Ethics Issues and Dilemmas in the Supervisory Relationship The Role of Supervision in Each Psychologist’s Training and Professional Development The apprenticeship model of training Supervisor as role model Training future supervisors
Competence in Supervision Competence in Supervision Competence in Clinical Practice Competence in Ethics
What is Competence? How and where do we get It? Knowledge Skills Attitudes, Values, and Judgment The ability to implement them effectively (See Haas & Malouf, 2005; Rodolfa et al., 2005) The roles of education, training, and supervised clinical experience
What Makes for Effective Supervision? What Supervisees have to say Presence of caring, trusting, and collaborative relationships Respect toward and support of supervisees Constructive feedback given in nonjudgmental and unthreatening manner Create a safe environment
Approachability and receptivity to supervisees’ ideas and opinions Clinically competent, flexible, experienced, with good relationship skills Focus on ethics in supervision and conduct themselves ethically
So What’s the Problem? Ladany (2002) found that more than 50% of supervisees surveyed reported experiencing at least one unethical behavior on the part of a clinical supervisor.
Relevant Ethics Issues Timely and thorough informed consent process Only supervising in one’s areas of competence Maintaining appropriate boundaries and avoiding potentially exploitative multiple relationships
Respecting clients’ and supervisees’ privacy and confidentiality Respecting clients’ and supervisees’ autonomy Providing timely and constructive feedback Attending to relevant diversity issues and avoiding bias
Adequate attention to self-care Appropriate delegation to subordinates Accurate representation to the public Training supervisees to think and act ethically (Kitchener, 2000)
Reasons for this Study Need to better understand ethics dilemmas and difficulties in the supervisory relationship Need to understand supervisor and supervisee perspectives Need data to guide the development of specific ethics guidance for supervisors and supervisees
Method Parsimonious qualitative approach (confidential written survey of supervisors and supervisees regarding problematic incidents in supervision) Approved by University of Denver IRB Funded by DU Faculty Research Fund grant
Procedures 2 bulk mailings to 552 Internship Training Directors (ITDs) listed in the Association of Psychology Postdoctoral and Internship Programs (APPIC) Directory. Also E-mail reminder ITDs asked to forward surveys to one supervisor and one intern supervisee at their site (did not need to be a supervision pair) Necessary return rate dependent on when exhausted new categories and responses became repetitive (Kain, 2004): happened ½ way through scoring so return rate more than sufficient for the study
Instruments/Packets Developed by researchers Cover letters to Internship Training Directors, Supervisors, Supervisees Demographic sheet Survey (asked for description of a problematic incident in supervision, whether or not the participant felt this was an ethical problem, and what they did to resolve problem) Stamped return envelopes Stamped raffle postcard for IPOD mini
Participants: 62 Supervisees Mostly White (83.3%), female (86.4%), from clinical program (78.3%), ages 20- 30 (70%) 46.7% had 6 - 9 supervisors 60% had taken a course in supervision, with 51.7% also having further training 62.3% described an ethical problem in supervision; 75.4% had tried to resolve it
Participants: 66 Supervisors Mostly White (90.8%), female (66.2%), PhD (61.5%), from clinical program (67.7%), ages 41 – 50 (61.5%) 41.5% had supervised for 15+ years, with 47.7% having 26+ supervisees Only 38.5% had taken graduate courses in supervision, but 67.7% had received further training in supervision 68.2% described an ethical problem in supervision; 92.4% of those tried to resolve the problem
Scoring Used critical incident scoring method: Kain, D. L. (2004). 2 raters initially sorted responses, developed descriptions of critical incident categories, changed/refined categories Sent categories to 3 rd researcher who independently scored responses Multiple conference calls and E-mails to refine categories
Reliability for time one: 66% for supervisors and supervisees Reliability for time two: 95% for supervisors and 86% for supervisees Discovered two researchers not using multiple categories for single responses, so had to rescore Collaborated for consensus rating: 100%
Categories for Supervisees General incompetence of the supervisor (e.g., supervisor unavailable, falls asleep during supervision, focuses only on case management of irrelevant issues) Personal problems (e.g., supervisor appears intoxicated, discusses divorce) Shaming (e.g., supervisee feels shamed about personal beliefs in individual or group format)
Multiple relationships/Boundary issues (e.g., supervisor sees relative of supervisee in psychotherapy) Inappropriate role modeling (e.g., supervisors arguing in a public place) Disagreement with supervisor about administrative issues (e.g., paid time off) Disagreement with supervisor about clinical issues (e.g., choice of tests)
Problem with a different staff member Never had any problematic incidents in supervision
Categories for Supervisors General incompetence of the supervisee (e.g., frequently late or no/shows, inadequate clinical skills, poor or missing paperwork, not ready for internship) Personal problems (e.g., emotional problems, depressed and suicidal, externalized blame, insecure, lied) Dual relationship/Boundary problems (e.g., met client for lunch, ran over time in sessions)
Confidentiality (e.g., discussed clients in public space, released information without client permission) Failed to consult with supervisor (e.g., didn’t ask about need to report child abuse) Failed to follow supervisor’s instructions or agency policy (e.g., refused to give appropriate diagnoses)
Falsified documentation (e.g., wrote notes for clients never seen) Lack of informed consent (failed to obtain informed consent) N/A (behaviors that did not imply unethical conduct – e.g., supervisee showed general lack of initiative, but no ethical or clinical problems)
