| AUTHOR: | Debra C. Cobia and Susan R. Boes |
| TITLE: | Professional Disclosure Statements and Formal Plans for Supervision: Two Strategies for Minimizing the Risk of Ethical Conflicts in Post-Master's Supervision |
| SOURCE: | Journal of Counseling and Development 78 no3 293-6 Summ 2000 |
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ABSTRACT
Ethical conflicts related to the issues of informed consent, due process, competence, confidentiality, and dual relationships in supervision are discussed. Two strategies are proposed as ways to minimize the potential for ethical conflict in post-master's supervision: the use of professional disclosure statements by supervisors and the development of formal plans for supervision.
Almost all state jurisdictions in the U.S. (including the District of Columbia) regulate the practice of counseling through professional counselor licensure (American Counseling Association [ACA], 1998). In all instances, requirements include postdegree supervision for counselors by approved supervisors (Borders, Cashwell, & Rotter, 1995). The fact that all states regulating licensure require postdegree supervision suggests that prospective licensees who have not had such supervision are not yet competent to practice independently (Bernard & Goodyear, 1998). Consequently, the supervisor's dual role is to promote the development of skills and knowledge necessary for independent practice and to protect the welfare of the supervisee's clients (Sherry, 1991). As supervisors attempt to accomplish both of these purposes, they will likely encounter conflicts related to one or more of the major ethical issues for clinical supervisors identified by Bernard and Goodyear (1998): informed consent, competence of supervisor, due process and competence of supervisee, confidentiality, and dual relationships.
The purpose of this article is to describe two interventions, professional disclosure statements and formal plans for supervision, and how they might be used to minimize the potential for common ethical conflicts in postdegree supervision. The distinctions between supervision provided for persons pursuing an academic degree and those pursuing licensure are largely contextual. Ethical issues common to supervision may present in both environments; however, the ways they are manifested and the specifics of how they are addressed will differ. Although the interventions we describe in this article are applicable to supervision in academic settings, our examples and foci are for postdegree supervision.
Although our emphasis here is on how to use professional disclosure statements and supervision plans, we view the interventions as a complement to not a replacement for supervision environments where ethical reasoning is routinely used. Kitchener (1984) has suggested reliance on the ethical principles of autonomy, beneficence, nonmaleficence, fidelity, and justice as the basis for ethical reasoning (see also Sherry, 1991). Coupled with a model for ethical decision making or problem solving, such as the one described by Keith-Spiegel and Koocher (1985), these principles provide a framework within which issues not specifically addressed by the codes and guidelines adopted by state and the District of Columbia counseling boards and professional associations can be resolved (c.f. Association for Counselor Education and Supervision [ACES, 1993]; the American Mental Health Counselors' Association [AMHCA, 1987]; and ACA, 1995).
In addition, we believe both of the strategies have the potential to positively affect supervision. Specifically, the strategies increase the opportunities for learning the skills necessary for professional collaboration; establish an environment conductive to open, honest communication; and promote the development of rapport and trust in the supervisory relationship.
PROFESSIONAL DISCLOSURE STATEMENTS AND FORMAL PLANS FOR SUPERVISION
The document used to describe the professional service being considered (supervision) is a professional disclosure statement. The express purposes of the statement are to fully inform the prospective supervisee of the mutual rights and responsibilities of all parties, the parameters of supervision, methods of evaluation, desired outcomes, and potential risks and benefits of participation in supervision (Disney & Stephens, 1994; McCarthy et al., 1995; Storm & Haug, 1997). A well-written document describing each of the previously listed points also has the potential to serve as a springboard for open professional discussions that can facilitate the establishment of a professional relationship and rapport between supervisor and supervisee (Cottone & Tarvydas, 1998).
The formal plan of supervision can also be described as an individualized learner contract. Spiegler (1983) described a contract as very exact, simply stated in unambiguous language, and signed by both individuals involved. Such contracts specify mutually agreed on goals for supervision, how progress toward the goals will be evaluated, and the time period over which the evaluation will take place, as well as the responsibilities of both supervisor and supervisee if the goals are not achieved (Tanenbaum & Berman, 1990). Based on a comprehensive assessment, identified areas for growth and improvement logically lead to specific supervision goals, which can be included in the formal plan of supervision. The supervisor and supervisee work together to formulate a plan of supervision designed to increase competence. An additional benefit of engaging the supervisee in goal setting is the establishment of a collaborative supervisory relationship (Talen & Schindler as cited in Bernard & Goodyear, 1998).
