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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. Overview. Introduction (Jeff Barnett) Methods/Results (Jenny Cornish)

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supervisor supervisee ethical expectations what goes on behind closed doors

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.

overview
Overview
  • Introduction (Jeff Barnett)
  • Methods/Results (Jenny Cornish)
  • Discussion (Karen Kitchener)
  • Reflections (Rod Goodyear)
ethics issues and dilemmas in the supervisory relationship
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

competence in supervision
Competence in Supervision
  • Competence in Supervision
  • Competence in Clinical Practice
  • Competence in Ethics
what is competence how and where do we get it
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
what makes for effective supervision what supervisees have to say
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
slide7
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
so what s the problem
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.
relevant ethics issues
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
slide10
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
slide11
Adequate attention to self-care
  • Appropriate delegation to subordinates
  • Accurate representation to the public
  • Training supervisees to think and act ethically (Kitchener, 2000)
reasons for this study
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
method
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
procedures
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
instruments packets
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
participants 62 supervisees
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
participants 66 supervisors
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
scoring
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
slide19
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%
categories for supervisees
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)
slide21
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)
slide22
Problem with a different staff member
  • Never had any problematic incidents in supervision
categories for supervisors
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)
slide24
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)
slide25
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)
results supervisees
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
results supervisors
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
significant differences
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)
discussion
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
slide30
Limitations
    • Lack of training for third rater
    • Possible sample bias
    • Different perspectives
  • Directions for future research
    • Random sample; larger population
slide31
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
contact information
Contact information
  • Jeffrey Barnett: drjbarnett1@comcast.net
  • Karen Kitchener: kkitchen@du.edu
  • Jenny Cornish: jcornish@du.edu
  • Rod Goodyear: goodyea@usc.edu
references
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.
slide35
.
  • 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.
slide36
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.
slide37
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.

slide38
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.

slide39
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.