Issues in Supervision and Consultation

Chapter Nine3.25.08

How would you describe the qualities of your best supervisor?

Are the skills used in counseling the same as those needed to adequately supervise

counselors in training?

Introduction

• Supervision is the most important component in the development of a competent practitioner.

• Four goals of supervision are: – (1) to promote supervisee growth and development;– (2) to protect the welfare of the client; – (3) to monitor supervisee performance and to serve as a

gatekeeper for the profession; and – (4) to empower the supervisee to self-supervise and

carry out these goals as an independent professional.

Ethical Issues in Clinical Supervision

• The Association for Counselor Education and Supervision (ACES) has developed “Ethical Guidelines for Counseling Supervisors”

Ethical Issues in Clinical Supervision…

• Informed consent in supervision is as essential as informed consent in counseling.

• At times, faculty members need to be updated regarding students’ progress.– However, personal information that supervisees share

in supervision should generally remain confidential.

Supervisor’s Roles and Responsibilities

• Supervisors are ethically and legally responsible for the actions of their trainees.

• Supervisors should maintain records pertaining to their work with trainees.

• Supervisors need to be careful not to misuse the inherent power in the supervisor-supervisee relationship.– Sherry (1991) the clients’ welfare comes first, followed

by that of the supervisees.– Pages 354-355 list supervisory responsibilities

Methods of Supervision

• The most important element in the supervisory process is…? – The kind of person the supervisor is…

• Supervisors need to create a collaborative relationship that encourages trainees to reflect on what they are doing.

• Verbal exchange and direct observation are the most commonly used forms of supervision.

Methods of Supervision continued

• Self-report is one of the most widely used methods, but it may be the least useful.

• Process notes build on the self-report by adding a written record explaining the content of the session and the interactional processes.

• Audiotapes are a widely used procedure that yields direct and useful information about the supervisee.

Methods of Supervision continued

• Videotape recording allows for an assessment of the subtleties of the interaction between the supervisee and the client.

• Live supervision provides the most accurate information about the therapy session.

Styles of Supervision

• Supervisors try to promote autonomy without overwhelming supervisees.

• Socratic supervisors function as a catalyst for exploration to help trainees realize that the answers lie within themselves.

• Although the trainee’s ability to assess and treat a client’s problems is important, in supervision, we are MORE concerned with the interpersonal aspects that are emerging.

Styles of Supervision continued

• Most important goals for clinical supervisors:– To promote the supervisee’s self-awareness and ability

to recognize personal characteristics that could have a negative impact on the therapeutic relationship.

– Goal may be impeded by an emphasis on the supervisor’s legal responsibilities and the threat of being sued.

– Concerns lead to the supervisor to become more directive and controlling.

Ethical Practices of Clinical Supervisors

• Ladany et al., (1999) found that 51% of the 151 supervisees sampled reported what they considered to be at least one ethical violation by their supervisors.– Ethical guidelines most frequently violated:

• adequate performance evaluation• confidentiality issues relevant to supervision• ability to work with alternative perspectives.

Findings of Ladany et al. (1999)

• 33% did not provide adequate evaluations

• 18% felt confidentiality was not handled appropriately

• 18% reported supervisors were not open to other theoretical perspectives

• 13% indicated Sup’s did not ensure adequate sessions or respect

• 9% indicated Sup’s never explained roles

• 9% viewed their supervisors lacked competence

Ladany et al., continued…

• 8% Sup’s did not address how to disclose student status to clts.

• 8% didn’t model or respond to ethical concerns

• 7% expressed crisis policies & procedures weren’t discussed

• 7% multiculturally insensitive

• 6% dual relationships• 5% didn’t address

termination or f/u appropriately

• 5% didn’t differentiate between therapy & supervision

• 1% sexual or romantic issues

Competence of Supervisors

• Standards for qualifying to be a clinical supervisor included formal course work and supervision of one’s work with supervisees are a recent development.

