Ethical and Legal Issues in

Supervision: Essentials for

Effective Supervisors

JEFFREY E. BARNETT, PSY.D., ABPP

LOYOLA UNIVERSITY MARYLAND

 THE SIXTH INTERNATIONAL INTERDISCIPLINARY CONFERENCE

ON CLINICAL SUPERVISION

JUNE 10-12, 2010

 What is Supervision?

A distinct professional activity in which education and

training aimed at developing science-informed practice
are facilitated through a collaborative interpersonal
process. It involves observation, evaluation, feedback, the
facilitation of supervisee self-assessment, and the
acquisition of knowledge and skills by instruction,
modeling, and mutual problem solving…Supervision
ensures that clinical consultation is conducted in a
competent manner in which ethical standards, legal
prescriptions, and professional practices are used to
promote and protect the welfare of the client, the
profession, and the society at large (Falender and
Shafranske, 2004, p. 3)
 What is Supervision?

An intervention provided by a more senior member

of a profession to a more junior member or members
of that same profession. This relationship is
evaluative; extends over time; and has the
simultaneous purposes of enhancing the professional
functioning of the more junior person(s), monitoring
the quality of professional services offered to the
clients that she/he, or they see, and serving as a
gatekeeper for those who are to enter the particular
profession (Bernard & Goodyear, 2004, p. 8).
 Understanding Supervision

 Clinical supervision is the mental health professions’

“signature pedagogy” (Goodyear, 2007, p. 273).
 Romans, Boswell, Carlozzi, and Ferguson (1995) have
reported that clinical supervision “is a central component in
the training of graduate students in clinical, counseling, and
school psychology” (p. 407).

 Differentiating Supervision and Consultation:

 Licensure status
 Responsibility
 Accountability
 Overarching obligations
 Obligations for the recipient
 Key Ethical Issues

 Informed Consent
 Competence
 Protection of the Public
 Accurate Representation to the Public
 Confidentiality
 Documentation and Record Keeping
 Boundary Issues and Multiple Relationships
 Diversity
 Evaluation and Feedback
 Gatekeeper Functions
 Legal Liability and Responsibility
 Relevant APA Ethics Code Standards

2.01 Boundaries of Competence

2.03 Maintaining Competence
2.05 Delegation of Work to Others
2.06 Personal Problems and Conflicts
3.04 Avoiding Harm
3.05 Multiple Relationships
3.06 Conflict of Interest
3.08 Exploitative Relationships
3.10 Informed Consent
4.01 Maintaining Confidentiality
4.02 Discussing the Limits of Confidentiality
4.03 Recording
 APA Ethics Code (cont.)

5.01 Avoidance of False or Deceptive Statements

6.01 Documentation of Professional and
Scientific Work and Maintenance of Records
6.04 Fees and Financial Arrangements
6.06 Accuracy in Reports to Payors and Funding
Sources
7.06 Assessing Student and Supervisee
Performance
7.07 Sexual Relationships With Students and
Supervisees
Relevant Standards of the NASW Code of Ethics

 1.03 Informed Consent

 1.04 Competence
 1.05 Cultural Competence and Social Diversity
 1.06 Conflicts of Interest
 1.07 Privacy and Confidentiality
 1.09 Sexual Relationships
 3.01 Supervision and Consultation
 3.02 Education and Training
 3.03 Performance Evaluation
 3.04 Client Records
 3.05 Billing
 4.02 Discrimination
 4.04 Dishonesty, Fraud, and Deception
 4.05 Impairment
 4.06 Misrepresentation
 Informed Consent to Supervision

Informed Consent Between Supervisor and

Supervisee
Informed Consent Between Supervisee and Client
Purposes of Informed Consent
Requirements for Consent to be Valid
Issues to Include in Informed Consent Agreements
The Supervision Contract
 Why Informed Consent?