ETHICAL ISSUE: INFORMED CONSENT
Professional disclosure statements have long been a standard element of counseling practice specifically designed to provide clients with enough information about the counselor and his or her approach to counseling to make a fully informed decision about participation. Although written documents are sometimes labeled "informed consent," informed consent for our purposes is not a document, but it is the client's right to agree to participate in the professional service after such services are fully described to him or her (Cottone & Tarvydas, 1998). In the case of postdegree supervision, the supervisee has a right to choose a supervisor based on sufficient information including the voluntary nature of his or her participation; supervisor and supervisee involvement; benefits and risks associated with supervision; confidentiality and privilege and exceptions to each; theoretical orientation of the supervisor; strategies and interventions to be used by the supervisor; record-keeping information; ethical guidelines; licenses and credentials held by the supervisor; practical aspects such as time and length of each session, group versus individual appointments, payment policies, and emergency contact procedures; approaches to resolving or reporting disputes and complaints; cancellation policies; and consultation procedures (Cobia & Boes, 1996; McCarthy et al., 1995). Review of the supervisor's disclosure statement logically leads to a review of the supervisee's statement for clients. If the supervisee has not yet prepared such a statement for his or her clients, development of a professional disclosure statement might become a supervision goal that would lead to a discussion of clients' rights including, but not limited to, that of informed consent.
ETHICAL ISSUE: SUPERVISOR'S COMPETENCE
To facilitate the supervisee's development and to ensure quality services for his or her clients, supervisors need to be competent in the area(s) of the supervisee's practice. Therefore, the supervisor's areas of competence to provide supervision with specific client problems, diagnoses, and client groups are important elements of a professional disclosure statement. One's supervision is limited to those areas in which he or she has sufficient training, supervised experience, or both. Basically, supervisors are urged not to provide supervision in areas in which they are not entitled to practice (Tanenbaum & Berman, 1990). If supervisees are working outside the area of competence of the supervisor, it is incumbent upon the supervisor to arrange for competent clinical supervision of the case(s) in question.
A supervisor might add areas of competence through participation in peer supervision (Tanenbaum & Berman, 1990), individual supervision with a more experienced supervisor, supervision consultation (Hall, 1988), and other professional development activities designed to increase knowledge and skill in specific practice areas. However, activities that require discussion of supervisees and limit the extent to which confidentiality can be assured need to be clearly identified in the supervisor's disclosure statement.
Similarly, the supervisee and supervisor should fully discuss those areas of practice in which the supervisee feels competent and those in which additional knowledge, skill, and supervised practice are needed. Such a discussion would most appropriately be one of mutual disclosure and would include both counseling and supervision experiences and practices.
ETHICAL AND LEGAL ISSUES: COMPETENCE AND DUE PROCESS
Initially, a comprehensive evaluation of the supervisee's skills in the areas of appraisal and assessment; case conceptualization; and ability to plan, deliver, and evaluate counseling services is necessary. The extent and nature of the supervisee's education, training, and experience and how that training pertains to the anticipated practice is also important information for the supervisor. On the basis of both assessment data and professional history, the supervisor and supervisee are able to establish supervision goals that are specifically designed to keep the counselor working within his or her limits of competence. In the event that the expected practice differs from previous preparation, the supervision goals include strategies for developing competence in another area through additional training, education, and supervised experience.
The ethical issues of competence and fairness and the legal issue of due process are clearly linked. Two types of due process can be said to exist: procedural and substantive. In using the term due process, we are referring to the procedural meaning of the term (i.e., fairness on the part of the supervisor toward the supervisee). However, in some instances procedural due process may be expected to have substantive outcomes related to laws of practice. Evaluation of the supervisee's progress occurs over a specified period of time, depending on the requirements of the regulatory body with authority over the supervisee. At the end of the specified time period, usually 1 to 2 years, the supervisor is asked to render a judgment regarding the supervisee's competence to practice independently and make a recommendation based on these judgments to the credentialing body, the employer, or both. From an ethical perspective, supervisees expect that the supervisor will exercise fairness or justice in his or her final recommendations.
The professional disclosure statement for supervision is an excellent vehicle for informing supervisees about how such judgments will be made. Specifically, supervisees have a right to know (a) against what standards they are being judged, (b) how assessments will be made, (c) how feedback will be delivered to them and with what frequency, and (d) how information about them will be conveyed to the relevant credentialing body (Cormier & Bernard, 1982). Tanenbaum and Berman (1990) suggested that supervisees be provided feedback in both written and oral form throughout the course of the supervision period (formatively) as well as at the end of the contract period (summatively) on various data points (see also Brown & Srebalus, 1988).
