First, Meet Ethical Obligations

Clinical supervisors often are responsible for both supervision of a clinical team and many hours worth of administrative tasks. Issues such as time keeping, record keeping, personnel matters, implementation of agency policies and procedures, and other administrative duties related to management of a program often fall under clinical supervisors’ obligations. Some supervisors may serve on committees or task forces, especially if they are part of a larger organization or a hospital.

If there is an expectation that a supervisor devote time to administrative functions, there may be little time left for high-quality clinical supervision of staff. If this is the case, supervision sessions occasionally may be canceled in favor of other pressing matters. Often the individual sessions with counselors, although labeled as clinical supervision, may consist merely of administrative oversight. This may result in little or no observation of counseling sessions, a lack of documentation regarding issues discussed in supervision, and infrequent opportunities to address topics relevant to skill development and ethical conduct.

What are the clinical implications of solely focusing on administrative oversight versus providing clinical supervision? When supervisors spend an inordinate amount of time on administrative duties, it is often at the expense of good client care. Although one cannot ignore the realities of today's treatment environment with its many demands placed on those in supervisory roles, program directors must take a look at the tasks delegated to supervisors and determine whether the time demands associated with them detract from the provision of ethically sound clinical supervision. If this is the case, this may risk causing negligence on the part of supervisors who are not being made fully aware of potential unethical behavior by counselors—and are therefore open to a malpractice suit if something goes awry.

Duty of care

Clinical supervision is, of course, much more than administrative oversight of counselors’ performance. It is also much more than a series of unstructured sessions merely discussing cases chosen by the counselor. Clinical supervision has become a clinical specialty with its own set of ethical and legal responsibilities, including protecting the welfare of clients and furthering the professional growth of counselors. Addressing this topic, Janet Falvey writes that the supervisor has “ethically and legally defined responsibilities—a duty of care—that demand careful consideration when interacting with clients, supervisees, colleagues, employers, and society at large.” 1


Thomas G. Durham, PhD, LADC The clinical work of supervisors and counselors directly (and sometimes powerfully) influences the lives of others. Falvey advises that clinical supervisors be alert, effectively address competing demands, and be cognizant of potential consequences of decisions and advice. She adds, “Personal quality control minimizes judgment errors that can lead to clinical transgressions and professional liability.” 1

Clinical supervisors have a number of ethical obligations in their supervisory roles. Counselors often face decision-making dilemmas, and supervisors need to be available to help counselors recognize these dilemmas and form a framework of ethical decision making. As part of the process of guiding counselors toward developing a framework for ethical decision making, a series of questions can be posed to increase their awareness of ethical responsibilities. These questions address what have been designated as the four primary principles of biomedical ethics. These principles, applicable to all helping professions, are autonomy, beneficence, nonmalfeasance, and justice.2 The questions, in the above order for the four principles, are:

1. Is the counselor giving the client the freedom to make choices about his or her direction in treatment?

2. Is the counselor providing hope, encouragement, and support for the client's decisions that are individualized, in line with the client's values, and in the client's best interest regarding change toward successful recovery?

3. Is the counselor working with the client in a way that will “do no harm”?

4. Are ethical codes, laws, and universal values being followed by the counselor, and is the counselor providing fairness to all who are involved with this client's treatment?

Posing these or similar questions not only gives the supervisor valuable information about a counselor's work with a client, but also can be a catalyst in promoting a counselor's ethical thinking. Supervisors not only must be aware of what is occurring in the sessions conducted by supervisees, but they also are obligated to ensure that what is occurring is ethically sound and clearly understood by counselors. This type of awareness not only ensures client welfare, but also protects the supervisor and the agency from being held liable for any negligence on the counselor's part.

Be aware of liability

The supervisor and the agency may be held liable for damages, solely as a result of the supervisory relationship, occasioned by the professional negligence of a supervisee. This can occur, according to Falvey, when three conditions are met that clarify the existence of a legal supervisory relationship: The supervisee agrees to work under the direction and control of the supervisor; the supervisee is acting according to a defined set of duties and tasks expected of the supervisor; and the supervisor has the authority to control the work of the supervisee.

Most clinical relationships in licensed or accredited treatment programs meet the conditions of legal supervisory relationships. If these conditions are met and the supervisor is not aware of what is going on between counselor and client, the supervisor could be found to be vicariously liable in a malpractice suit when professional negligence occurs. The key to protection against vicarious liability is to have proof (through documentation) that clinical supervision is occurring and that the material discussed in supervision follows ethical and legal guidelines that promote professional growth for the supervisee and, most importantly, the welfare of the clients being treated.

Most instances of a supervisor being named in a malpractice suit occur when a supervisor either gives advice that directly leads to negligence or allows negligence to occur by not making a reasonable effort to supervise. Merely providing administrative oversight of a counselor's work constitutes an example of not making a reasonable effort to supervise.

Counselors face ethical dilemmas frequently, but unfortunately many are ill-equipped to meet the many demands common to counseling and psychotherapy. If a supervisor continues to juggle multiple demands and responsibilities and as a result is pulled away from providing adequate clinical supervision, the counselor, supervisor, and ultimately the agency can be held liable for negligence. Yes, supervisors often must wear many hats. But I recommend that the hat of choice for supervisors be the one labeled “ethically responsible supervisor.”

Thomas G. Durham, PhD, LADC, is Executive Director of The Danya Institute in Silver Spring, Maryland, where he coordinates training programs including those delivered by the Central East Addiction Technology Transfer Center.

References

1. Falvey J.. Managing Clinical Supervision: Ethical Practice and Legal Risk Management. Pacific Grove Calif.:Brooks/Cole; 2002.
2. Beauchamp T, Childress J. Principles of Biomedical Ethics, Fifth Edition. New York:Oxford University Press; 1995.