 The process of sharing information with patients that is essential to

their ability to make rational choices among multiple options” (Beahrs
& Gutheil, 2001)
 Intended to protect the welfare of clients by offering them the
opportunity to make free and informed choices (Corrigan, 2003).
 Provides the information needed for individuals to make an informed
decision about whether or not to participate in a professional
relationship.
 It serves as a means of sharing decision-making power in the
professional relationship (Meisel et al., 1977).
 It promotes autonomy and self-determination, helps minimize the risk
of exploitation and harm, fosters rational decision making, and
enhances the working alliance (Snyder & Barnett, 2006).
 Requirements of Valid Informed Consent

It is given voluntarily

The individual is competent to consent (legally as
well as cognitively/emotionally)
We actively ensure the individual’s understanding of
what s/he is agreeing to
It is documented

An ongoing process, not a singular event

Provided verbally and in writing
 Elements of Informed Consent to Supervision

The number and types of clients to be supervised

The number of hours of supervision to be provided
When and where the sessions will occur
The frequency and length of supervision sessions
Appropriate reasons for cancelling supervision sessions
and the mechanism for doing so
Fees and financial arrangements
Charges for missed or cancelled sessions
The method of supervision, preparation required or
expected
Limits of decision making by supervisee and
responsibility of supervisor for delegating tasks
 Elements (Cont.)

Expectations for any special requirements such as audio

or video taping
A detailed timetable for informal and formal written
evaluations, evaluation criteria, and standards to be met
A clear statement of the limits of confidentiality in the
supervisory relationship
Documentation requirements
Use of outside consultation
Emergency contact information
Potential reasons and mechanism for terminating the
supervisory relationship
Procedures for resolving disagreements (Barnett, 1991)
 Contracting for Supervision

 Ethics codes for psychologists require that informed consent

be obtained from supervisees as well as other recipients of
psychological services. This can be accomplished with a
supervision contract. The following are examples of the types
of information that should be included.
 Limits of confidentiality in supervision must be described, and
each exception listed. This list should include those exceptions
affecting psychotherapy relationships, (i.e., confidentiality will
be breached if there is a court order; abuse or neglect of a
child or vulnerable adult; potential suicide, homicide or threat
of physical harm.
 Additionally, supervisees must be made aware of any
requirements to report unethical behavior that may apply to
them. These requirements will depend on which licensing
board or boards govern their professional behavior.
 Contracting (cont.)

 Confidentiality policies must be established regarding

information about both clients and supervisees. For example,
the supervisor and supervisee will need to determine whether
identifying information about clients will be used in the
supervision. If so, clients must be informed that such
information will be discussed in supervision, and must
consent to participation in therapy with this understanding. If
not, supervisees must be advised of their responsibility to
protect the identities of clients they discuss.
 The policy should also include a statement indicating that the
supervisor will keep confidential any information obtained in
the context of supervision. If information will be shared with
other staff members at the agency, with college faculty (if the
supervisee is a student), or others, supervisees must be so
informed at the outset.
 Contracting (cont.)

 Supervisory contracts should also include an agreement that:

 the supervisee will keep the supervisor informed about all
significant aspects of his/her client's treatment including suicidality,
conflicts between the supervisee and a client, and accusations of
unethical behavior, as well as personal factors that could potentially
impair the supervisee's effectiveness;
 the supervisor has the final say in treatment decisions because
he/she is legally responsible for the management of the case.
 
 Consultation contracts should include information about the limits
of confidentiality, but need not contain a mandate about the types of
client issues that must be discussed in the consultation.
Additionally, a statement clarifying that responsibility for treatment
decisions rests solely with the consultee, and not the consultant,
should be included.
 (Janet Thomas, St. Paul Minnesota, 2006)
 Competence

The Supervisor’s Competence

 Competence in Supervision
 Competence in the areas being supervised
 Sub-contracting supervision on areas outside o
of the supervisor’s expertise

Training to be a Supervisor vs. On-the-job training

 What is Competence?

