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ECS3333 - SECTION 3: RESPONSIBILITIES OF SUPERVISION

 

 

Section 3: Responsibilities of Supervision

Embedded within the role of the clinical counseling supervisor are a number of essential responsibilities to which a conscientious supervisor much attend:

 

- Monitoring client welfare

- Ensuring compliance with applicable legal, ethical, and professional standards of practice

- Creating and maintaining an effective therapeutic working alliance in supervision

- Evaluating clinical performance and the professional development of supervisees

- Gatekeeping, or assuming responsibility to certify supervisee performance and potential for academic selection, employment, and credentialing.

 

Of these responsibilities, the one that is likely to present the most trouble for the supervisor is the gatekeeping responsibility. As noted in the last chapter, some time will be spent to address that responsibility here.

In the real world, there are two key factors that will work together to make this responsibility particularly problematic. First, not every person who sets out to become a mental health professional will have – to a sufficient degree - the right combination of elements needed to operate competently in this field. Supervisors may be faced with supervisees whose aptitudes may not allow them to provide clinical services without putting clients at risk, or supervisees who are unwilling or unable to put aside their own needs, interests, or personal problems sufficiently to operate in a mission-driven way.

For some clinicians, this competency insufficiency may be a function of time. Some clinicians simply are slower to develop the necessary aptitudes and require an extended time horizon. In such instances, the gatekeeping responsibility will point in the direction of delaying moving that person forward, rather than outright rejection of their intention and desire to become a licensed clinician.

However, this is a difficult discussion to have with a supervisee, to say the least. Even more so with clinicians whom the supervisor expects may not be able to make the journey to a sufficient level of competence in any foreseeable time frame. This is made more difficult by the next factor in this question.

Second, in order to become a mental health profession, a person will make a significant investment of time, energy and money to meet the basic level of education that will permit entry into the field. A supervisor who takes his/her gatekeeping responsibilities seriously may end up having to place barriers to entry in front of a supervisee who is not a good candidate to advance in the field. This will threaten to put to waste the considerable investment made by that supervisee, something that is not likely to be well received by the supervisee.  A variety of conflicts within the supervisory relationship can be expected under these conditions. 

This is not something to be taken lightly, and every attempt should be made to increase the level of support, education, and motivation to help the supervisee reach a sufficient level of competence to allow them to proceed forward. It may suggest the need for additional supervision, education and training, personal therapy, or other supportive measures to raise the clinician’s aptitudes sufficiently to meet a baseline standard of competence.  However, a leader who operates with integrity and pursues a truly mission driven approach to this issue will not simply push a clearly incompetent supervisee through to positions where harm will come to clients

A conscientious supervisor should anticipate that this situation may occur at some point in their supervisory career - and be prepared to address this early in the supervisory relationship. This is an aspect of the supervisory relationship that is best addressed in some detail during the informed consent process.  It should be covered with as much clarity and detail as possible about what would constitute an insufficient level of competence on the part of the supervisee to lead to this gatekeeping responsibility being exercised by the supervisor.

Of particular concern and complexity will be situations in which the supervisee’s personal problems represent the greatest challenge to the successful completion of the responsibilities of clinical work. It should come as no surprise to any supervisor that many people come into this field with a history of problems within their own families of origin and their career choice coincides with efforts to sort out their own personal issues.

This is not necessarily a bad thing or a deal breaker, as it may allow for a deeper understanding of the client’s experience on the part of the clinician. However, it may also lead to problems with boundaries and countertransference, as well as problems with the generation of professional authority if not handled well. 

As uncomfortable as it may be to address this issue early in a supervisory relationship, when trust is just beginning to be developed, this is an issue that should not be excluded from the informed consent agreement and process. It should be addressed early, clearly, and in a manner where expectations are established and normalized. The mission of mental health practice requires that clinicians sufficiently understand and address their own issues to a degree that client progress is not impeded by the clinician’s problems.

To make this gatekeeping process even more explicit in all areas related to clinician competency, the supervisor should take care to develop a structured evaluation process that adequately records the supervisee’s competency in core practice areas, as well as the supervisee’s progress – or lack thereof – in a way that creates a verifiable record of why the supervisor needs to exercise his/her gatekeeping responsibility. This should be accompanied by regular feedback to the supervisee over the whole course of the supervisory process so that there is little doubt or uncertainty about why the supervisor cannot in good conscience move the supervisee forward to the next level of practice.

