The Supervisee and Supervisor’s Checklist: Ethical, Legal, and Clinical Issues

Good supervision is a collaborative process, and that collaboration begins before the first case consultation, with the pairing up. The potential supervisor and supervisee each have responsibilities that encompass clinical, legal, ethical and personal considerations.

Whether in agencies or private practice, good supervision is not automatically likely to come to the supervisee; the supervisee has to seek it. And the supervisor’s responsibilities begin before the first case consultation.

What follows is a checklist for supervisees and supervisors.

Gatekeeping. Neither graduate schools nor licensing boards do an effective job at screening out people who are not ready to be therapists. Supervisors are occasionally the last line of defense for current and prospective clients. It is a supervisor’s responsibility to keep public safety in mind by recognizing those instances in which a therapist should not be working a particular client or with clients in general.

Competence and Education. Supervisors should supervise only in areas of practice in which they are competent. In these days of budget and personnel cutbacks, some supervisors working with agencies may find themselves pressured to supervise interns and students in areas outside their particular expertise. Supervisors must resist this. In private practice, it is permissible to take on a supervisee in areas in which supervisors don’t have considerable expertise providing the supervisor finds his own consultation and supervisor. Supervisor competence also includes having taken training in supervision itself, both in the techniques of supervision and the ethics. Barnett cautions that having been a supervisee oneself is NOT a qualification for supervising. Supervisors should also assess the supervisee’s training needs and competence. Effective supervision involves not just case consultations but determining the nature and extent of any additional training and supervision that might be needed. This should be an ongoing assessment.

Supervisees should not be content with what Barnett calls generic supervision. They should seek supervision that is responsive to their particular training needs.

Informed Consent. Supervisors should utilize a comprehensive informed consent process at the beginning of the supervisory relationship. This both reinforces the importance therapists using an informed consent process with clients and helps establish the integrity of the supervisory relationship. Elements of the informed consent should include meeting time and location, complete contact information for both supervisor and supervisee between supervision sessions (including emergency contacts), fees, the nature and timing or evaluative procedures to be used and with whom they will be shared, and an agreement on each person’s responsibilities. The informed consent should be updated to include any changes that occur during supervision. The informed consent may also include the role of discussing professional development issues (see “Competence and Education”) and issues that intertwine with such issues as maintaining the balance between work and family and other interests and career choices.

Limits to Confidentiality. As with informed consent, supervisors should ensure that the supervisee’s informed consent and confidentiality agreements with patients include the supervisor’s involvement in the treatment process. Patients have the right to know that information should be shared with supervisors, what information will be shared with supervisors, and how this information will be utilized.

Phases in Supervision. It is very important that supervisors understand the professional developmental stages involved. For more on this, see articles #1 and #7 in this course.

Supervision as a Safety Zone. The supervisory process should feel safe, not threatening, critical, or punitive. It should provide a forum for guided experimentation that offers enough security and safety so that supervisees will not be afraid to try anything new or fear failure. If this safe environment does not develop, it is the supervisee’s right and responsibility to discuss this with a supervisor or seek assistance from a trusted advisor.

An Atmosphere of Trust and Professionalism. Both the level and intensity of supervision must be adequate and geared toward supervisees’ training needs. Supervisors who merely ask how things are going with clients is not adequate, nor is vague, general praise. Trust is based upon honest feedback, delivered as clearly and supportively as possible. It helps supervisees to remember that the close scrutiny of supervisors is not only their ethical but their legal responsibility. If supervisees are unlicensed, the supervisor is responsible for all that they do professionally, and even in cases in which the supervisee is licensed, supervisors may find themselves targets of client complaints. This ethical responsibility is therefore bi-directional: by not discussing cases fully and sharing treatment notes and audio and/or videotapes of treatment sessions (with appropriate patient consent), supervisees may be not only deprive themselves of full training but may be putting their supervisor in legal jeopardy.

If supervisees do not feel that the supervisory experience is adequately meeting their training needs, they should not tacitly acquiesce, but be proactive and assertive.

Accurate Representation. Supervisees must represent and advertise themselves in a manner that does not imply competence or licensure that they do not have. Clients must be informed that supervisees are receiving supervision (see Informed Consent).

Documentation. Supervisors and supervisees must maintain adequate documentation of supervision sessions, including follow-up on suggestions, recommendations and goals. These records must be maintained in the same way as other clinical records. As with clinical case notes, it is also helpful for both parties to review notes of supervisory sessions over time to check for trends and patterns that may be important to discuss.

Legal and Ethics Issues. Be sure that thorough attention is paid to legal and ethics issues in supervision in addition to patient treatment issues. Supervisors and supervisees should be knowledgeable of, and adhere to, the appropriate professional ethics code of their association and relevant state laws and regulations. Acquiring and following such knowledge should be considered an integral part of the supervision.

Diversity Issues. Supervisors should be sensitive to diversity issues between themselves and supervisees, as well as supervisees’ clients. Such issues should include age, race, ethnicity, culture, gender, religion, and sexual orientation.

Boundary Issues. In addition to all issues typically considered in relationships with patients, supervisors and supervisees must be sensitive to the fine line that at times exists between supervision and psychotherapy. Supervisors should not cross that line and enter into the role of psychotherapist with supervisees. Rather, they should make referrals when indicated. Supervisors hold more power in the supervisory relationship and should not take advantage of supervisees’ trust or dependence on them. All their actions and behaviors should be consistent with the goals of training and professional development.

Multiple Relationships and Multiple Loyalties. Supervision always involved multiple relationships and multiple loyalties that have to be navigated with caution and thoughtfulness. Following are some of these concurrent multiple relationships:

Supervisor-Supervisee
Supervisee-Client
Supervisor-Client
Agency/Clinic-Supervisor
Agency/Clinic-Client
Agency/Clinic-Supervisee
Supervisor –Public
Agency/Clinic- Public

Consultation. When unsure on any of these or related issues, supervisees should consult with an experienced colleague. Regarding legal matters, consult with an attorney before taking or recommending action. If uncomfortable with how the supervisory process or relationship is proceeding, supervisees should attempt to discuss this with the supervisor, but if this is not productive, they should consult with some other qualified person. Professional training should meet training needs in an ethical and appropriate manner. Supervisors should also remember to consult with trusted colleagues if necessary.

 
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