Ethical Framework for the Use of Technology in Supervision

By LoriAnn S. Stretch, DeeAnna Nagel and Kate Anthony

Ethical and Statutory Considerations

Supervisors must demonstrate and promote good practice by the supervisee to ensure supervisees acquire the attitudes, skills, and knowledge necessary to protect clients. Supervisors and supervisees must research and abide by all applicable legal, ethical, and customary requirements of the jurisdiction in which the supervisor and supervisee practice.   The supervisor and supervisee must document relevant requirements in the respective record(s).  Supervisors and supervisees need to review and abide by requirements and restrictions of liability insurance and accrediting bodies as well.

Informed Consent

Supervisors will review the purposes, goals, procedures, limitations, potential risks, and benefits of distance services and techniques. All policies and procedures will be provided in writing and reviewed verbally before or during the initial session. Documentation of understanding by all parties will be maintained in the respective record(s).

Supervisor Qualifications

Supervisors will only provide services for which the supervisor is qualified.  The supervisor will provide copies of licensure, credentialing, and training upon request.  The supervisor will have a minimum of 15 hours of training in distance clinical supervision as well as an active license and authorization to provide supervision within the jurisdiction for which supervision will be provided. Supervisors providing distance supervision should participate in professional organizations related to distance services and develop a network of professional colleagues for peer and supervisory support.

Supervisee and Client Considerations

Supervisors will screen supervisees for appropriateness to receive services via distance methods. The supervisor will document objective reasons for the supervisee’s appropriateness in the respective record(s).  Supervisors will ensure that supervisees screen clients seeking distance services for appropriateness to receive services via distance methods. Supervisors will ensure that the supervisee utilizes objective methods for screening clients and maintains appropriate documentation in the respective record(s).

Supervisors will ensure that supervisees inform clients of the supervisory relationship and that all clients have written information on how to contact the supervisor.  Written documentation of the client acknowledging the supervisory relationship and receipt of the supervisor’s contact information should be maintained in the respective record(s). Supervisors will only advise the supervisee to provide services for which the supervisee is qualified to provide.
Clients and supervisees must be informed of potential hazards of distance communications, including warnings about sharing private information when using a public access or computer that is on a shared network.  Clients and supervisees should be discouraged, in writing, from saving passwords and user names when prompted by the computer.  Clients and supervisees should be encouraged to review employer’s policies regarding using work computers for distance services.

The entire story is here.

Effective and Ineffective Supervision

Nicholas Ladany, Yoko Mori, and Kristin E. Mehr
The Counseling Psychologist
January 2013 41: 28-47
First published on May 23, 2012

Abstract


Although supervision is recognized as a significant tenant of professional growth for counseling and psychotherapy students, the variability of the effectiveness, or ineffectiveness, of supervision has come under scrutiny in recent times. Our sample of 128 participants shed light on the most effective (e.g., encouraged autonomy, strengthened the supervisory relationship, and facilitated open discussion) and most ineffective (e.g., depreciated supervision, performed ineffective client conceptualization and treatment, and weakened the supervisory relationship) supervisor skills, techniques, and behaviors. Moreover, effective and ineffective behaviors, along with best and worst supervisors, were significantly differentiated based on the supervisory working alliance, supervisor style, supervisor self-disclosure, supervisee nondisclosure, and supervisee evaluation. Implications for supervision competencies and supervisor accountability are discussed.

The entire article can be found here.

A presentation by Nicholas Ladany on effective supervision can be found in the PowerPoint Vault on this blog.

Verification of Postdoctoral Experience: Pitfalls for Students

By Rachael Baturin, MPH, JD
The Pennsylvania Psychologist
June 2012

One of the requirements for students interested in becoming licensed in Pennsylvania is to complete one year of postdoctoral experience. It is very important for potential supervisees to review the postdoctoral experience requirements before they start this experience as there are a lot of nuances to the law, and the postdoctoral experience requirements vary from state to state. There have been cases where supervisees did not review the requirements before starting their experience, their experience did not qualify for the postdoctoral year, and they needed to repeat it.