Disney and Stephens (1994) identified "due process" as a term designating the procedure that protects the rights of the supervisee to a notice and a hearing before his or her right to practice can be taken away. Bernard and Goodyear (1998) stated that violations of due process most often occur when supervisees have been given negative summative evaluations without adequate time to demonstrate improvement or without specific feedback about remediation requirements. Adherence to a regular schedule of assessment and evaluation, as outlined in the disclosure statement, and commitment to a well-developed plan of supervision protect the supervisee's right to due process and keep the supervisory focus on developing the skills and knowledge necessary to practice independently.
ETHICAL ISSUE: CONFIDENTIALITY
As stated previously, supervisors may be participating in professional activities to add to their areas of competence (e.g., supervision of their supervision, peer group supervision, or consultation), which require discussion of supervisees and limit the extent to which confidentiality can be assured. These and similar activities are clearly identified in the supervisor's disclosure statement and are consented to by the supervisee. Similarly, supervisees develop and use an appropriate disclosure statement explicitly describing the limits of confidentiality for clients, including a description of the supervisee's participation in supervision.
Supervision requires extensive discussion of client issues and review of client materials (i.e., case notes, assessments, audio and videotapes). Therefore, supervisees sometimes get the message that third-party discussions are appropriate in other contexts (Bernard & Goodyear, 1998). Supervisors, by their own behavior, model for the supervisee appropriate ways to describe and reference clients, keeping information protected and used only in the context of supervision (Bernard & Goodyear, 1998). For example, supervisors would neither engage in discussions about the supervisee's clients in a public place or in a context other than that specifically consented to by the client, nor would the supervisor discuss the supervisee in any context other than those explicitly stated in the disclosure statement.
ETHICAL ISSUE: DUAL RELATIONSHIPS AND THEIR COMPLEX NATURE
Ethical conflicts may arise when one role or relationship (counseling supervisor) is superimposed on another, preexisting relationship (agency administrator; Borys, 1992). Ideally, such multiple relationships are to be avoided. Unfortunately, choice of and access to supervisors may be limited for prospective licensees. For example, there may be only one approved supervisor in a rural community mental health center, and that person may also be a center administrator. In such cases, conflicts sometimes arise because multiple roles, all of which are supervision appropriate, may have competing goals.
In the role of supervisor, one may encourage supervisees to be open and self-disclosing--an appropriate goal for supervisee development. However, supervisees sometimes reveal personal information in the context of supervision that is also relevant to their professional competence. The supervisor, also an agency administrator in this example, must constantly balance the use of such information. It is possible that the supervisee may disclose material, as a result of supervisor encouragement, that leads to the conclusion that the supervisee is not suited for the professional role of counselor. Therefore, action taken by the supervisor to protect the welfare of current and future clients may clash with the supervision goals of encouraging supervisee development. Consistent with the "Ethical Guidelines for Clinical Supervisors" (ACES, 1993), the welfare of the client is the priority of both supervisor and supervisee. Each of these points or risks must be clearly articulated by the supervisor, allowing the supervisee to make an informed decision about participation in the supervision (Sherry, 1991).
In addition to role conflicts, there are other types of multiple or dual relationships (e.g., sexual relations, sexual harassment, business relationships, friendships, family connections) that have the potential to impair the judgment of the counselor (supervisor), risk exploitation of the client (supervisee), or both. Sexual misconduct with clients is an extreme but regularly reported example of a counselor meeting his or her own needs to the detriment of the client (Disciplinary Information Network, American Association of State Counseling Boards, 1997). When potentially conflicting roles are identified but circumstances such as limited access and choice regarding post-master's supervision are a reality, the potential risks associated with the conflicting roles need to be identified and disclosed so that strategies can be included in a formal supervision plan to reduce the supervisee's risks.
CONCLUSION
Supervision's importance to the ongoing professional development of counselors is being increasingly recognized and regulated by some jurisdictions in the United States. Supervision is a complex professional endeavor that, by its very nature, places the participants at increased risk for involvement in ethical conflicts related to competence, conflicting roles, dual relationships, evaluation, and confidentiality (Bernard & Goodyear, 1998). Although there is no foolproof approach to preventing ethical dilemmas, there are several ways to minimize the potential for their occurrence. One method suggested here is to use professional disclosure statements for supervision that fully disclose to supervisees the potential risks, benefits, and expectations of entering into the supervisory relationship.
Risks to supervisees, and potential ethical dilemmas related to misunderstanding about the expectations, goals, and evaluative aspects of supervision, can be further minimized by developing and adhering to a specific plan for supervision. Goals for this specific plan, or contract, are based on a review of supervisee preparation and experience, as well as ongoing assessment of his or her skills and development as a counselor. A mutually developed and agreed on contract for supervision can increase the accountability felt by supervisees for the progress of supervision and can also serve as a framework for effective and appropriate review and feedback (Tanenbaum & Berman, 1990).