Knowledge
Skills
Attitudes and Values
And the Ability to Implement them Effectively, to include
professional judgment
The habitual and judicious use of communication,
knowledge, technical skills, clinical reasoning, emotions,
values, and reflection in daily practice for the benefit of
the individual and community being served based on
habits of mind, including attentiveness, critical curiosity,
self-awareness, and presence (Epstein & Hundert, 2002,
p. 227).
 The Cube Model of Competence

Foundational Competencies: scientific knowledge and

methods, reflective practice and self-assessment, ethical
and legal standards, awareness of diversity factors, the
ability to relate to others in an effective manner, and
knowledge of concepts in closely related fields (Rodolfa
et. al., 2005).
Functional Competencies: assessment, diagnosis, case
conceptualizations, modes of intervention, consultation,
research, supervision, and management (Rodolfa et. al.,
2005).
Stages of Professional Development: graduate level
education, internship, postdoctoral training, and
continuing education (Rodolfa et. al., 2005).
 Relevant Competencies

 Core Competencies include the following areas:

psychological assessment, intervention, consultation and
interprofessional collaboration, supervision, professional
development, and core values as related to ethical conduct
principles (Kaslow, 2004).
 Specialty Competencies are distinctive to specific areas
of practice. They are built on the foundation of core
competencies through the attainment of advanced
attitudes, knowledge, and skills for a distinctive area of
practice (Kaslow, 2004).
 Generic Competencies, Specialty Competencies, Technical
Competencies.
 Assessing Supervisee Competence

Prior to the supervisee treating any clients the

following may occur:
Review of transcripts or other academic records,
letters of recommendation, c.v., past training
experiences, list of tests administered and scored, list
of types of clients treated and modalities used.
Interview/discussion with the supervisee.
Informal assessment of supervisee competence.
Formal assessment of supervisee competence;
verbal, written, practical.
 Protection of the Public: Paranoia vs. Trust

How closely to supervise?

Level of intensity of supervision?
Taking a developmental perspective:

Supervisee observes supervisor provide treatment

followed by analysis and discussion.
Supervisor and supervisee provide treatment
together followed by analysis and discussion.
Supervisee provides treatment while observed by
supervisor – bug in the ear, call-in, etc.
 Paranoia vs. Trust (cont.)

Supervisee provides treatment that is videotaped.

Videotape and documentation are reviewed by
supervisor prior to supervision session.
Supervisee provides treatment that is audiotaped.
Audiotape and documentation are reviewed by
supervisor prior to supervision session.
Supervisee provides treatment, documents it, and
supervisor reviews the documentation prior to the
supervision session. (Still may have one case
video/audio taped for more intensive supervision)
 Accurate Representation to the Public

Never imply practicing Independently.

See relevant ethics code standards.
See relevant laws
 E.g., in Maryland “Psychology Associate”. In
written communications may only represent oneself
as a Psychology practicing under the supervision of
(name of psychologist), Maryland licensed
psychologist number (license number).
 Confidentiality

Ensuring a clear understanding of the limits of

confidentiality and including this in the informed
consent agreement/contract:
 Between supervisee and client (mandatory
exceptions to confidentiality relevant to all clients as
well as how supervision impacts confidentiality such
as review of documentation and audio/video tapes,
observation of sessions, etc.
 Between supervisor and supervisee (feedback to
training program or others, etc.)
 Documentation and Record Keeping

See APA Ethics Code (http://www.apa.org/ethics/)

See APA Record Keeping Guidelines
(http://www.apapracticecentral.org/ce/guidelines/index.aspx)

Documentation of professional services provided by the

supervisee to clients
Documentation of supervision sessions by both
supervisor and supervisee
 Accountability, record of what transpired, agreements
and obligations, follow-up, evaluations of supervisee, etc.
 Documentation of Supervision (cont.)

