Supervisor/supervisee ethical expectations: What goes on behind closed doors?

1. Supervisor/supervisee ethical expectations: What goes on behind closed doors? Jeffrey E. Barnett, Psy.D., ABPP Karen Strohm Kitchener, Ph.D. Jenny Cornish, Ph.D., ABPP Rodney Goodyear, Ph.D.

2. Overview • Introduction (Jeff Barnett) • Methods/Results (Jenny Cornish) • Discussion (Karen Kitchener) • Reflections (Rod Goodyear)

3. 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

4. Competence in Supervision • Competence in Supervision • Competence in Clinical Practice • Competence in Ethics

5. 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

6. 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

7. 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

8. 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.

9. 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

10. 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

11. Adequate attention to self-care • Appropriate delegation to subordinates • Accurate representation to the public • Training supervisees to think and act ethically (Kitchener, 2000)

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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 3rd researcher who independently scored responses • Multiple conference calls and E-mails to refine categories

19. 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%

20. 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)

21. 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)

22. Problem with a different staff member • Never had any problematic incidents in supervision

23. 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)

24. 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)

25. 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)

26. 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

27. 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

28. Significant differences • Supervisees were more likely than supervisors to indicate they had taken a supervision course (p<.05) • Supervisors were more likely than supervisees to indicate they had tried to resolve ethical issues in supervision (p<.01)

29. 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

30. Limitations • Lack of training for third rater • Possible sample bias • Different perspectives • Directions for future research • Random sample; larger population

31. 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

32. Reflections

33. Contact information • Jeffrey Barnett: drjbarnett1@comcast.net • Karen Kitchener: kkitchen@du.edu • Jenny Cornish: jcornish@du.edu • Rod Goodyear: goodyea@usc.edu

34. 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.

35. . • 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.

36. 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.

37. 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.

38. 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.

39. 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.