Although it is our contention that "an ounce of prevention is worth a pound of cure," we also acknowledge that even the most careful attention to disclosure and the development of a specific plan for supervision will not be sufficient to prevent all ethical dilemmas from arising in the context of supervision. Therefore, supervisors should be well acquainted with the relevant statutes and professional codes governing their practice, as well as the moral principles of autonomy, beneficence, nonmaleficence, justice, and fidelity and how these might be considered in the context of a decision-making model for resolving ethical conflicts.
ADDED MATERIAL
Debra C. Cobia is an associate professor and coordinator of school counseling in the Department of Counseling and Counseling Psychology at Auburn University, Auburn, Alabama, and is a counseling supervisor and chair of the Alabama Board of Examiners in Counseling in Birmingham, Alabama. Susan R. Boes is an assistant professor in the Department of Counseling and Educational Psychology at the State University of West Georgia in Carrollton and is a counselor in Georgia and Alabama. Correspondence regarding this article should be sent to Debra C. Cobia, 2084 Haley Center, Auburn University, Auburn, AL 36849 (e-mail: cobiadc@auburn.edu).
REFERENCES
American Counseling Association. (1995). Code of ethics and standards of practice. Alexandria, VA: Author.
American Counseling Association. (1998, April 16). Practice resources: State licensure/certification information-state summary chart [On-line]. Available: http://www.counseling.org/resources/licensure_summary.htm
American Mental Health Counselors' Association. (1987). AMHCA code of ethics. Alexandria, VA: Author.
Association for Counselor Education and Supervision. (1993, Summer). ACES adopts standards for counseling supervisors. ACES Spectrum, 53, 5-8.
Bernard, J. M., & Goodyear, R. K. (1998). Fundamentals of clinical supervision (2nd ed.). Needham Heights, MA: Allyn & Bacon.
Borders, L. D., Cashwell, C. S., & Rotter, J. S. (1995). Supervision of counselor licensure applicants: A comparative study. Counselor Education and Supervision, 35, 54-69.
Borys, D. S. (1992). Nonsexual dual relationships. In L. VandeCreek, S. Knapp, & T. L. Jackson (Eds.), Innovations in clinical practice: A source book, Volume II (pp. 443-454). Sarasota, FL: Professional Resource Press.
Brown, D., & Srebalus, D. J. (1988). An introduction to the counseling profession. Englewood Cliffs, NJ: Prentice-Hall.
Cobia, D. C., & Boes, S. R. (1996, May). The ethical practice of counseling supervision. Paper presented at the annual spring convention of the Licensed Professional Counselors' Association of Georgia, Peachtree City.
Cormier, S. L., & Bernard, J. M. (1982). Ethical and legal responsibilities of clinical supervisors. The Personnel and Guidance Journal, 60, 486-491.
Cottone, R. R., & Tarvydas, V. M. (1998). Ethical and professional issues in counseling. Upper Saddle River, NJ: Merrill.
Disciplinary Information Network, American Association of State Counseling Boards. (1997). Annual report. Baltimore: Author.
Disney, M. J., & Stephens, A. M. (1994). Legal issues in clinical supervision (ACA Legal Series, Vol. 10). Alexandria, VA: American Counseling Association.
Hall, J. E. (1988). Protection in supervision. Register Report, 14, 3-4.
Keith-Spiegel, P., & Koocher, G. P. (1985). Ethics in psychology: Professional standards and cases. New York: Random House.
Kitchener, K. S. (1984). Intuition, critical evaluation, and ethical principles: The foundation for ethical decisions in counseling psychology. The Counseling Psychologist, 12, 43-55.
McCarthy, P., Sugden, S., Koker, M., Lamendola, F., Maurer, S., & Renninger, S. (1995). A practical guide to informed consent in clinical supervision. Counselor Education and Supervision, 35, 130-138.
Sherry, P. (1991). Ethical issues in the conduct of supervision. The Counseling Psychologist, 19, 566-584.
Spiegler, M. D. (1983). Contemporary behavioral therapy. Mountain View, CA: Mayfield.
Storm, C. L., & Haug, I. E. (1997). Ethical issues: Where do you draw the line? In T. C. Todd & S. L. Storm (Eds.), The complete systemic supervisor: Context, philosophy, and pragmatics (pp. 26-40). Boston: Allyn & Bacon.
Tanenbaum, R. L., & Berman, M. A. (1990). Ethical and legal issues in psychotherapy supervision. Psychology in Private Practice, 8(1), 65-77.