All issues discussed

Recommendations made
Actions taken
Areas in need of remediation, recommendations
made, actions taken, assessment, and follow-up
Assignments given
Results achieved (Barnett, 2000)
Boundary Issues and Multiple Relationships

Supervisor as Role Model

Standards in the APA Ethics Code
Strict adherence to Boundaries
Boundary Crossing
Boundary Violations

Multiple Roles vs. Multiple Relationships

Compartmentalizing Roles and Responsibilities
 Diversity Issues in Supervision

Multicultural Competence by supervisor and supervisee

Integrating attention to diversity issues into all treatment
and supervision sessions – intentionally making this a
focus of supervision, in the supervisory relationship, in
the treatment relationship, and in the client’s treatment
(e.g., diagnosis, conceptualizing the client’s difficulties,
etc.)
Seeing multicultural competence as essential to being
competent
Taking a broad view of diversity (See APA Ethics Code
Principle E)
 Principle E:
Respect for People's Rights and Dignity

 Psychologists respect the dignity and worth of all people, and

the rights of individuals to privacy, confidentiality, and self-
determination. Psychologists are aware that special
safeguards may be necessary to protect the rights and welfare
of persons or communities whose vulnerabilities impair
autonomous decision making. Psychologists are aware of and
respect cultural, individual, and role differences, including
those based on age, gender, gender identity, race, ethnicity,
culture, national origin, religion, sexual orientation, disability,
language, and socioeconomic status and consider these factors
when working with members of such groups. Psychologists try
to eliminate the effect on their work of biases based on those
factors, and they do not knowingly participate in or condone
activities of others based upon such prejudices.
 Evaluation and Feedback

Program Requirements
Informal Verbal Feedback on an Ongoing Basis
Periodic Written Feedback as Specified in the
Informed Consent Agreement
 Disclosing evaluation criteria and rating form from
the outset
 Specifying with whom the evaluation results are
shared
Supervisor as Gate Keeper to the Profession
 SUPERVISEE’S FEEDBACK FORM

 What did you find most helpful about this supervision

session?
 What did you find least helpful about this supervision
session?
 What frustrated you during this supervision session?
 What are you feeling anxious about regarding your future
helping skills and supervision sessions?
 What can your supervisor do to assist you with the issues
raised in #4 above?
 What do you want your supervisor to know that will be
important for helping you to develop and grow as a
psychotherapist?
 What are your goals for the next supervision session? What do
you hope will occur?
 SUPERVISOR’S FEEDBACK FORM

 How did you feel most helpful during this supervision

session?
 Where did you feel least helpful about this supervision
session?
 What frustrated you during this supervision session?
 What are you feeling anxious about regarding your future
supervision skills and supervision sessions?
 What can your supervisor/course instructor do to assist you
with the issues raised in #4 above?
 What do you want your supervisor/course instructor to know
that will be important for helping you to develop and grow as
a supervisor?
 What are your goals for the next supervision session? What do
you hope will occur?
 Creating Ethical Professionals

Supervisor as Role Model

Supervisor as Mentor
 Going beyond clinical supervision
 Introducing the supervisee to the profession
A Focus on Self-Care and Psychological Wellness
 Distress, burnout, impaired professional
competence, vicarious traumatization, self-care, and
psychological wellness
 Professional Life/Personal Life Balance
 Liability Issues

Direct Liability: the supervisor caused the unethical

behavior indirectly through the supervisee and is
held accountable
Vicarious Liability: the supervisee caused the
unethical behavior but the supervisor is held
accountable
Respondeant Superior: legal doctrine stating that
employers are to be held accountable for the actions
of their employees
 Direct and Vicarious Liability

 Charges of direct liability can be based on the supervisor’s erroneous actions or

omissions – for example, having the trainee carry out inappropriate treatment or
asking the trainee to complete a task that the supervisor knows (or should know)
the student is not trained for; negligent supervision.

