulate the details of the supervisory relationship and help to avoid later misunderstandings.

Logistics of supervision. A discussion of logistics should lead to an agreement on a myriad of details: frequency of supervision sessions, duration of sessions, fees and payment arrangements (if applicable), forms of documentation that will be required from both the supervisor and supervisee, modalities of supervision that will be used (such as video-or audiotaping, live supervision, case consultation, group and individual supervision), procedures for handling emergency situations, and any contractual obligations of both parties that will need to be fulfilled.

Ethical and legal considerations. It is risky business for supervisors to assume that their supervisees have been taught and know all they need to know about ethical and legal counseling practice. Supervisors are, to some extent, responsible for the acts of their supervisees. Supervisors can protect themselves and safeguard the welfare of their supervisees’ clients when they ascertain at the beginning of the supervisory relationship whether there are areas of ethical and legal practice in which the supervisee may need further instruction or clarification (Remley & Herlihy, 2005). When deficits in knowledge or skill are noted, the supervisor would be wise to assume an instructional role and assure that the supervisee acquires the needed competencies.

Rapid Reference 2.1 summarizes the elements of informed consent for supervision. More detailed information and examples can be found in Chapter 6 under documentation of supervision.


Rapid Reference 2.1

Elements of Informed Consent for Supervisees


• Purposes of supervision

• Information about the supervisor

• Expectations, roles, and responsibilities

• Logistics of supervision

• Ethical and legal considerations

Informed Consent for Clients of Supervisees


The supervisee’s clients must be informed that their counselor is under supervision. Sometimes supervisees are tempted to gloss over the fact that they are under supervision, out of a fear that their clients may have less confidence in their abilities to provide competent services. Supervisors should ensure that these fears do not inhibit supervisees from informing clients of their supervision status. If clients seem uneasy about the idea that a supervisor, who is a faceless stranger to them, will be listening to audiotapes of their counseling sessions or watching from behind a one-way mirror, arrangements might be made (if possible) for the client to meet the supervisor to express any concerns and ask questions directly (Remley & Herlihy, 2005).

Clients need to understand how supervision affects their confidentiality. Because supervisors will have access to confidential client information, clients should be informed regarding what information about them will be shared, with whom, and for what purposes. Will the supervisor be reviewing tapes of counseling sessions? Reading clinical case notes? Observing counseling sessions from behind a one-way mirror? If the supervisee is receiving group supervision as well as individual supervision, clients need to know this and also to understand that the supervisee will protect their identities when discussing their cases within the group format.

Sharing client information with a clinical supervisor is ethically acceptable and is not considered a breach of the client’s confidentiality. The umbrella of confidentiality is understood to be extended to other professionals (such as supervisors, consultants, or fellow members of a treatment team) with whom a counselor shares client information when the purpose is to improve services to clients (Remley & Herlihy, 2005).

Privileged communication is the legal counterpart to confidentiality. Supervisees need to know whether their relationships with their clients are considered to be privileged under the law in the state where they practice. Generally, the answer depends on whether the supervisor’s communications with clients are privileged. Privilege is usually extended to assistants and supervisees of professionals who themselves have privileged communication with their clients (Remley & Herlihy, 2005).

From an ethical perspective, it is important for supervisors to remember that they share the same obligations to client confidentiality as does the supervisee. Supervisors must maintain the confidentiality of any materials in their possession that may contain identifying information about clients, and they need to ensure that tapes of sessions are erased after they have served their purpose.


COMPETENCE


In the past, it was generally assumed that a professional who was a skilled practitioner would also make a good supervisor. Today, it is recognized that being a highly competent practitioner of one’s profession does not necessarily translate into being a competent supervisor and that supervision requires a specialized knowledge base and unique skills.


DON’T FORGET

Clients of supervisees must be informed that their counselor is working under supervision.

Competence in supervision is an elusive concept that can be difficult to define, particularly because competence is not an either-or characteristic. Competence exists on a continuum with maximum professional effectiveness on one end and gross negligence or incompetence at the other extreme. Generally speaking, however, competence as a supervisor is viewed as a quality that can be intentionally acquired through training, credentials, and experience.

To become a competent supervisor, it is necessary to acquire specific training in supervision. Professional organizations of most mental health professions make this obligation explicit to their members. For example, the Association for Counselor Education and Supervision’s (ACES) Ethical Guidelines for Counseling Supervisors (1993) require that those who undertake a supervisory role receive training in supervision before taking on that role, and the National Association for Social Workers (NASW) Code of Ethics (1999) requires social workers to have the knowledge and skills needed to supervise properly. Best-practice standards for competent supervision in counseling, as described in the ACES “Standards for Counseling Supervisors” (1990), include the following knowledge and skill components:

• Effectiveness as a counselor

• Attitudes and traits such as sensitivity to individual differences, motivation and commitment to supervision, and comfort with the authority inherent in the supervisory role

• Knowledge of and skill in applying ethical, legal, and regulatory dimensions of supervision

• Understanding of the professional and personal nature of supervision and the impact of supervision on the supervisee

• Understanding of the methods and techniques of supervision

• Appreciation for the process of counselor development as it unfolds in supervision

• Skill in case conceptualization and case management

• Ability to evaluate performance fairly and accurately and to provide constructive feedback

• Knowledge of oral and written reporting and recording procedures

• Knowledge of the rapidly expanding body of theory and research about supervision

Credentials are another possible means to gauge competence as a supervisor. Although a license or certification is required to practice most mental health professions, there is no standardized credentialing process for supervision. Counselor licensure boards in some states (e.g., California, Louisiana, Ohio, Texas) require those who supervise counselor interns not only to be licensed as counselors but also to hold a separate credential as a board-approved supervisor. The American Association for Marriage and Family Therapy (AAMFT) also offers an approved supervisory credential. The Center for Credentialing and Education (CCE), an affiliate of the NBCC, offers a national supervisory credential, but it is a voluntary credential. As was noted in the introductory chapter, supervisor competence is a vital issue that remains to be addressed on a consistent basis by the mental health professions.

The third criterion for achieving competence is clinical experience. Supervisors are expected to be well experienced in the areas of client services in which they are supervising. It would be impossible for any supervisor to have the breadth and depth of experience that would be needed to be competent to supervise in every specialty area, in every practice setting, and with every type of clientele who might present for services. Therefore, those who intend to provide supervision should be very clear about the kinds of cases they would not supervise (e.g., genetic counseling, child sexual abuse, or gerontological counseling if the supervisor lacks experience with these issues) and the kinds of settings that are outside their range of experience (e.g., inpatient treatment facilities for the chronically mentally ill if the supervisor’s experience is limited to the school setting).

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Mar 22, 2017 | Posted by in PSYCHOLOGY | Comments Off on – ETHICAL AND LEGAL ISSUES IN SUPERVISION (BY BARBARA HERLIHY)

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