This should also be accompanied by a structured supervisee development plan that not only outlines the improvement areas related to reaching a sufficient level of competence, but also clarifies the role and responsibilities the supervisee needs to assume in order to move towards competence. If the supervisee is unable or unwilling to accept the role and responsibilities outlined in that development plan, then it clarifies that the obstacle to moving forward is in the supervisee’s arena, not the supervisor’s arena.  

There are legal and ethical considerations that must be understood here. The most extreme manifestation of a supervisee’s unhappiness with being denied access to advancement may include legal action and/or ethical complaints. The degree to which a supervisor has organized - and recorded - a structured approach to assessing, evaluating, following, and intervening in problems with a supervisee’s competence, the more the supervisor will be protected from adverse actions and outcomes.   

During this module, additional focus will be directed at these issues, and guidance about elements to add to the informed consent agreement will be covered. At a later time, yourceus.com will also offer a course on supervision that includes a best practices Performance Management system and process that will address this issue in a more comprehensive way.  

 

Roles and Boundaries

The Therapeutic Working Alliance

Clinical counseling supervision is a supervisee-centered, collaborative relationship driven by the clinical and developmental needs of the supervisee, in which the process of identifying and addressing the supervisee’s needs as they arise must be the mutual responsibility of both professionals. As noted in the paragraphs above, it is in the best interest of the supervisor to engage in a well-structured process of clarifying the nature of this relationship, and the roles and responsibilities for both the supervisor and the supervisee.

This course has spent time addressing the supervisor’s leadership role and responsibilities. It is good practice on the part of the supervisor to make clear and explicit to the supervisee what this role and these responsibilities consist of, and to include these elements in the formal informed consent agreement.

An example of what might be included in a section on supervisor responsibilities within an informed consent agreement is shown below.

 

Supervisor’s Responsibilities 

- It is the supervisor’s responsibility to provide the appropriate amount of supervision

- It is the supervisor’s responsibility to educate the supervisee concerning confidentiality and informed consent for the clients seen by the supervisee

- It is the supervisor’s responsibility to assure that the supervisee has appropriate tools for the supervisee to assess his/her own growth and skills.

- It is the supervisor’s responsibility to be aware of any biases and prejudices that may affect the supervisory relationship and to alert the supervisee to those biases and prejudices prior to entering into the supervisory relationship

- It is the supervisor’s responsibility to clarify the limits of confidentiality within the supervisory relationship

- It is the supervisor’s responsibility to clarify to the supervisee the boundaries between the supervisory relationship and any other relationship that the supervisor may have with the supervisee

- It is the supervisor’s responsibility to address with the supervisee any circumstances in which the supervisee is not acting in accordance with Professional Codes of Ethics, and, where appropriate, to take action to either correct the circumstances, or to report the ethical violations if the supervisee is unwilling or unable to take appropriate corrective action.

- It is the supervisor’s responsibility to help the supervisee recognize if his/her functioning as a clinical practitioner is impaired due to any personal or emotional difficulty, and for ensuring that appropriate corrective action is taken.

- It is the supervisor’s responsibility to help the supervisee recognize if his/her functioning as a clinical practitioner is not meeting appropriate standards to permit the supervisor to support the advancement of the supervisee, and to direct the supervisee towards corrective developmental actions to meet appropriate standards 

Likewise, it is good practice to begin the conversation about the supervisee’s rights, role and responsibilities early in the informed consent process, and to include these elements in the informed consent agreement that the supervisee will sign within the first few supervisory meetings. As the supervisory relationship moves forward, supervisors may also feel free to edit and update the informed consent agreement as the need arises. The informed consent agreement is a purposeful and living document, and any edits and updates may be viewed from the perspective of meeting on an ongoing basis the larger purposes of what is intended in clinical counseling supervision.

An example of what might be included in a section on supervisee’s rights within an informed consent agreement is shown below.

 

Supervisee Rights

- Supervisees have the right to be fully informed of the supervisor’s approach to supervision prior to beginning the supervisory relationship

- Supervisees have the right to receive supervision from a professional with the necessary knowledge and skill to supervise

- Supervisees have the right to clarification about the conditions that dictate their status and progress prior to beginning the supervisory relationship

- Supervisees have the right to receive clarification about their responsibilities prior to beginning the supervisory relationship

- Supervisees have the right to be assigned tasks appropriate to their level of competence

- Supervisees have the right to confidentiality with regard to their disclosures, as well as clear explanation of the limits to that confidentiality prior to beginning the supervisory relationship

- Supervisees have the right to access the records of their supervisory sessions

- Supervisees have the right to provide feedback to their supervisors during the supervisory process

An example of what might be included in a section on supervisee’s responsibilities within an informed consent agreement is shown below. Please note the section on the supervisee’s responsibility to seek treatment for mental health difficulties that interfere with the completion of clinical responsibilities.