This article will discuss some of the pitfalls that supervisees and supervisors have faced when trying to complete the verification of postdoctoral experience form, which must be sent to the State Board of Psychology upon completion of postdoctoral requirements. If readers would like to review all postdoctoral requirements in Pennsylvania, they can be found in the Pennsylvania State Board of Psychology’s regulations, Section 41.32 and Section 41.33, available on the State Board’s website: http://www.pacode.com/secure/data/049/chapter41/chap41toc.html.

Practical Issues

First, the supervisee should check to see whether the supervisor has been subject to any disciplinary actions by the State Board of Psychology. If they are currently being disciplined, they may not qualify as a supervisor. After December 1, 2015, postdoctoral supervisors must have completed either a course in supervision or 3 hours of continuing education in supervision.

Second, supervisees are required to have at least half of their training in diagnosis, assessment, therapy, other interventions, consultation, and individual supervision received as a supervisee, and the other half may be in teaching in association with either an organized psychology program preparing practicing psychologists and/or a postdoctoral training program, supervision provided as a supervisor, professional development, or research. For example, if a supervisee is doing 40 hours per week of research and 20 hours per week of direct services, the student should count 20 hours of research and 20 hours of direct services per week because at least half must be in direct services. There have been cases where the supervisee submitted a verification form on which it appeared as though 50% of the time was not in providing direct services because the supervisee was submitting too many research hours.

An hour of diagnosis, assessment, or therapy does not necessarily have to be an hour of direct patient contact. For example, a supervisee could spend an hour in therapy with a child and then spend another hour talking to the pediatrician and the school. Both of those hours should be counted toward fulfilling the 1,750-hour requirement for the postdoctoral year.

As another example, if the supervisee is just starting supervision and is seeing clients fewer than 15 hours per week, the supervisee could ask the supervisor for a research project to undertake in order to obtain additional hours, as long as they do not exceed 50% of the postdoctoral hours.

Next, supervisees are required to have 2 hours of face-to-face meetings with their supervisors per week. If you need to complete your experience in two different settings, you are still required to have 2 hours of face-to-face meetings with your supervisor at each site unless the sites are interrelated. For example, if one site is owned by ABC Corporation and the other is owned by XYZ Corporation, then the supervisee is required to get 2 hours of supervision at each site. However, if both sites were owned by ABC Corporation and one was the main office and the other a satellite office then the supervisee would be required to obtain only 2 hours of supervision for both sites. Also, supervisees must be present at each site for at least 6 consecutive months for the experience to count. There have been cases where students failed to meet this requirement and had to repeat the experience.

Last, the supervisor is required to maintain records or notes of the scheduled supervisory sessions, observe client/patient sessions of the supervisee or review verbatim recordings of these sessions on a regular basis and must prepare written evaluations or reports which are discussed with the supervisee. Once again, cases exist in which the supervisor failed to produce the written evaluations and the experience did not count.

Dual Relationships

The supervisor and supervisee must not be in a dual relationship. The supervisor cannot be related to the supervisee by blood or marriage, nor can the supervisor have a therapeutic relationship with the supervisee. In addition, supervisees are not allowed to pay supervisors for supervision (although supervision may be paid by a third party). The supervisor must be free from the supervisee’s control or influence and must be allowed to stop the supervisory relationship if necessary.

Termination of Supervision Requires Planning

Termination of Supervision Requires Planning

Supervising the Countertransference Reactions of Case Managers

Supervising the Counter Transference of Case Managers

This chapter is found in the public domain.

My psychoanalyst’s twisted final session

Once a legend in his field, he was clearly losing his grip. Still, why did he have such a hold on me?

By Simon Yisrael Feuerman

Published by Salon.com

It was with some trepidation that I called Dr. M.

I had read his articles in various psychoanalytic journals and heard his name tossed around at conferences and institutes. He was one of the princes of psychoanalysis and supervision, a member of the old school. He knew people who had been analyzed by Freud and was a colleague of some of the last century’s bad/good boys of psychoanalysis – Hyman Spotnitz, Lou Ormont, Ethel Clevans, Phyllis Meadow.

