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The Supervision Quarterly


Winter 2015

Welcome to the Winter edition of the Supervision Quarterly


Before I launch into this edition’s topic of ethics a quick update on what’s been happening over the past few months and what is planned for spring.
 

New trainers join the team

A few new trainers have come on-board to CSS to share their expertise in the area of clinical supervision.  You can see their profiles on the website under ‘Meet the Team’.  They are:
  • Roy Laube, who I have known and worked with for many years both in the field of cross cultural mental health and in running supervision workshops together;
  • Lydia Senediak who has expertise in school counselling supervision; and
  • Nicola Gates who brings to the team expertise in supervision of psychometric assessment and neuropsychology practice. 

New specialist Master Classes

CSS is now offering two new specialist Master Classes in October 2015:  

Full Training workshop

Just a reminder that there is one more Full Training workshop for new supervisors scheduled for 6-7th November 2015.  Early bird registration for the Full training program ends 30th June 2015.
 

The Use of Self/Family of Origin workshop

There are only a couple remaining spots for the Use of Self/Family of Origin intensive 2 day workshop on 4-5 September 2015. Feel free to email if you have any queries regarding this workshop.
Download flyer
Register on the website


Other supervision training

The past few months have been a very busy period. CSS has run supervisor training for University of Tasmania and Macquarie University and for ACT Health in addition to our regular workshops.  We are also about to launch training for 90 psychologists across the state with a program generously funded by HETI. Our expert team will provide these workshops during July and August. 

Just a reminder that this newsletter is dedicated to all things related to supervision so if you have a topic that you would like covered feel free to email your ideas to enquiries.css@optusnet.com.au

Ethical Issues in Supervision

This edition focuses on ethics and despite the concept that  ‘good human behaviour’ should be known and practiced amongst health professionals problems still regularly occur.
Psychologists have a Code of Conduct based on the APS Code of Conduct (2007) and other professions similarly have guidelines that inform professional practice. So why then do professionals still find themselves reprimanded, or worse, deregistered for unethical behaviour?
According to the AHPRA Psychology Regulation at Work in Australia Report, there were 487 notifications lodged against registered psychologists in 2013-14.  Thirty-one cases resulted in a caution or reprimand and in 49 cases the practitioner gave an undertaking in relation to improving their conduct, or conditions were imposed on the practitioner’s registration. In two cases the practitioners’ registration was suspended. Supervising in these contexts can cause a lot of angst for both the clinician and the supervisor. It is important to ensure that when supervising, the topic of ethics is very much a part of the ongoing discussion of psychological practice to avoid such situations ever arising.
Every day when working with clients, therapists are put in positions where they need to make decisions, sometimes very quickly.  Practicing ethically should be ‘second nature’. The relationship between a psychologist and the client is based on trust and psychologists regularly obtain information about their clients which places them in a powerful position. Roles can become diffuse when dual relationships develop or when the psychologist does not maintain clear and professional boundaries and poor judgments are made. 
As such informed consent, confidentiality, competence and multiple relationships are common ethical problem areas that should be raised in supervision with the supervisor teaching, modelling and managing ethical dilemmas in supervision.


Gatekeeping

A key goal of supervision is to ensure clients receive competent and ethical services.  Supervisors are in effect gatekeepers to the profession ensuring competence, informed consent, and ethical practice.  
The supervisor therefore must know how to supervise effectively, be a role model to the supervisee at all times, provide effective feedback and keep up to date records of supervision.  In effect, everything that needs to be taught to the supervisee in the course of supervision needs to be upheld in the supervisor’s own practice.
 

Red flag behaviour

Most psychologists don’t plan to be unethical and in fact are competent and caring professionals. We are taught from an early stage of our career that the psychology profession aims to help clients and that it is the psychologist’s responsibility to treat clients with dignity and respect.
However, it is unfortunate that psychologists are also human capable of making mistakes, losing perspective and doing harm or act in ways that are self-serving.  Why does this happen given that there are guidelines in place and if adhered to, should eliminate the likelihood of breaches from ethical standards occurring?  Sometimes therapists find themselves not taking care of themselves so therefore loosing perspective or using clients to meet personal needs without considering the unequal power relationship and the vulnerable and powerlessness position of the client.  Sometimes it can be a breach of confidentiality by a’ slip of the tongue’ and talking about a client.  Sometimes it is because they simply do not know or think about the consequences of their behaviour, or the bigger picture if something goes wrong or blows out to be bigger than anticipated. Ultimately therapists need supervision to help eliminate such breaches from occurring through recognition of potential ‘red flags’ and self-awareness of personal and professional restraints. 


Informed consent in supervision

Supervision is like therapy in that as clients should know what to expect in a session the supervisee should know what to expect from the supervisory relationship. Both supervisor and supervisee need to know and agree on their respective responsibilities including:
1. Purpose of supervision
What is the end goal of our meetings?