 

Supervisee’s Responsibilities

- It is the supervisee’s responsibility, as part of the informed consent procedure, to notify his/her clients of his/her level of training and licensure, the presence and nature of the supervisory relationship and how clinical information will be used within the supervisory relationship.

- It is the supervisee’s responsibility to provide the supervisor with adequate clinical information to allow the supervisor to provide direction and guidance, and not to knowingly withhold information that may be important to an understanding of the clinical features of any case.

- Where it becomes evident that mental health, emotional or psychological difficulties or other matters of a personal nature on the part of the supervisee represent a legitimate obstacle to the successful provision of counseling / psychotherapy services to clients, it is the responsibility of the supervisee to procure appropriate counseling / psychotherapy services and apply those services to the successful resolution of the difficulties or personal matters to the extent necessary to be able to perform his/her counseling / psychotherapy functions.

At all times, it is preferable for the supervisor to give good, regular feedback about how the informed consent agreement relates and connects to the mission and purposes of the clinical work as performed by the supervisee - and to the supervisory process – as well as how well or poorly the supervisee is doing in terms of meeting the role and responsibility guidelines as outlined in that agreement. 

The more clarity that can be reached concerning the roles and responsibilities of both parties to clinical counseling supervision, the easier it will be for the supervisor to maintain effective boundaries concerning what is expected from each party. Given the disparity between the level of knowledge and skill of the two parties, there will inevitably be some healthy dependency that is created, where the supervisee depends upon the leadership, support, and direction of the supervisor to move progress forward.

However, this healthy dependency is different from circumstances where the supervisee is unable or unwilling to take responsibility for meeting reasonable expectations of clinical practice, and instead tries to relinquish responsibility onto the supervisor in an overly dependent way in order to protect him/herself from accountability and/or the hard work of professional development. Good supervisors will manage this boundary with careful scrutiny, as well as the application of sensitive limit setting and clear communication.

 

Professional Clinical Roles and Relationships

There are many different ways that persons with special expertise can lend their knowledge and experience to create a developmental effect for another individual or group: 1) Supervisor; 2) Consultant; 3) Mentor; 4) Coach; 5) Therapist. Since at times supervisors may provide elements of the consulting, mentoring, or coaching role within the supervisory relationship, it is helpful to know what constitutes each of these roles: what is similar and what is different. In that way the supervisor may understand what factors define the appropriate boundaries to observe.  

Please note that it is not appropriate for supervisors in clinical counseling supervision to take on the role of the supervisee’s therapist. This would represent a boundary violation and would create some serious problems for the successful functioning of the supervisory process. If a supervisee requires counseling services in order to address personal problems that are interfering with the completion of his/her clinical responsibilities, the supervisee should be referred elsewhere for therapy.

This role definition element should not only be clearly indicated in the informed consent agreement that the supervisee is asked to sign, it should be addressed frankly and explicitly early in the informed consent process – and reiterated whenever this specific boundary becomes unclear. An example of this element of the informed consent agreement may be found in the previous section outlining the supervisee’s responsibilities. 

Because in clinical work the clinician is the vehicle for change, it is important for each clinician to have a high level of clarity about when personal issues are likely to interfere with the counseling process with his/her clients. This is why it is recommended that all mental health clinicians have their own counseling prior to and/or concurrent with becoming a therapist themselves.

This is not to say that a clinical counseling supervisor will ignore or avoid personal material from the supervisee that arises in the course of the supervision. Nor is it to say that transference and countertransference will be absent from the supervisory relationship. It is rather to say that these issues will not be handled from the position and perspective of a client/clinician relationship between the supervisor and supervisee. No diagnosis will be generated, and no therapeutic responsibility on the part of the supervisor (as therapist) will be created as part of the supervisory relationship.

To summarize: 1) The supervisor will avoid taking on clinical responsibility for the personal material of the supervisee, leaving that task to the therapist that the supervisee hires for that purpose. 2) A clear boundary will be established and maintained in this area – and discussed in the informed consent process and on an ongoing basis within the supervisory relationship. 

Here are some important questions that the supervisor will want to ask as part of this process of role definition and the responsibility for avoiding the role of the supervisee’s therapist:

 

 

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