Nineteen years I had been with a previous analyst and supervisor with whom I had an irreparable break. Nineteen years may sound like a long time for most people, but in the rarefied world of New York psychoanalysis, 19 years is merely a beginning.

Finally, I had made the phone call. And now I was at Dr. M’s Upper West Side office for my interview. I had built a practice that was already sizable, but would I rate for his famous supervision group?

I had arrived about 10 minutes early and expected to read in the waiting room until the appointed hour. By tradition, an analyst will open his door precisely at the right time, neither early nor late.

To my surprise, he came out 10 minutes before our appointment time. Anticipating a silent rebuke I quickly said, “I apologize for coming early.”

“I apologize for seeing you early,” he said. “Come in.”

He had a shock of white hair. He was handsome. Looking at him in that dimly lit hallway in the late spring of 2009, I was taken aback. Why, he must be 90 years old, at least. (He was 89.) His body sent my body a message: I am dying. But at the very same time the vigor in his booming voice said something else entirely. It took hold of me. I was confused: While on the one hand he looked as though he might be nearing the end of his life — the office was dusty, his pants were hiked up too high, subtle but telltale signs of a man losing touch — his voice said, “Beginnings!” New life.

He talked, I talked. I talked, he talked. We had a rhythm. He seemed to be building an enthusiastic lather about having me as his newborn as though he were a man of 30 being given a baby to hold outside the delivery room. There was, you could say, a kind of love in the air.

And it made me somewhat uneasy. In fact, I was quite certain that I had made a mistake. I wanted to run away fast. I did not want to be in this man’s group. Perhaps I feared that I would have to face his death and my own here. I wanted to go to a group that promised me everlasting life. I did not want a dying analyst. I was looking for potency, vitality, virility. I had quite a bit myself, but sought it in others too.

As if magically sensing my turmoil, he stood up. “Enough for today,” he barked. “I would like you to join my group, but say in about nine months. Not before.”

I was astonished. Was he a master, I thought, one of these wonder-worker analysts who can read the mind and even ride like a bronco, two wildly opposing winds of thought in a man? Such things were possible in my world. I had great faith in analysts and their mad magic, their alchemy, their abilities to turn lead into gold and ambivalence and even death into life.

The rest of this interesting story is here.

Psychologists with Cancer: Clinical, Ethical, and Practical Challenges

Helen L. Coons, Ph.D., ABPP

Jana N. Martin, Ph.D.

From The Pennsylvania Psychologist

Psychologists living with cancer face clinical, ethical and practical challenges while coping with their own diagnosis and treatments. This brief article offers several suggestions to psychologists in practice and other professional settings who are coping with an early or advanced diagnosis of cancer.

Seek support and supervision. While most individuals are remarkably resilient in coping with cancer and its treatments, a new or recurrent diagnosis and the complex treatment decisions which follow can be highly stressful and frightening. Reaching out to colleagues early for support and supervision is important for psychologists with cancer. Ask colleagues if they know psychologists (or other mental health providers) who have experienced cancer treatment. Practical, informational and emotional support from someone with an insiders’ view is invaluable. The PPA listserv and APA Division listservs may also be helpful in identifying other psychologists with cancer.

Formal supervision from a respected colleague is essential to address clinical, ethical and practical issues that emerge as psychologists cope with cancer, and to support them in developing a practice management plan during and after treatments.

Develop a practice management plan. A cancer diagnosis will typically be followed by  treatment decisions related to surgery, chemotherapy, and/or radiation as well as acute, late, and long-term side effects. At any point in the treatment course, psychologists often face a series of challenging questions related to their practice and other professional roles. Some individuals are too ill, tired, or uncomfortable to work during treatment; some will have to work to maintain their income; and most will likely work part- or full-time with breaks for treatment. Psychologists undergoing cancer treatment are confronted with questions such as: (1) should they continue to see patients, teach, supervise, etc; (2) should they work full- or part-time; (3) if, how and when to disclose their diagnosis to patients, keeping in the mind their practice focus (e.g., children, teens, adults); (4) how to deal with breaks in treatment resulting from additional surgery or side effects of chemotherapy and/or radiation; (5) whether or not to treat patients who have or had cancer, are “at risk” for cancer, have lost a loved one to cancer, have significant attachment issues, or require a high degree of treatment consistency, etc; and (6) clinical, ethical and practical issues when closing a practice. Developing a practice management plan in consultation with a supervisor to address these and other questions can be helpful and empowering (Coons, 2010).

