There are several professional associations that promote ethical standards of practice for counselors and psychotherapists. This chapter will present some general guidelines for standards of practicing clinical supervision. The methodology for evaluating the supervisee's competence to practice counseling or psychotherapy should be described. Confidentiality must be addressed relating to the information arising from this relationship. Finally, a statement of agreement that the supervisee is voluntarily engaging the clinical supervisor for supervision should be included.
In this section, the clinical supervisor describes his or her personal model for supervision. I will draft quarterly, formal competency appraisals and discuss them with you documenting your skills competency based upon mutually agreed upon skills competency standards.
By observing behaviors, formulating strategies and providing feedback, I can provide you with assistance and motivation as you strive to implement these competency improvement strategies and hit your targeted goals. If unethical behavior occurs, I will be required to notify the appropriate professional bodies. As an integral part of your clinical supervision, you may be requested to complete additional reading assignments, attend and participate in certain courses, workshops or seminars, or participate in additional supervision hours if additional education, training or coaching is necessary for your development and ability to practice as a therapist. Should personal issues appear to be negatively affecting your ability to deliver therapeutic services to your clients, you may be required to seek personal therapy if you desire to continue to practice as a supervisee under my supervision. My supervision may focus on your personal functioning as it impacts your therapeutic skills and interventions but it is not therapy nor should it serve as a substitute for personal therapy. I understand the supervisor's personal clinical supervision model, the inherent risks and the competency appraisal process described in this Informed Consent: Clinical Supervision Agreement and I am interested in initiating clinical supervision with my supervisor as described within this document.
The clinical supervisor can document the occurrences of supervision sessions by utilizing a series of forms. The Clinical Supervision Record documents the important elements and activities of the clinical supervision session. An indication should be made that the Informed Consent & Release for clinical case presentation is in the client record. Finally, any training issues or concerned should be documented and added to the competency appraisal and coaching documentation process for follow-up. The Clinical Supervision Monthly Report documents a summary of the clinical hours delivered by the supervisee and the supervision hours provided by the supervisor during a monthly period. The supervisee's name and the start date and termination date of the clinical supervision relationship are recorded at the top of the form.
The fifth element of the clinical supervision relationship that should be documented is the existence of informed consent and confidentiality agreements. It is also necessary to document the supervisee's agreement not to discuss clients or cases with anyone other than his or her clinical supervisor, or the supervision group without a signed, written release of confidentiality and informed consent agreement approved by the practice, agency, institution or clinic. Finally, the supervisee's understanding of the consequences of breaching confidentiality should be acknowledged and the document should be signed by all parties to the supervision relationship, the supervisee and both the individual and group clinical supervisors. I will refrain from revealing any identifying information regarding my clients when presenting cases in either individual or group supervision. I will protect the confidentiality of my client's records by bringing minimal information for supervision and Genograms will not contain any identifying data.
This Agreement shall remain in effect from the date of execution until the termination of supervision with the undersigned supervisor(s).
The second clinical supervision practice standard is to comprehensively and systematically cover the general aspects of the clinical supervision relationship with each supervisee.
Mutual understanding and agreement around the supervisee's expectations and learning goals are an important starting point in any new clinical supervision relationship. Each supervisee should be challenged to develop a set of learning goals when they begin a clinical supervision relationship. The learning contract should be viewed and used as a fluid document open for revisiting and revising throughout the course of the supervisory process. Is something expected to occur as a consequence of successfully achieving the targeted outcome?
The second general area for discussion is the supervisee's related education, clinical training and related experiences.
It may also be helpful to determine whether or not the program was accredited by the COAMFTE (Commission on Accreditation for Marriage and Family Therapy Education), approved by the APA (American Psychological Association), or accredited by the NLNAC (National League for Nursing Accrediting Commission)? Talking about the supervisee's internship experiences will assist the supervisor in determining the types of cases the supervisee may be able to treat during the supervision process. If the supervisee has completed additional clinical training or continuing education experiences, these should be discussed as well.
A careful examination of the supervisor's clinical supervision model and personal supervision philosophy is important in aiding the supervisee's understanding of the supervisor's approach, orientation, and expectations in the supervisory relationship. Each supervisee should be required to read, sign, and date an Informed Consent & Clinical Supervision Agreement form prior to the commencement of the clinical supervision relationship.