Results - Supervisees Problems described in supervision by frequency: General incompetence (37.1%) Shaming (17.7%) Personal problems (12.9%) Multiple relationships/boundary issues (9.7%) Problems with a non-supervisor staff member (3.2%) Inappropriate role modeling (1.6%) 19.4% described clinical disagreements and 1.6% described administrative disagreements rather than ethical problems
Results - Supervisors Problems described in supervision by frequency: General incompetence (24.2%) Personal problems (18.2%) Refused to follow supervisor’s instructions or agency policy (16.4%) Dual relationships/boundary issues (10.6%) Confidentiality (7.6%) Failure to consult with supervisor (3%) Falsified documentation (3%) Failed to give informed consent (1.5%) 21.2% described incidents that were not ethical problems with supervisees
Significant differences SSupervisees were more likely than supervisors to indicate they had taken a supervision course (p<.05) SSupervisors were more likely than supervisees to indicate they had tried to resolve ethical issues in supervision (p<.01)
Discussion Supervisee perspectives Competence of the supervisor to supervise General incompetence Shaming Multiple relationships/boundary issues Supervisor perspectives General incompetence of the supervisee Personal problems which interfere with competent work Refusal to follow supervisor’s instructions or agency policy
Limitations Lack of training for third rater Possible sample bias Different perspectives Directions for future research Random sample; larger population
Implications High rates of ethical problems, especially related to competence Supervision needs a separate section of the APA Ethical Principles of Psychologists and Code of Conduct Need clear communication between academic programs (gatekeepers) and training sites Need clear communication between supervisors and supervisees regarding expectations Need better training in ethics as well as ethical decision making and reasoning
Contact information Jeffrey Barnett: email@example.com firstname.lastname@example.org Karen Kitchener: email@example.com@du.edu Jenny Cornish: firstname.lastname@example.org@du.edu Rod Goodyear: email@example.com@usc.edu
References American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57 (12), 1060-1073. Bernard, J. M. & Goodyear, R. K. (2004). Fundamentals of ethical supervision (3rd edition). Boston: Pearson Education. Barnett, J.E. (2000). The supervisor’s checklist: Attending to ethical, legal, and clinical issues. The Maryland Psychologist, 46 (1), 16-17. Barnett, J.E., Doll, B., Younggren, J.N., & Rubin, N.J. (2007). Clinical competence for practicing psychologists: Clearly a work in progress. Professional Psychology: Research and Practice, 38, 510-517.
. Barnett, J. E. (2007). Commentaries on the ethical and effective practice of clinical supervision. Professional Psychology: Research and Practice, 38, 268-272. Cornish, J. A. E. (2007). Toward competence supervision: Commentary on the ethical and effective practice of clinical supervision. Professional Psychology: Research and Practice, 38, 272-273. Ellis, M.V. (2001). Harmful supervision, a cause for alarm: Comment on Gray et al.(2001) and Nelson and Friedlander (2001). Professional Psychology: Research and Practice,48, 401-406 Falender, C.A., Erickson Cornish, J.A., Goodyear, R., Hatcher, R., Kaslow, N.J.,Leventhal, G., Shafranske, E., Sigmon, S.T., Stoltenberg, C., & Grus, C. (2004). Defining competencies in psychology supervision: A consensus statement. Journal of Clinical Psychology, 60, 771-785.
Goodyear, R. K. (2007). Toward an effective signature pedagogy for psychology: Comments supporting the case for competent supervisors. Professional Psychology: Research and Practice, 38, 273-274. Haas, L.J., & Malouf, J.L. (2005). Keeping up the good work: A practitioner’s guide to mental health ethics (4th ed.). Sarasota, FL: Professional Resource Press. Henderson, C.E., Cawyer, C.S., & Watkins, C.E. (1999). A comparison of student and supervisor perceptions of effective practicum supervision. Clinical Supervisor,18, 47-74. Kain, D. L. (2004). Owning significance: the critical incident technique in research. In deMarrais, K. & Lapan, S.D. Methods of Inquiry in Education and the Social Sciences. New Jersey: Lawrence Erlbaum Associates.
Kitchener, K.S. (2000). Foundation of ethical practice, research, and teaching in psychology. Mahwah, NJ: Lawrence Earlbaum Associates Ladany, N. (2002). Psychotherapy supervision: How dressed is the emperor? Psychotherapy Bulletin, 37(4), 14-18. Ladany, N., Ellis, M.V., & Friedlander, M.L. (1999). The supervisory working alliance, trainee self-efficacy, and satisfaction with supervision. Journal of Counseling & Development, 77, 447-455.
Martino, C. (2001, August). Secrets of successful supervision: Graduate students’ preferences and experiences with effective and ineffective supervision. In J.E Barnett (chair) Secrets of successful supervision – Clinical and ethical issues. Symposium presented at the Annual Convention of the American Psychological Association, San Francisco, California. Lowry, J.L. (2001, August). Successful supervision: Supervisor and supervisee characteristics. In J.E. Barnett (chair) Secrets of successful supervision – Clinical and ethical issues. Symposium presented at the Annual Convention of the American Psychological Association, San Francisco, California.
Rodolfa, E., Bent, R., Eisman, E., Nelson, P., Rehm, L, & Ritchie, P. (2005). A cube model for competency development: Implications for psychology educators and regulators. Professional Psychology: Research and Practice, 36(4), 347-354. Watkins, C.E. (1995). Psychotherapy supervision in the 1990s: Some observations and reflections. American Journal of Psychotherapy, 49, 568-581. Wulf, J., & Nelson, M.L. (2000). Experienced psychologists’ recollections of internship supervision and its contributions to their development. Clinical Supervisor, 19, 123-145.