2. Information about the supervisor 
Awareness of theoretical orientation and supervisory style.  
How might we negotiate difference?
3. Expectations, roles and responsibilities 
Explanation of the nature of the supervisory relationship, including requirements of reporting, evaluation and other administrative requirements.  
How might boundaries be managed within the supervisory relationship?
There should be recognition and discussion of the supervisor’s advantage of power over supervisees.  Supervisors hold a position of trust and should at all times act in the best interest of the supervisee’s welfare.


4. Logistics of supervision 
This should include any specific details about frequency of session, duration, fees, forms and documentation, modalities, procedure for emergency consultations and any other contractual requirements.  In effect, do not assume anything and make all parts of the supervisory relationship explicit.
5. Ethical and legal considerations 
Supervisors whether they like it or not can be held responsible for the acts of their supervisees. Ensure ethical and legal issues are regularly reviewed.  Where necessary assume an instructional role to ensure that the supervisee is aware of ethical competencies.
6. Informed consent for clients of Supervisees 
Supervisees need to feel comfortable to make explicit to their clients they are being supervised and that supervision ensures that the client is benefiting from expert guidance via this supervision.  Clients need to have explained how supervision affects their confidentiality and to what degree their information will be shared for the purpose of supervision. It is especially important at a trainee’s early stage of training to allow the client to elect not to receive such a service.  Supervisors share the same obligations to client confidentiality as does the supervisee.
 

Competence 

Being a good therapist does not translate into being a good supervisor.  However, the standards of training outlined by AHPRA ensure supervisors achieve a standard of competence to manage supervisory relationships, including personal awareness and insight.  
Competency lies on a continuum with many facets, including sound professional knowledge, professional skills and lastly recognition of limitations. Professional growth occurs through on-going self-reflection and re-examination of one’s competencies by integrating perception, reflection and analysing potential ethical situations. 
Supervisors must be aware and make explicit possible ethical issues in the supervisory relationship.  First and foremost are problems that arise as a result of dual relationships, including issues relating to power differential, therapy-like quality of the relationship and the conflicting roles of supervisor and supervisee (e.g. performance evaluation, friendships).
Supervisors need to make explicit the parameters of supervision in challenging situations such as at work lunches (if supervisor and supervisee work together), or if the supervisee is the employee of the supervisor (this is especially the case when working in a private practice context). Think about how this might affect factors such as openness, feedback, evaluation and client intervention.


Ethical Dilemmas 

When facing ethical dilemmas information should be sought from colleagues, senior practitioners and professional literature on the topic and the supervisor.  It is an ethical duty for staying-up-to-date with practice guidelines and a practitioner should never use as an excuse ‘’I was too busy to read that… keep up to date… or know about…’ At times it can be very hard to recognise an ethical dilemma because it can be on the continuum of right and wrong.  Dean (2010) states ‘what is right is right, what is right is kind of right, what is right is kind of wrong, and what is right becomes what is wrong’.  This ambiguity can be problematic when dealing with ethical decisions, even for the most competent psychologist.’
Common ethical dilemmas reported by supervisors include:
1. Boundary crossings and violations/ multiple and dual relationships
2. Competency issues
3. Confidentiality and duty to protect
4. Power imbalance (therapist – client)
5. Competently managing client diversity (e.g. communication skills, cultural diversity in testing)
6. Managing clients who pose risk to self or others
7. Psychological assessment and reporting
8. Therapies involving physical contact
9. Professional practice issues (e.g. client records, termination of services, communication to clients and other health providers, delegation and other professionals)
10. Group therapy and confidentiality.


Ethical decision making processes

There are a number of ways to address and manage ethical dilemmas systematically and APS provide some clear decision making guidelines, including an ethical decision making model (Shaw, E., Bancroft, H., MAPS, Metzer, J., &  Symons, M.).  The steps include:
Step 1: Recognise there is an ethical issue (lack of awareness or misunderstanding of an ethical standard is not itself a defence to a charge of unethical conduct) (Dean, 2010)
Step 2:  Clarify the ethical issues
Step 3: Generate and examine available courses of action
Step 4: Choose and implement the most preferred option
Step 5: Reflect on and review the process
Finally, as a supervisor your role is to work towards helping the supervisee develop ethical maturity.  This includes having the ‘reflective, rational emotional and intuitive capacity to decide actions are right and wrong or good and better having the resilience and courage to implement those decisions, being accountable for ethical decision made …. .and being able to live with the decision made’ (Carroll & Shaw, 2012). 

As supervisors integrate into the session reflective practice and logical problem solving so the supervisee learns to make wise decisions.  A supervisee who is in touch with their feelings and emotions about what is happening makes sound judgments involving ethical and moral reasoning. 
I hope you have enjoyed the 2015 winter edition of the newsletter and that some of the ideas that have been shared help to build on your supervisor and supervisee experiences. 

Stay warm,
Christine 
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