A practice management plan during and after cancer treatment may include creating flexibility in the psychologist’s schedule. For example, some psychologists reduce their patient and teaching load, and/or block their schedule after each chemotherapy cycle when side effects (e.g., nausea, fatigue, pain, low blood counts, etc.) are more likely to emerge and may adversely affect one’s ability to work. Some individuals undergoing chemotherapy have also shifted the focus of their clinical work to more testing or consultation so that they can schedule evaluations between cycles when they have more energy. Others have found that the familiarity of work is a healthy break from cancer treatment. A management plan should include finding colleagues to be on standby to call and re-schedule clients (who have provided informed consent) so that psychologists do not have to explain to patients how they are feeling.

Pace yourself during and after treatment. Throughout and after cancer treatment, psychologists need to be mindful of their physical, emotional and cognitive well-being. Psychologists have an ethical obligation to ensure that their own physical and psychological well-being is healthy enough to care for patients, teach, supervise, etc. Fatigue, pain, nausea and vomiting and the medications used to treat these symptoms or side effects may compromise some individuals’ ability to meet the demands of clinical practice. Chemotherapy and other medications used in cancer treatment, for example, can diminish cognitive functioning. While changes in concentration, memory, processing speed, and the ability to multitask are likely to be mild and time-limited, high level clinical decision-making is essential for differential diagnosis and treatment. Psychologists undergoing cancer treatment must evaluate if they are healthy enough to meet the demands of practice and other professional responsibilities.

Designate a clinical power of attorney. Consistent with the APA Ethical Principles of Psychologists and Code of Conduct (2002), psychologists are obligated to ensure that patients will be taken care of if they are not able to meet professional responsibilities because of personal problems or when there are interruptions in therapy or termination. While many psychologists with cancer will continue to practice during and after treatment, it is important to designate a clinical power of attorney in the event that the psychologist is unable to take care of patients. This colleague should be able to access the psychologist’s office (i.e., they have door and file keys), patient lists, appointment schedules, and records; will contact patients and can either reschedule or provide care to patients, or refer them to other colleagues with the appropriate clinical expertise. See Pope and Vasquez, (2007); Spayd & O’Leary Wiley (2009); and www.apapracticecentral.org for more detailed discussions on closing a practice.

Personal experience with cancer and expertise in psychosocial oncology.  Psychologists who undergo their own cancer treatment will have a special understanding of the experience faced by so many adults across the life span. After treatment, they may even consider taking care of patients with cancer. While well meaning, the psychologist’s own treatment experience is very different from having the expertise in psychosocial oncology necessary to provide evidence-based assessment and treatment to adults with early and advanced cancers. Treating patients with cancer requires a highly specialized fund of knowledge and clinical competencies to ensure quality care and outcomes. While psychologists may want to help others deal with this challenge, they still have the ethical obligation to practice within their scope of expertise. Again, supervision from a respected colleague can be invaluable to sort out if and when a psychologist should treat others with or affected by cancer.

References

American Psychological Association (2002). Ethical principles of psychologists and code of conduct. Washington, DC: Author.

Coons, H. L. (2010). Psychologists with early and advanced breast cancer: Clinical, ethical and practical challenges. Manuscript submitted for publication.

Pope, K. S., & Vasquez, M. J. T. (2007). Ethics in psychotherapy and counseling: A practical guide. San Francisco: John Wiley.

Spayd, C. S., & O’Leary Wiley, M. (2009, December). Closing a professional practice: Clinical and practical considerations. The Pennsylvania Psychologist, 69(11), 15-17.

Helen L. Coons, Ph.D., ABPP, is a board certified clinical health psychologist who is President and Clinical Director of Women’s Mental Health Associates in Philadelphia. She has specialized in psychosocial oncology for 30 years, mentors psychologists and other health care providers with cancer, and underwent treatment for breast cancer. Dr. Coons may be reached at hcoons@verizon.net or 215-732-5590.

