ETHICAL ISSUES IN CLINICAL SUPERVISION
If ethical guidelines for the helping professions are perceived as fairly recent developments (Neukrug, 2000), the development of guidelines for the professional practice of clinical supervision could be said to be in its infancy. According to Bernard and Goodyear (1999) the first code of ethics that specifically addressed clinical supervision was passed in 1993 (Supervision Interest Network, 1993). Because of its close relationship to the practice of counseling and psychotherapy, it may not come as a surprise that many of the same ethical issues that arise in these settings also arise in the practice of clinical supervision. What follows is a discussion of some of these common issues as well as some of the unique issues common to clinical supervision. This section is drawn heavily from the work of Bernard & Goodyear (in press; 1999).
Informed consent covers not only the relationship between a therapist and his or her client, but also the relationship between a supervisors and trainee. Trainees should be made aware of the fact that supervision is an evaluative process and upon what criteria they will be judged. Furthermore, the roles and responsibilities of both the supervisor and the trainee should be clearly delineated. More specifics should be presented in a clinical supervision disclosure statement. Elements of this disclosure statement would include, but not necessarily be limited to the following:
1. Rationale for providing the disclosure statement.
2. Name and contact information of the clinical supervisor
3. Unique qualifications for the provision of clinical supervision
(licenses, coursework, certifications, etc.)
4. Supervisor's theoretical orientation
5. Types of interventions and supervision strategies that might be used (e.g.
roleplay, reviewing tapes, homework, journaling, etc.)
6. The supervisor's position on referral for counseling should the trainee prove to need it.
7. Evaluation strategies
8. Time and place where supervision will be conducted
9. Responsibilities of supervisor
10. Responsibilities of trainee
11. Contact information for licensure or credentialing agencies or an appropriate individual should the trainee experience a problem or dissatisfaction with supervision.
It should also be noted that trainees who are receiving clinical supervision should inform their clients of this fact. This provides clients with the opportunity to choose a more "experienced" therapist should they feel that they need one. A number of agencies will often have a form that you may present to your clients.
In the helping professions confidentiality is one of the key ethical principles. Helpers are relied upon to provide a safe environment for clients are free to disclose their problems. This principle becomes more complicated to enforce in the supervision process. Trainees must learn that all client information must be kept confidential except that used for supervision purposes. Cases should be presented with first names only. Tapes and videotapes must also be treated carefully. Once again, clients must be made aware of the fact that they are being seen by a counselor in training and furthermore, that content from his or her sessions will be shared with supervisors (class instructors, etc.) in an educational context. Trainees must also apply the principle of confidentiality to their own supervision.
Supervisors must also treat their interactions with their trainees as confidential to the extent possible due to the complexity of the relationship. Trainees should be made aware of the fact that information might be shared with persons who have some stake in their evaluation. Furthermore, trainees should be made aware of the limits of confidentiality at the beginning of the supervisory relationship so that he or she can make an informed decision about what might be appropriate to share in supervision.
Falvey (2002) listed some situations when a therapist or supervisor may break confidentiality:
1. when a client gives informed consent to disclosure
2. when a therapist is acting in a court-appointed capacity
3. when there is a suicidal risk or some other life-threatening emergency
4. when a client initiate litigation against the therapist
5. when a client's mental health is introduced as part of a civil action
6. when a child under the age of 16 is the victim of a crime
7. when a client requires psychiatric hospitalization
8. when a client expresses intent to commit a crime that will endanger society or another person (duty to warn)
9. when a client is deemed to be dangerous to him- or herself
10. when required for third-party billing authorized by the client
11. when required for properly utilized fee collection services (p. 93)
Dual relationships in supervision are often tricky because of the fact that the clinical supervisor often has more than one professional relationship with the supervisee. For example, your clinical supervisor might be your teaching assistant or instructor in another class. In an agency, your agency supervisor might provide clinical and professional supervision. Hall (1988) described a dual relationship as unethical when the relationship impairs the supervisor's judgment and the trainee faces the possibility of exploitation as a result of the relationship.
Supervisors should be diligent in helping trainees understand the ramifications of dual relationships with their clients.
As mentioned previously in this module, supervision is an evaluative process. It is imperative that the trainee be made aware of the criteria by which he or she will be evaluated. Trainees should know what constitutes the successful mastering of the criteria. They should also be aware of the possible consequences and their rights should the criteria not be met. Evaluation should be an on-going process and the results of any formal evaluation should not come as a "surprise" to the supervisee.
While you are receiving clinical supervision, you have the right to due process. Due process is a legal concept. It describes a process that ensures that notice and hearing must be given before an important right can be removed (Disney & Stephens, 1994). There are two types of due process---substantive and procedural. In terms of clinical supervision, substantive due process addresses the fair and consistent application of the criteria that govern a training program. Procedural due process concerns itself with the rights that you have as a participant in a training program. They are delineated as follows:
1. The supervisee or student should be apprised of the academic requirements and program regulations.
2. The supervisee or student should receive notice of any deficiencies.
3. The supervisee or student should be evaluated regularly.
4. The supervisee or student should have an opportunity to be heard.
You have just studied some of the most common ethical issues that might arise in clinical supervision. The concluding section of this module deals with reporting ethical issues