Posted By AnnetteTaylor on May 14, 2012
Providing clinical supervision to practicum students, interns, and postdoctoral fellows/ residents is a wonderful way to give back to the profession of psychology, to help the next generations of clinicians to develop their skills, and to keep our own clinical skills sharp. However, it is also a tremendous responsibility and it is important that current and future supervisors take the time to develop their knowledge of legal and ethical standards when it comes to supervision. The topic of legal and ethical issues in supervision is vast; this article focuses on issues related to patient care and supervisor liability.
For psychologists, ethical standards are largely guided by the American Psychological Association’s Ethical Principals of Psychologists and Code of Conduct. With regards to patient care provided by a supervisee, the supervisor has several responsibilities to the patient. These responsibilities are related to protecting the patient’s rights and acting in his/her best interests. The supervisor is also charged with ensuring that the supervisee’s patients are receiving a reasonable standard of care; while there are many ways this can be accomplished, a good way is to periodically conduct observations of the supervisee’s work, such as through one-way mirror observation, viewing videotapes or listening to audiotapes of sessions (the patient must first sign a written consent to be videotaped/ audiotaped). The supervisor must also ensure that the supervisee’s patients are informed regarding the risks and benefits of treatment, as well as the different types of treatment, and the fact that the supervisee will be participating in regular supervision.
As supervisors, in legal situations we are subject to two types of liability when it comes to our supervisees’ work. There is direct liability, which refers to liability for our own actions that caused harm to the patient. These situations tend to be less common as the supervisor generally does not have very much direct contact with the supervisee’s patients. There is also vicarious liability, which refers to liability for the supervisee’s actions which led to harm to the patient, even if the supervisor was not aware of those actions. Examples of vicarious liability are: Situations where the patient was not informed of the supervisee’s status; the supervisee failed to adequately identify situations involving risk; the supervisee has too many cases for the supervisor to monitor appropriately; the supervisee commits a breach of confidentiality that resulted from a lack of understanding of the concept of confidentiality; or the supervisor fails to obtain adequate information about a case from the supervisee during supervision, leading to patient harm.
How can we as supervisors protect ourselves in these situations? It is important that we are able to demonstrate our own competency as supervisors; for example, by participating in supervision workshops. We should also ensure that we are knowledgeable about current legal and ethical standards, and that our supervisees are knowledgeable as well. We should maintain adequate liability insurance (and supervisees should maintain insurance as well). We should periodically review our supervisees’ documentation and do what we can to keep their caseloads at manageable levels. We should be available in emergency/crisis situations. An extremely important aspect of responsible supervision is documentation. We should take the time to document our supervisees’ performance and progress, but we also need to maintain documentation of each patient on the supervisee’s caseload. Such documentation should contain demographic and clinical information about each patient and information about when each case was opened and closed. This documentation should be kept in a locked cabinet, separate from notes about the supervisee.
In crisis situations involving a supervisee’s patient, the supervisor should also document what was discussed during supervision regarding the crisis situation, taking particular note of all suggestions and recommendations that were provided to the supervisee. Equally important, the supervisor should follow up with the supervisee afterwards and document the results of the follow-up. In situations where the supervisor chooses to consult with a colleague on a supervisory matter, the supervisor should also document the consultation and any suggestions that were discussed.
With careful, thorough preparation and vigilance, supervision can be a rewarding, enriching experience for supervisors and supervisees alike. Those who are interested in learning more about legal and ethical issues in supervision, or other issues related to supervision such as dual relationships, competence, due process, etc., are encouraged to explore the references below.
Cynthia Medina, Ph.D., is a licensed psychologist in private practice in San Mateo. She specializes in evaluations for children and adolescents experiencing difficulties with attention, learning, executive functioning, and mental health/behavioral issues such as anxiety and depression.
References:
Bernard, J.M., & Goodyear, R.K. (2008). Fundamentals of Clinical Supervision (4th Ed.)
Falendar, C.A., & Shafranske, E.P. (2004). Clinical Supervision: A Competency-Based Approach.
American Psychological Association (2002). Ethical Principles of Psychologists and Code of Conduct.
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