Jana N. Martin, Ph.D., is a licensed psychologist in independent practice in Long Beach, CA. Some of her work with children, adults, and families has focused on coping with chronic diseases such as cancer, and she is in remission from lymphoma. She may be reached at drjanamartin@verizon.net.

Supervisor Self-Disclosure

*Psychotherapy: Theory, Research, Practice, Training* has scheduled an article for publication in a future issue: "Supervisor Self-Disclosure: Supervisees' Experiences and Perspectives."

The authors are Sarah Knox, Lisa M. Edwards, Shirley A. Hess, and Clara E. Hill.  Here's how the article begins:

[begin excerpt]

Farber (2006) suggested that, in addition to the inherent need for supervisee self-disclosure, supervisor self-disclosure (SRSD) is also crucial to supervision.

He asserted that supervisors disclose to build the supervision relationship, share discoveries from their own professional experiences, model skills, and provide feedback.

Given the role that SRSD may have in supervision, it is important to examine its impact on supervisees and on supervision.

Existing studies, primarily using quantitative survey methods, have described types and outcomes of SRSDs (Bahrick, 1990; Gray, Ladany, Walker, & Ancis, 2001; Hess et al., 2008; Ladany, Hill, Corbett, & Nutt, 1996; Ladany & Lehrman-Waterman, 1999; Ladany & Melincoff, 1999; Ladany & Walker, 2003; Ladany, Walker, & Melincoff, 2001; Norcross & Halgin, 1997; Walsh, Gillespie, Greer, & Eanes, 2002; Worthen & McNeill, 1996; Yourman, 2003). In the only qualitative study in this area, Knox, Burkard, Edwards, Smith, and Schlosser (2008) examined supervisors' perspectives about using SRSD with supervisees. Supervisors used SRSDs when supervisees struggled, and intended them to teach or normalize. Supervisors' disclosures focused on supervisors' reactions to their own or their supervisees' clients. These SRSDs had positive effects on supervisors, supervisees, the supervision relationship, and supervisors' supervision of others.

These results suggest that the supervisors were attuned to their supervisees' clinical needs and sought to intervene such that supervisees could function more effectively, all of which led to salutary results. Although Knox et al.'s results are intriguing, we wonder if supervisees feel the same way about SRSDs . . . do such disclosures have the salutary effects that supervisors perceived? Relatedly, the literature is replete with examples of supervisees' negative feelings about their supervisors, and also the belief that they must hide such feelings for fear of political suicide (Gray et al., 2001; Hess et al., 2008; Nelson & Friedlander, 2001). Learning about supervisees' reactions could thus help us understand the other side of the SRSD interaction. We need, then, a probing examination of supervisees' experiences of SRSD, so that we may "get inside" the phenomenon by asking those to whom it is directed how they experienced such disclosure.

A qualitative design could help us fill this gap in the literature by addressing the central question of the current study: How do supervisees experience SRSD? How does SRSD affect supervision and supervisees' clinical work? Examining such questions from the supervisee perspective is essential, and will add important new understandings to the extant literature. In the present study, then, we examined supervisees' experiences of SRSD, extending with a distinct sample the work by Knox et al. (2008) about supervisors' experiences of SRSD. We asked supervisees to describe in depth one particular instance of SRSD and its impact.

[end excerpt]

Another excerpt: "When describing a specific SRSD experience, supervisees reported a range of antecedents (e.g., difficult clinical situation, selfdoubt, tension in supervision relationship) followed by supervisor disclosures about clinical experiences or personal information. Supervisees perceived that their supervisors disclosed primarily to normalize, but also to build rapport and to instruct. The SRSDs had mostly positive effects (e.g., normalization), though some negative effects (e.g., deleterious impact on supervision relationship) were reported."

The author note provides the following contact information: " Sarah Knox, PhD, Associate Professor, Department of Counselor Education and Counseling Psychology, College of Education, Marquette University, Milwaukee, WI 53201-1881. E-mail: sarah.knox@marquette.edu.

Thanks to Ken Pope for this information.