Ch. 11-Ethical And Legal Foundaions Of Sup Practice Flashcards
Describe inadequate supervision vs. harmful supervision.
- Inadequate supervision-neglecting to vote adequate time to the supervision process
- Harmful supervision-causing harm (i.e. sexual relationship with supervisee)
What did Corps, Ellis and Taylor (2017) find as prominent themes of supervisees who wrote about harmful experiences?
- Abuse of power
- Discrimination based on cultural characteristics
- Public shaming
How do ethical codes and the law overlap?
- The law may qualify how an ethical principle is implemented
- Sanctions for ethical misconduct can trigger legal sanctions (or vice versa).
How are ethics and the law different?
- Ethics grounded on universal and enduring principles.
2. Law can vary across time and jurisdiction
What emphases did Thomas (2014b) find all ethical codes shared?
- Contextual factors (these differ among countries)
- Boundary issues and multiple relationships
- Informed consent to supervision
- Competence in supervisors and supervisees
What are 3 moral principles that are found both in APA and ACA codes of ethics?
- Respect for autonomy/respect for dignity
- Beneficence
- Nonmaleficence
What are 3 OTHER moral principles that are found both in APA and ACA codes of ethics?
- Justice
- Fidelity
- Veracity/integrity
What does due process ensure?
- Notice and hearing is given before an important right can be removed from a person
- The criteria being used are fair
What are the two components of due process?
- Substantive-using the standard of whether a decision was arbitrary of capricious
- Procedural-individual’s right to be notified, apprised of performance, receive notice of deficiencies, evaluated regularly
What does ACES state about supervisors’ ethical guidelines?
Supervisors should:
- Incorporate informed consent and participation
- Clarify requirements, expectations, roles and rules
- Incorporate due process in policies of the institution, program, courses and supervisory relationships
- Make available to supervisees the mechanisms for due process
What is proposed that training programs do to ensure due process?
- Develop policy statements to guide evaluation processes
- Descriptive criteria about personal characteristics essential for success as a mental health practitioner
- Clear supervision plan
- Clear and consistent evaluation procedures
Re: informed consent, what do research participants, therapy clients and supervisees have the right to?
- The best information about what they are involved in, including risks and benefits
- To choose whether to participate based on that information
Supervisors have 3 levels of responsibility with respect to informed consent and must:
- Provide supervisee with informed consent
- Determine that the supervisee informs clients about parameters of therapy.
- Determine that supervisee informs clients about parameters of supervision that will affect them
What should be included in the supervision contract?
- Gatekeeping responsibilities
- Conditions necessary for success/advancement, incl. personal/interpersonal competencies
- Supervisees’ responsibilities to the supervision process
- Supervision methods used, time needed for supervision, expectations of supervisor, theoretical orientation of supervisor, documentation required
What is a program has a policy that personal counseling may be mandated or recommended?
Trainees must be aware of this practice upon entering the program.
Describe conflicts of conscience and how it comes up with informed consent.
Not wanting to work with certain clients based on the therapist’s personal beliefs
Therapists must be made award that they must have minimal competence skills with diverse clients, even if they challenge the therapist’s own beliefs.
What does Haas (1991) suggest as 4 categories of necessary and sufficient informed consent?
- Risks of treatment
- Benefits of treatment
- Logistics of treatment
- Type of counseling/therapy offered to clients
What does Haas (1991) suggest as 3 OTHER categories of necessary and sufficient informed consent?
- Supervisor involvement in emergency procedures
- Confidentiality
- Client understands the provider’s qualifications
When do multiple relationships become problematic?
- When there is a power differential between the 2 parties
2. The multiple roles put the person with less power at risk for exploitation or harm
RE: sexual attraction, all supervisees should receive instruction on (Hamilton and Spruill, 1999) these 4 areas:
- Powerful effects of attraction on familiarity, similarity, self-disclosure, and physical closeness
- Clinician disclosure on their encounters with sexual attraction in therapy
- Specific actions to take when feelings arise
- Suspected risk factors
RE: sexual attraction, all supervisees should receive instruction on (Hamilton and Spruill, 1999) these 3 OTHER areas:
- Consequences of therapist sexual misconduct
- social skills training
- Clear explanation of program policy
Re: Ladany et al (2005) discussion of sexual attraction, what are supervisors encouraged to do?
- Recognize markers of overt and covert boundary vulnerability
- Engage supervisees in discussion about their feelings
Describe a Professional Disclosure Statement for supervision.
Includes:
- Details of one’s training and experience
- Confidentiality
- Alerts supervisee and clients about the nature of the relationship
- Contact information
What are 5 multiple roles described by Pearson and Piazza(1997)?
- Circumstantial (happen by coincidence)
- Structured multiple professional roles
- Shifts in professional roles
- Personal and professional role conflicts
- Predatory professional
What are ethical issues to watch for in supervision relationships?
