Columnists and Correspondents

Malpractice and Risk Management

Jeffrey E. Barnett, Psy.D.

While each psychologist has received supervision at some time, becoming a supervisor requires much more knowledge and training than just being an experienced clinician. All gifted clinicians will not necessarily be competent, ethical, and effective clinical supervisors; but, all hold the capacity to be. With appropriate attention to the issues highlighted in this "supervisor's checklist" those providing clinical supervision, or aspiring to do so, will be better able to meet legal, ethics, and clinical standards. This checklist should also be of value to supervisees who will better understand their role in the supervisory relationship and be more well-informed consumers of this important service.

1. Supervisee Competence: Assess supervisee competence and training needs to determine the nature and extent of additional training and supervision needed. Reassess over the course of supervision and respond accordingly. Don't assume all supervisees possess the same skills or level of competence. Each supervisee's individual training needs should be comprehensively assessed at the outset of the supervisory relationship and the process of supervision tailored based on each supervisee's particular strengths and weaknesses.

2. Supervisor Competence: Only supervise in those areas of practice in which you are competent. In other areas arrange for supervision by an appropriately trained colleague. Just as we can't possibly be competent to provide clinical services in all possible areas of practice, the same limits to our scope of competence hold true for supervision. Be sure to obtain formal training in supervision. Being a skilled clinician does not necessarily equate with being a skilled clinical supervisor.

3. Informed Consent: Utilize a comprehensive informed consent process at the beginning of the supervisory relationship. Be sure to include: meeting times and location, how to reach you between supervisory sessions, emergency arrangements, fees and financial arrangements (if any), the nature and timing of evaluative procedures to be used and with whom they will be shared, and an agreement on all responsibilities for each individual.

4. Paranoia vs. Trust: Ensure that the level and intensity of supervision are adequate. Remember that if the supervisee is unlicensed, you are responsible for all services provided. Be sure to review all treatment notes and at least periodically review audio and/or videotapes of selected treatment sessions (with appropriate patient consent). Direct observation of services provided by the supervisee is valuable as well. Be sure that the intensity of the supervision is consistent with the supervisee's training needs. The supervision of neophytes should be much more active and intensive than for more experienced clinicians.

5. Accurate Representation: Be sure supervisees represent and advertise themselves in a manner that does not imply competence or licensure that they do not possess. Patients should be informed of each clinician's credentials and professional status when treatment begins. The existence of ongoing supervision should be made clear. The use of titles such as Psychologist and Licensed Psychologist should only be used as allowed by state law.

6. Limits to Confidentiality: Ensure that informed consent agreements with patients address the limits to confidentiality to include your involvement in the treatment process. Patients should be informed in advance if treatment will be discussed with a supervisor, treatment records will be reviewed, audio or video recording will be done, or observation of sessions is to occur. They have the right to know with whom information will be shared, its extent, and how it will be used. The use of audio and video taping should be clearly specified in a written informed consent agreement.

7. Documentation: In addition to thorough documentation of clinical services provided, be sure both supervisor and supervisee document the supervisory sessions. All issues discussed, recommendations made, actions taken, areas in need of remediation, assignments given, and results achieved should be documented. Maintain these records as you would other clinical records.

8. Legal and Ethics Issues: Include legal and ethics issues in supervision in addition to patient treatment issues. Be sure supervisees are knowledgeable of, and adhere to, the APA Ethics Code and relevant state laws and regulations. Be cognizant of the regulatory environment in which the treatment services are provided. For example, facilities such as state hospitals, federal prisons, county mental health centers, and so on, may have their own particular regulations that must be followed as well.

9. Diversity Issues: Be sensitive to diversity issues between you and the supervisee as well as in your attention to each patient's treatment. Issues to consider include age, race, ethnicity, culture, gender, religion, and sexual orientation. Be mindful that supervisees will attend to not only what we say as supervisors but also, and perhaps more importantly, how we conduct ourselves.

10. Boundary Issues and Multiple Relationships: In addition to all issues typically considered in relationships with patients, be sensitive to the fine line that at times exists between providing supervision and conducting psychotherapy. Make referrals when indicated. When considering acting in more than one role with supervisees be sure their best interests are being served. Also, be attentive to boundary issues for supervisees regardless of their level of training. Regularly bringing up these issues in supervisory sessions will help ensure supervisee sensitivity to boundary issues that arise between themselves and their patients.

11. Consultation: When unsure on any of these or related issues, consult with an experienced colleague. Regarding legal matters, consult with an attorney before taking or recommending action. No one is expected to know everything; we just need to know our limits of competence and when
to seek assistance from others.

12. The Supervisor as Role Model: Remember, your supervisees are always watching and potentially being influenced by all you do and don't do. It's do as I do, not do as I say! Remember the important role you play in each supervisee's professional development. It is a great responsibility and also a great opportunity.