 Vicarious liability holds the supervisor responsible for the trainee’s actions IF
 The trainee has voluntarily agreed to work under the direction and control of
the supervisor
 The trainee has acted within the defined scope of tasks permitted by the
supervisor
 The supervisor must have the power and control to direct the trainee’s work

 Potentially not liable when: Competent supervision that is appropriately

documented, appropriate delegation of tasks, appropriate training and
oversight, and the supervisee engages in inappropriate actions.
Top ten factors contributing to “Best” supervisor
ratings
 (In descending order):
 • Clinical knowledge and expertise
 • Flexibility and openness to new ideas and approaches to
cases
 • Warm and supportive
 • Provides useful feedback and constructive criticism
 • Dedicated to students’ training
 • Possesses good clinical insight
 • Empathic
 • Looks at countertransference
 • Adheres to ethical practices
 • Challenging (Martino, 2001)
 Top ten factors contributing to “Worst”
supervisor ratings
(In descending order):
 • Lack of interest in student’s training and
professional development
 • Unavailable
 • Inflexible to new ideas and approaches to cases
 • Limited clinical knowledge and experience
 • Unreliable
 • Unhelpful, inconsistent feedback
 • Punitive/critical
 • Not empathic
 • Lack of structure
 • Lack of ethics (Martino, 2001)
 Supervisee ratings of the most effective
supervisors

Have good technical skills (good clinical skills and a

broad knowledge base; helpful feedback)
Have good interpersonal skills (supportive of the
trainee, warm, accepting)
 Create a perception of investment in the supervisory
process
 Model ethical practice and respect for diversity
(Lowery, 2001)
 Supervisee ratings of the most ineffective
supervisors

Lacking in technical skills (poor clinical skills and

unhelpful feedback)
Poor interpersonal skills (poor communication skills,
unreliable, or unavailable)
Gave the perception that they lacked investment in
the supervision (disorganized, not prepared for
supervisory sessions, attention focused elsewhere)
Unethical, demonstrates poor boundaries, making
pejorative statements about clients. (Lowery, 2001)
Additional Qualities of Effective Supervisors

 The presence of caring, trusting, and collaborative

relationships (Ladany, Ellis, & Friedlander, 1999; Wulf &
Nelson, 2000);
 Respect toward and support of supervisees (Watkins, 1995);
 Constructive feedback given in a nonjudgmental and
unthreatening manner (Martino, 2001);
 Approachability and receptivity to supervisees’ ideas and
opinions (Henderson et al., 1999);
 Supervisors “create a safe environment in which supervisees
can openly discuss their work, address insecurities and
concerns they experience, and have the freedom to
experiment or try new strategies and techniques” (Barnett et
al., 2007, p. 269).
 Critical Incidents in Supervision Reported by
Supervisees

General incompetence of the supervisor, personal

problems, shaming, multiple relationships/boundary
issues, inappropriate role modeling, and problems
with a non-supervisor staff member.
Disagreement with the supervisor about
administrative issues (e.g., paid time off),
disagreement with the supervisor about clinical
issues (e.g., choice of tests), and never experiencing
any problematic incidents in supervision. (Barnett,
Erickson Cornish, Kitchener, & Goodyear, 2006)
 Critical Incidents in Supervision Reported by
Supervisors

General incompetence of the supervisee,

Personal problems,
Dual relationships/boundary problems,
Confidentiality,
Failure to consult with the supervisor,
Failure to follow the supervisor’s instructions or agency
policy,
Falsified documentation,
Lack of informed consent/failure to consult with the
supervisor (Barnett, Erickson Cornish, Kitchener, &
Goodyear, 2006)
 Resources

Barnett, J. E. (1991). The supervision of psychological services: Legal and

ethical guidelines. The Maryland Psychologist, 37(2), 11-12.
Barnett, J.E. (2000). The supervisor’s checklist: Attending to ethical, legal, and
clinical issues. The Maryland Psychologist, 46 (1), 16-17.
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competence for practicing psychologists: Clearly a work in progress.
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(3rd ed.). Boston: Pearson Education.
 
 Resources (cont.)

Corrigan, O. (2003). Empty ethics: The problem with informed consent. Sociology
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Epstein, R. M., & Hundert, E. M. (2002). Defining and assessing professional
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 Resources (cont.)

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