The professional development of mental health clinicians after graduate school rests heavily on the quality of their clinical work experience and the support provided to that supervisee/clinician from their employers and their clinical supervisors. The process of becoming a therapist (or more specifically a psychotherapist – counselor, clinical social worker or marriage and family therapist) is multilayered. At the heart of that process is a structure that allows clinical supervision to occur.
The structure of clinical supervision is based on a supervisory relationship. That supervisory relationship is guided by supervision ethics. In my experience as a clinical supervisor, trainer and consultant for other supervisors; I have observed that the more subtle aspects of supervision ethics take a back seat to the more obvious ethical considerations. In other words we are all looking for big and obvious violations and problems and often miss the poor practices or poor structures that sabotage all concerned. It is my estimation that those who supervise clinicians who are post graduate school and pre-independent licensure must safeguard the supervisory process itself. Here are some important ethical considerations for clinical supervisors, directors and supervisees.
- On-site and off-site supervision play important roles. The vicarious liability inherent in clinical supervision is informed by proximity to the work itself and the opportunity the supervisor has to provide oversight of that work. In other words, the on-site clinical or administrative supervisor has a responsibility above and beyond any off-site supervisor to make sure competent and ethical practice is being supported. All three parties should hold mutual respect and understanding for one another’s roles. As an off-site clinical supervisor, I often encourage supervisees to discuss critical decisions of an ethical nature with their on-site director, administrator or supervisor before moving forward. It is important that the off-site supervisor provide guidance, however that guidance should not be without consideration for the responsibility the on-site supervisor holds as well as the clinician/supervisee themselves.
- The primary responsibility of the clinical supervisor is toward the supervisee; not the agency, practice or organization. Supervisory ethical decision making says that we must consider the patient/client/consumer; next the supervisee/clinician; then the supervisor; and finally the organization. Supervisors have the primary relationship with the supervisee. We hear about and in some cases meet the client, however it is through our supervision of the clinician/provider that we impact the therapy. An off-site supervisor has a unique opportunity to think about what is best for the supervisee’s professional/personal life and well-being. A supervisee who is not well, or not “okay,” is a supervisee whose practice can be more readily compromised. Employers play an important role in the quality of work/life of their staff. It may be difficult for an on-site supervisor to manage the distress that their supervisee has from the agency itself.
- While people who own practices or manage organizations intend to put the patient first, they are often constrained by the demands of the organization. This can include inadequate resources, wherein supervisee/clinicians are asked to do more with less. Supervisors must support supervisees in developing the skill of advocacy for themselves and for their clients. Advocacy is an important standard in ethical practice. Inadequate pay, under staffing, lack of supplies and limited or inadequate training and general support contribute to clinician/supervisee burnout and general dissatisfaction in the profession. Supervisees who are burned out or overworked are at risk for missing important clinical cues in clients/patients. When clinical supervisors support clinician/supervisees in developing the characteristics that support advocacy we collectively support effectiveness within the profession.
In short, supervision ethics can be summed up by knowing who you should be looking out for, when you should be looking out for them, and why. Almost every boundary violation in therapy or supervision starts with a boundary crossing. When we cross a boundary in an attempt to be beneficial, we must consider our ethical obligations to support autonomy and self determination. We must consider the power dynamics and we must lead with empathy and respect.
Copyright © 2019 Ruby Blow. All rights reserved.
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