- Sexual attraction
- Sexual harassment
- Intimate committed relationships
- Nonsexual multiple relationships
- doing therapy with supervisee
What are some ways to prevent supervisor transgressions?
- Public supervision, esp with multiple relationships
2. Supervisor aware of own relationship biases
RE: harmful supervision, describe moral distress.
Supervisee’s to perform as one thinks one should because of felt vulnerability in the supervisor relationship
What are 2 broad areas to describe supervisor competence?
- Knowledge and skills to provide type of services their supervisees are providing
- Knowledge and skills in supervision itself
Define metacompetence.
Knowing when one is outside of one’s comfort zone of competence and requires consultation of supervision
What does supervisor competence include?
- Metasupervision
- Formal supervision training
- Ability to assist supervisees with conflict of conscience
- Ability to recognize own value conflicts with supervisees
What is ethical bracketing?
Supervisee brackets own personal values and beliefs to provide appropriate counseling.
What are the supervisor’s responsiblities to client confidentiality and disclosures?
- Must ensure supervisees keep all client info. Confidential
- Group supervision-use first names only, little demographic detail
- Use technology approved by HIPAA
What are differences between confidentiality, privacy and privileged communication?
- Confidentiality is an ethical concept referring to counselor’s obligation to keep client’s privacy
- Privacy is client’s right to not have private info. Divulged
- Privileged communication gives privacy legal status
What are some exceptions to privileged communication?
- Client gives informed consent
- Therapist acting in court-appointed capacity
- Client initiates litigation against therapist
- Mental health introduced as part of a civil action
- Child under 16 victim of a crime
What are OTHER exceptions to privileged communication?
- Suicidal risk/life-threatening emergency
- Requires hospitalization
- Intent to commit crime/danger to self or others
- When required for 3rd party billing
- When required for fee collection services
What differentiates a claim of ethical violation and a claim of malpractice?
Whether the aggrieved brings complaints to a regulatory body or a court
Plaintiff must prove the negligence resulted in harm
What are 2 types of torts (civil wrongs)?
- Intentional
2. Unintentional
Malpractice is defined as:
Harm to another due to negligence consisting of the breach of a professional duty or standard of care
What 4 elements must be met to succeed in a malpractice claim?
- Fiduciary relationship established
- Conduct improper or negligent and falling below acceptable standard of care
- Client (supervisee) suffered harm or injury
- Causal relationship between the injury and the negligence or improper conduct
Describe vicarious liability or respondent superior.
Liable for client’s well-being as the supervisor.
Describe the Tarasoff case.
- On advice of supervisor (for breach of confidence) therapist did not warn potential victim of violence.
- Poddar (client) did not return to tx and then killed Tarasoff.
- Claim brought against therapist for failing to warn.
What are 2 issues embedded in duty to warn?
- Assessing level of dangerousness of client
2. Identifiability of potential victims
What 3 conditions must be met for vicarious liability to be established?
- Supervisee voluntarily agrees to work under direction and control of supervisor and act in ways that benefit supervisor
- Supervisees must be acting within defined scope of tasks permitted by the supervisor.
- Supervisor must have power to control and direct supervisees’ work.
What are other factors that might establish vicarious liability?
- Time, place and purpose of the act
- Motivation of the supervisee
- Whether the supervisor could have reasonably expected the supervisee to commit the act
Describe strict liability.
Supervisor is held liable for actions of supervisee when these were not suggested or even known by supervisor.
What are the best safeguards in competent supervision to reduce legal risks?
- Supervision on a regular basis
- Aware of what happens in therapy sessions
- Strong working alliance with supervisee
- Ongoing assessment of supervisee competence
What guidelines does Snider (1985) suggest to reduce malpractice as a supervisor?
- Trusting relationship with supervisees
- Up to date with legal issues
- Head of agency-retain attorney who specializes in malpractice litigation
- Liability insurance
What are 4 risk management strategies to avoid malpractice?
- Supervisor conduct thorough screening of supervisee before entering the relationship
- Informed consent-review parameters/conditions for termination
- Stay current with professional standards
- Identify process for responding to a lawsuit
What are 4 OTHER risk management strategies to avoid malpractice?
- Boundary expectations with supervisees and importance of keeping supervisor informed
- Keep detailed records with supervision contract, goals, evaluations and remediation plans.
- If possible, involve more than one supervisor.
- Attend to own emotional/physical well-being
What strategies can help supervisees develop expertise in ethical decision making?
- Explicitly focus on personal values.
- Master content of ethical codes.
- Teach explicit ethical decision making models.
- Take opportunities to apply ethical knowledge
- Model ethical behavior
What is the DCBA mnemonic to help supervisees keep ethical principles in working memory?
- D (danger, duty and document)
- C (consent, confidentiality, competence and consultation)
- B (boundaries)
- A (applying decision-making model, act, assess)