Next, the supervisor and supervisee should review and discuss the Confidentiality Agreement - Supervisee form. Other forms are also recommended to accurately document the supervisory relationship and the type, frequency and duration of the supervisee's experiences. There are numerous legal and ethical issues that may arise during the course of the supervisory relationship. Each professional association has a set of ethical guidelines or a code of ethics by which members are expected to practice their profession. Confidentiality issues between the supervisor and supervisee, supervisee and clients, and supervisees in a group supervision experience should be discussed in detail.
Although emergencies may be infrequent, whenever one occurs it is critical that policies and procedures have been created and reviewed beforehand to ensure that everyone's safety and well-being are managed effectively. At a minimum, there should be contact phone numbers for yourself and a back-up person in your absence.
In the event of a suicidal or homicidal client, additional emergency procedures should be carried out. Discussing assessment and evaluation procedures and emergency interventions with clients who are actively suicidal, homicidal or an immediate threat or danger to themselves or others is another important part of preparing for clinical emergencies before they arise. A dual relationship is created at any time a counselor or therapist engages in two roles simultaneously or sequentially with another person with whom they currently have or previously have had a professional relationship involving the delivery of professional services. Most professional associations for professional counselors and therapists have specific standards in their Codes of Ethics regarding dual relationships.
American Association for Marriage and Family Therapy, Revised AAMFT Code of Ethics, effective July 1, 2001. 1.3 Marriage and family therapists are aware of their influential positions with respect to clients, and they avoid exploiting the trust and dependency of such persons. 1.5 Sexual intimacy with former clients is likely to be harmful and is therefore prohibited for two years following the termination of therapy or last professional contact.
1.7 Marriage and family therapists do not use their professional relationships with clients to further their own interests (AAMFT, 2001).
We do not engage in harassment, abusive words or actions, or exploitative coercion of clients or former clients.

All forms of sexual behavior or harassment with clients are unethical, even when a client invites or consents to such behavior or involvement.
Boundaries during infancy, childhood and adolescence allow us to experience security and containment, support and independence, belonging and autonomy, and joining and separating, all of which can occur without the loss of love, protection, safety or acceptance. As adults, boundaries continue to serve important roles for creating safety and security within the context of our relationships with one another. Others choose the opposite boundary response and develop patterns of extreme openness, conflict avoidance and a smothering pattern of relating to others.
Clinical supervisors have a professional responsibility to be aware of and effectively set and manage their own professional role boundaries in relationship to their supervisees.
Professional role definition boundaries may be crossed in both inappropriate and appropriate ways. Gabbard (1995) identifies a set of warning signs that can alert both therapists and clients to the possibility that boundary violations may be occurring. Talking about the therapist's problems or concerns during the client's session, spending both the client's time and money (Gabbard, 1995).
Like many professions, counselors are not exempt from the risks of burnout, unmanageable stresses and the potentially damaging effects of unattended transference and countertransference issues. Core competencies and supporting standards should be developed for the supervisee in the form of a position description (job description). Creating a workplace environment that fosters maximum professional skills development and learning involves communication and understanding around practice logistics.
The clinical supervisor is responsible for the client's treatment when an unlicensed counselor is providing psychotherapeutic services under his or her direction. By personally conducting the initial intake session and speaking with any referral sources and previous treatment providers, the supervising clinician can make an accurate assessment of the client's needs and the supervisee's skills, training and abilities to address them. If the clinical supervisor conducts the initial intake, the supervisee and the clinical supervisor could co-facilitate the first treatment session together so that continuity of care and a smooth transition are provided to clients. Some discussion is necessary around the supervisor's fee and payment arrangements for the delivery of clinical supervision services. Additionally supervisees should clearly know where the supervision will be conducted, how frequently sessions will occur and how long each session will last. Supervisees should also be made aware of how clients will be referred or assigned for clinical treatment. Talking about supervision session expectations beforehand can greatly reduce future conflicts around misunderstandings regarding punctuality, smoking, eating and drinking and preparation beforehand (cueing tapes, preparing case notes, etc.).
In agency or institutional settings, copies of the employee handbook, policy and procedure manual, and benefits documentation should be provided to supervisees. The clinical supervisor and the supervisee both indicate by their signatures below that all the primary clinical supervision discussion points contained in this document have been discussed, understood and mutually agreed upon by both parties.
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Some of these include the American Association for Marriage and Family Therapy, American Association of Pastoral Counselors, American Counseling Association, American Psychological Association and the National Association of Social Work. Members of professional associations are responsible for knowing and practicing within the standards promulgated by their respective organizations. Minimally this should include the model's assumptions, the perceived roles of the supervisor and the supervisee and the model's limitations.
