ETHICAL AND LEGAL ISSUES IN SUPERVISION


Perhaps the greatest clinical and ethical challenge of supervision is that the supervisor must attend to the best interests of the client and supervisee simultaneously. There are a number of ethical and legal issues that must be considered by supervisors and their supervisees. The topics of direct and vicarious liability, duty to warn, confidentiality, dual relationships, and informed consent will be discussed. See the following links for the ethical standards related to supervision and training. 
  • Ethical Guidelines for Counseling Supervisors by the Association for Counselor Education and Supervision (ACES)
  • The Approved Clinical Supervisor (ACS) Code of Ethics
  • American Counseling Association (ACA) Code of Ethics – Teaching, Training and Supervision (SectionF)


Direct and Vicarious Liability

If a professional fails to follow acceptable standards of practice and harm to a client results, the professional can be held liable for the harm caused.
 
Direct liability would be charged when the actions of a supervisor were themselves the cause of harm to a supervisee or a client (for instance, if a supervisor suggested (and documented) an intervention that was determined to be the cause of harm). The supervisor does not have to actually carry out the intervention, but if the supervisee follows the suggestion of a supervisor and this results in harm – this is direct liability.
 
Vicarious liability is being held liable for the actions of the supervisee when these were not suggested, or even known, by the supervisor. Therefore, if a supervisory relationship exists, the supervisor can potentially be held liable for any negligent acts of the supervisee.

It should be obvious that the supervisor is very invested in the actions of his/her supervisee – and must take the responsibility of supervision very seriously.


Duty to Warn

The duty to warn is as relevant for supervisors as counselors working directly with clients. In fact, in the Tarasoff case (the impetus for the duty to warn standard/law) the supervisor, in addition to the counselor, was implicated in the case. The supervisor has a responsibility to advise the supervisee of conditions under which it is appropriate to warn an intended victim.
 

Confidentiality

Supervision allows for third-party discussion of therapy situations. It is important to remember that the type and depth of discussion allowed in supervision, is unethical in other situations. Supervisees must keep confidential all client information except of the purposes of supervision. It is sound practice to keep explicit identifying information confidential (for instance, use only first names and reveal few specific demographics).

Supervisees also have a right to privacy and it is the supervisor’s responsibility to keep information obtained in supervision confidential except for the exceptions recognized by the profession and law.


Dual Relationships

There are two major categories of dual relationships: sexual and non-sexual.

Sexual Dual Relationships

There are four categories of sexual relationships:

Sexual Attraction
Sexual attraction is not an uncommon occurrence in supervision relationships. Unfortunately, however, there is little attention to how to openly address and discuss the implications of the attraction – leading to successful resolve of the issue. Because acting on an attraction poses serious ethical dilemmas, addressing the attraction in supervision or through consultation with other professionals is vital.

Sexual Harassment
Unlike sexual attraction, sexual harassment is a clear abuse of power by the supervisor and is never acceptable. Sexual harassment can leave the supervisee feeling violated, vulnerable and confused.

Consensual (but Hidden) Sexual Relationships
Results of studies indicate that the majority of sexual relationships between supervisor and supervisee fall in this category. Because of the power differential inherent in supervision, it is suggested that no true “consensus” can be freely given by the supervisee. Supervisors have a responsibility to own the “power” that is automatically attributed to them by nature of their role.

Intimate Romantic Relationships
There is no distinction in the literature between relationships that occur within supervision, and those that begin there. It is understood that intimate relationship may develop when adults work together in the world of therapy. The important factor is to assure that a relationship that grew out of a supervision relationship poses no ethical compromise for the supervisor or supervisee – and that there are no consequences for the supervisee’s clients.
 
The general consensus about sexual dual relationships is that there is much more potential for harm and negative outcomes, than the potential for good or even acceptable outcomes. Supervisees and supervisors are encouraged to seek discuss these issues and/or seek consultation. The secrecy that typically occurs in the development of dual relationships is an important signal that there is a strong potential for unethical conduct and harm.

Nonsexual Dual Relationships

There is a general consensus that dual relationships between supervisors and supervisees (particularly in counselor education programs) are inevitable. Unlike therapy relationships, persons who work together will share other experiences with each other. In counselor education programs, faculty members may be instructors, supervisors, academic advisors, personal confidants, and mentors.

The potential for negative outcomes, as a result of dual relationships, centers on the power differential between the two parties. Dual relationships may be problematic in that they increase the potential for exploitation and for impairment of the objectivity of both parties, and they can interfere with the professional’s primary obligation for promoting the student’s welfare.

Some authors acknowledge that dual relationships are not tantamount to negative outcomes Indeed, with appropriate attention to the power differentiation, there can be great flexibility in non-sexual dual relationships. While there is the potential for harm, there are also training and personal benefits. These relationships tend to attract more confusion than harm.

Supervisors have a responsibility to openly acknowledge and discuss the management of the multiple relationships that may exist between supervisor and supervisee. Supervisees are encouraged to ask for clarifications regarding any confusion resulting from dual relationships.


nformed Consent

The concept of informed consent is being addressed last, as it has the potential for impacting the ethical/legal issues discussed to this point. Informed consent is the best defense against the difficult and confusing issues that arise in supervision.

Supervisors have an obligation to determine that clients have been informed by the supervisee regarding the parameters of therapy. Clients must not only be aware of therapeutic procedures, but also of supervision procedures. The supervisor assures that clients are informed of the parameters of supervision that may affect them.

In addition, supervisors have a responsibility to inform supervisees about the supervision process, potential for dual relationships, limits of confidentiality, and the conditions of their success or advancement (evaluation criteria and process). Supervisors may use a Professional Disclosure Statement as a to facilitate the informed consent discussion.


Ethical Decision Making

Ethical dilemmas are inevitable in counseling and supervision. To increase your ability to successfully manage dilemmas, consider the following:
1. Successful management relies on the ability to recognize dilemmas – attend to feelings of confusion, concern, anxiety and fear.
2. Incorporate experiential learning and case analysis into your work
3. Include questions regarding potential legal and ethical issues as part of case discussions
4. Familiarize yourself with ethical and legal codes and cases
5. Adopt and regularly implement an Ethical Decision Making Model