• Counselor licensure laws in a number of states (Arkansas, Louisiana, Michigan, Ohio, South Carolina, and Texas) now stipulate that licensed professional counselors who practice supervision are required to have relevant training experiences and course work in supervision.

Attributes of Competent Supervisors

• Humor• Empathy• Respect• Genuineness• Personal warmth• Supportive attitudes• Ability to confront• Immediacy

• Concern for supervisee growth and well-being

• Concern for clients’ welfare

• Availability for self-reflection

• Flexibility & openness to new ideas & approaches

• Courage• Tolerance, and openness

to learning styles.

Signs of Supervisor Impairment

• Boundary violations • Misuse of power • Sexual contact with supervisees• Substance abuse• Extreme burnout • Diminished clinical judgment

Legal Aspects of Supervision

• Legal considerations:– informed consent– confidentiality and its limits– direct & vicarious liability.

• Supervisors have a relationship with the trainee’s clients.

• Supervisees and their clients are fully informed about the limits of confidentiality, including those situations in which supervisors have a duty to warn or to protect.

Legal Aspects of Supervision

• McCarthy et al., (1995) recommend addressing the following areas in a written informed consent document: purpose of supervision, professional disclosure statement, practical issues, supervision process, administrative issues, ethical and legal issues, and statement of purpose.

• Supervisors are both ethically and legally vulnerable to the work performed by those they are supervising.

Legal Aspects of Supervision continued

• Direct liability– derelict in the supervision of their trainees– if they give trainees inappropriate advice about

treatment– if they give tasks to trainees that exceed their

competence• Vicarious liability

– the responsibilities supervisors have due to the actions of their supervisees.

• See pg. 364 of our text for a list of risk management practices for supervisors (Haynes et al., 2003).

Special Issues in Supervision for School Counselors

• Page, Pietrzak, & Sutton (2001), only 13% of school counselors were receiving individual clinical supervision and only 10% were receiving group clinical supervision.

• Page et al., found that a majority of counselors desired but did not receive clinical supervision.

Liability Issues in Supervision of School Counselors

• Concerning accountability and liability, administrative supervisors or employers have direct control over the actions of counselors in the school.

• Administrative supervisors are legally liable for the actions of the school counselors they hire, evaluate, and may fire.

• Clinical supervisors are not directly responsible for the actions of school counselors because they do not have the authority to hire and fire.

Rights of Supervisees• Supervisory sessions free from distractions• To be fully informed of supervisor’s approach• Confidentiality with regard to supervisee’s disclosure • Confidentiality with regard to clients except as mandated

by law• Continual access to records maintained during supervision• To provide feedback to supervisors concerning supervision

experience• To seek consultation from other professional as necessary

Issues and Ethics - Chapter 9 (1)

Osborn & Davis (1996)

• Purposes, goals, & objectives of supervision• Context of services• Method of evaluation• Supervisor’s scope of competence• Duties & Responsibilities

– Supervisor– Supervisee– Procedural Considerations

Multicultural Issues in Supervision

• Dimensions of a good multicultural model:– pluralistic philosophy– cultural knowledge– consciousness raising– experiential training– contact with racial and ethnic minorities– practicum or internship with culturally diverse

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Multiple Roles & Relationships in the Supervisory Process cont.

• The crux of the issue of multiple-role relationships in the training and supervisory process is the potential for abuse of power.

• Certain multiple relationships are unavoidable in most training programs.

• It is misleading to confuse nonsexual dual or multiple relationships with unethical sexual relationships.

Multiple Roles and Relationships

in the Supervisory Process• Sexual intimacies during training:

– core issue is difference in power and status • Providing counseling for trainees:

– dual relationship standard of ethical conduct should be used

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Ethical and Professional Issues in Consultation

• Ethical standards for consultants• Value issues in consulting• Competence in consultation• Consultant training• Relationship issues in consulting• Rights of consultees• Issues involving consulting group

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