This section should minimally include what standards will be used, how competence will be measured, how feedback will be given and how coaching will be provided to continuously improve the supervisee's skills and competence in delivering counseling or psychotherapy services. This statement should summarize that the supervisee understands the supervisor's personal clinical supervision model and its inherent risks, competency appraisal process to be used and an expressed interest in initiating clinical supervision with this supervisor on a voluntary basis. The primary focus of supervision is to improve your competence as a therapist in improving the functioning of your clients, while the primary focus of personal therapy is to improve the functioning of the client. One form should be completed for each client case presented in each clinical supervision session. The clinical hours are broken down into three categories: Individuals, Couples and Families.
The agency, practice or institution is identified and the individual and group clinical supervisors are identified. This should include both an agreement of confidentiality by the supervisee and an informed consent and release for documentation and case presentation for clinical supervision from each client. This documents the supervisee's agreement to maintain the confidentiality of his or her clients and the clients of peers (other supervisees in the practice, agency, institution or clinic). It should also be clearly stated that the supervisee understands that he or she should not discuss client cases with family members, significant others, friends, colleagues, supervisors, faculty, referral sources, administrators and other students who are not a part of the clinical supervision group.
I will not discuss clients or cases with anyone other than my clinical supervisor, or my supervision group unless a person or persons are so designated on a Release of Confidentiality form.
The clinical supervisor should invite and encourage open dialogue around the supervisee's expectations for the supervisory process. These learning goals should be discussed and modified as necessary with the clinical supervisor and documented in a learning contract between the clinical supervisor and the supervisee.
The primary objective for creating it is to provide a series of checkpoints to assist in assessing and evaluating the supervisee's progress in incremental learning and incremental skills development. Talking about the supervisee's graduate education will give the clinical supervisor insights into the supervisee's educational preparation for clinical practice.
This discussion should include the location, length of time spent at that location, type of clients treated, size of caseload, the total number of clinical hours completed and the type and style of supervision used.
This would include conferences, workshops, post-graduate internships, fellowships and hospital or agency in-service education programs.
A dialogue should also occur seeking contrasts and comparisons with the supervisee's philosophy of the supervisory relationship. The length of the supervisory relationship should be discussed and agreed to at this time too. These forms should also be reviewed and discussed to ensure that the supervisee understands the intent and purpose of these documents.
You, as the supervisor, should know your scope of practice and be able to articulate it to your supervisees.
The limits of confidentiality and mandated reporting responsibilities should be explored as well. Even if you are a solo practitioner supervising one supervisee in your private practice it is essential that you develop emergency contact procedures to safeguard your clients, your supervisee and yourself.
Many clinicians use an answering service or a voice mail and pager service for emergency contacts during a clinical emergency.
Emergency phone numbers for the local law enforcement agency, local county mental health, and the psychiatric emergency response team (if available in your area) should also be easily accessible to staff members. Therapists, therefore, make every effort to avoid conditions and multiple relationships with clients that could impair professional judgment or increase the risk of exploitation. In an effort to avoid exploiting the trust and dependency of clients, marriage and family therapists should not engage in sexual intimacy with former clients after the two years following termination or last professional contact.

While acknowledging the complexity of some pastoral relationships, we avoid exploiting the trust and dependency of clients.
Sexual behavior is defined as, but not limited to, all forms of overt and covert seductive speech, gestures, and behavior as well as physical contact of a sexual nature; harassment is defined as, but not limited to, repeated comments, gestures or physical contacts of a sexual nature.
Therefore, all sexual behavior or harassment as defined in Principle III, G with former clients is unethical.
This power differential is so significant that many would argue there is an actual inability on the part of the client to make an informed consent decision regarding a dual relationship. As newborn children, we are thrust into a turbulent, new existence where we experience the familiar and the unknown. They must be simultaneously flexible and restricting yet clearly understood by both the child and the caregiver.
We may develop patterns of boundary responses depending on the outcomes of our relationships with others. They develop such a deep-seated fear of abandonment that they lose their sense of self in relationship with another. People who choose this pattern of relating to others move from one extreme phase of rigid boundaries to the other extreme phase of boundarylessness. Additionally, they are responsible for effectively managing and directing supervisees in the process of professional role boundary setting and management with their clients.
These should be discussed in detail with the supervisee and used as a baseline for co-creating learning goals. Before a supervisor can make an effective client referral to his or her supervisee he or she must know the client's history, presenting problems, provisional diagnosis and a treatment plan. If this practice is used, the Intake Counselor should be licensed and highly experienced in conducting initial assessments, taking comprehensive histories and functioning as a liaison with referring agencies, professionals and previous treatment providers. This practice should be considered when an Intake Counselor is not available such as in private practice settings or small agencies.
Supervisors should be aware that many state laws set parameters around the ratios between supervision sessions and client hours, the duration of supervision sessions and the number of supervisee participants in group supervision sessions to qualify the supervisee for licensure experience hours. The process for determining the supervisee's appropriate skill and experience level and assessing a client's initial diagnosis and treatment needs are also important points of discussion. Information about telephone procedures, answering service and paging, on-call coverage, scheduling, office hours, parking and scheduling consultation rooms is also important for maintaining a smooth operation. Each client should be assigned a case number to preserve client anonymity in these records. This includes a commitment to refrain from revealing any identifying information regarding clients during case presentations in either individual or group supervision. I understand that this includes my family, significant others, friends, colleagues, supervisors, faculty, referral sources, administrators and other students. Knowing what specific coursework was taken will also help to provide the clinical supervisor with insights into the educational foundation of the supervisee's training.
Engaging supervisees in dialogue over these issues can assist the supervisor in uncovering potential areas in which the supervisee may need additional training and education.
This will assist you in determining each supervisee's scope of practice and how it can be expanded within your own. In cases where either the supervisor or the supervisee is a member of a specific professional association, that association's code of ethics should also be included. For the purposes of our discussion in this text, we will focus on dual relationships between clinical supervisors and supervisees. Such relationships include, but are not limited to, business or close personal relationships with a client or the client’s immediate family.
Should therapists engage in sexual intimacy with former clients following two years after termination or last professional contact, the burden shifts to the therapist to demonstrate that there has been no exploitation or injury to the former client or to the client’s immediate family. Counselors do not accept as clients, superiors or subordinates with whom they have administrative, supervisory, or evaluative relationships. Counselors do not have any type of sexual intimacies with clients and do not counsel persons with whom they have had a sexual relationship. Counselors do not engage in sexual intimacies with former clients within a minimum of 2 years after terminating the counseling relationship.
Therefore, the responsibility for avoiding such relationships falls completely on the shoulders of the therapist. This dependency should be regarded with care and all decisions should be made with the client's best interests and well-being at the forefront.
Some people may establish a pattern of rigid boundaries within which they become so fearful of being hurt by another that they close off themselves from intimacy and closeness.
It is almost a state of boundarylessness, within which a sense of self becomes so blurred and undifferentiated that they may come to believe that there is nothing of self left to be rejected by someone else.
This pattern of relationship choices often creates confusion and frustration because the individual is perceived as unpredictable and unsteady.
Professional role boundary violations result in harm, damage and exploitation to someone else.
A proposed set of seven competencies and the supporting standards are presented later in Chapter Five: Recruiting Competent Supervisees. Note that in California it is illegal for interns or trainees to be paid as independent contractors. These include audio taped client sessions, video taped client sessions, live observation (one-way mirror), co-therapy, and case presentations. Next, I will compare observed behaviors and competence to our mutually predetermined goals and share this information with you.
A commitment is also made to protect the confidentiality of client records by bringing minimal information for supervision sessions and only Genograms that lack all client identification data. The American Association for Marriage and Family Therapy, American Psychological Association, American Nurses Association, National Association of Social Workers and the American Counseling Association all have codes of ethics governing member's conduct (See Resources Section for contact information).
When the risk of impairment or exploitation exists due to conditions or multiple roles, therapists take appropriate precautions.
Counselors who engage in such relationship after 2 years following termination have the responsibility to examine and document thoroughly that such relations did not have an exploitative nature, based on factors such as duration of counseling, amount of time since counseling, termination circumstances, client's personal history and mental status, adverse impact on the client, and actions by the counselor suggesting a plan to initiate a sexual relationship with the client after termination. A lifelong process is begun in which we wrestle with self-creation and how to function as an individual self in a world of others.
They give up their ability to be resilient and flexible and in the process of attempting to protect themselves, they injure themselves deeply through isolation, withdrawal and loneliness.
Professional role boundary crossings that are not violations may be classified as a change in role or behavior that does more good than harm to another without the occurrence of exploitation. If both individual and group supervision sessions are used, then the role of other supervisees in the group should also be discussed.
Together, we will formulate strategies for incremental learning and incremental improvement toward achieving your competency goals. Third, I will give feedback to you addressing both what appeared to be effective effort and what could be demonstrated differently.

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