Clinical supervision occurs when a senior practitioner oversees and monitors a junior member’s practice in order to increase his/her quality of service. The counseling profession has its ethical standards and particular tools to ensure compliance among practitioners when they face decision-making issues (Francis & Turner, 2020). The most critical ethical codes regarding clinical supervision are the American Counseling Association (ACA), the Approved Clinical Supervisor (ACS), and the National Board for Certified Counselors (NBCC) codes of ethics. Practitioners often struggle with such ethical and legal dilemmas as confidentiality, informed consent, and dual relationship. Supervisees are expected to inform clients about supervision and all elements of treatment to ensure their informed and free choices. Supervisors should have clearly defined roles and maintain boundaries with the practitioners. The client also has to be aware of the extent of confidentiality shared between a supervisee and supervisor (Francis & Turner, 2020). The related case will be further presented and discussed through the prism of legal statutes and ethical codes.
After earning a degree in psychology and being granted psychology licensure eight months ago, David has started his own practice. He used to help patients suffering from depression and anxiety since that time. One of the practitioner’s usual clients recommended her friend John with Post-Traumatic Stress Disorder (PTSD) to see David. The latter found this case challenging and decided to ask Dr.Williams, a resident psychiatrist, for supervision. Dr.Williams familiarized herself with the client’s case, David’s materials, and his evaluation. Although David himself is her former patient, she eventually agreed. At the next session, David informed his client about supervision, assured that his case will be discussed in confidentiality and that he will not have personal meetings with Dr.Williams. The confused client orally expressed his consent, while supervision was not further discussed. David continued to send notes and recordings to Dr. Williams and discuss treatments with her during supervision sessions.
Ethical and Legal Dilemmas
The first ethical dilemma distinguished is a dual relationship issue. According to Arizona Revised Statutes §32-3251 (2021), a dual relationship occurs when a licensee has both professional and non-professional relationships with a client that negatively impacts his/her professional judgment. In this case, David had been Dr. William’s patient, and their current professional relations could be avoided. The ACS (2016) code of ethics also states that any dual relationships should be circumvented in supervision for the same reasons. The supervisor must have a well-defined role contributing to treatment optimization of psychologists’ and counselors’ clients. For that reason, Dr. Williams should have rejected David’s offer since their previous non-professional experience may blur her new role and related obligations. Both may eventually continue their patient-therapist relationship instead of constructing the supervisor-supervisee one.
Informed consent is the next dilemma presented in this scenario. Under the ACA (2014) code of ethics, counselors are obliged to use understandable and clear language when providing clients with adequate information regarding themselves and the counseling process. It includes information about potential risks and benefits of services, techniques, purposes, therapeutic approaches, the counselor’s qualifications, and supervision. Clients should be appropriately informed to decide whether they enter, remain, or leave a counseling relationship. The trust and rapport between counselors and clients can be achieved through good communication (Francis & Turner, 2020). It is excellent that David told his patient that he needs to request assistance from the senior and received the latter’s oral agreement.
Nevertheless, John, who has PTSD, had not clearly understood what David said, and his consent was not eventually expressed in written form. It had to be clearly explained and documented as requested by current counseling standards. In this case, David apparently just wanted to make his client aware of the supervision rather than ask for his implied consent. John as a patient, should be aware of the supervisor’s and therapist’s commitments to each other and their supervisory relationship.
The confidentiality issue should also be distinguished and addressed here. According to Francis and Turner (2020), therapists usually get their clients’ permission before sharing their work and notes with the clinical supervisor since they include personal information. The limits of confidentiality and its possible breach should also be discussed and agreed upon in written form with the client. It has to be done to avoid legal and ethical issues that may emerge in the future. Under the ACS (2016) code of ethics, a clinical supervisor is obliged to hold the received information about a client in the strictest confidence. However, David made a mistake when he decided to share John’s private information with Dr.Williams before discussing the supervision process. It is also alarming that the limit of confidentiality was not set. Without having a written consent, David continued to share John’s recordings and documents with his supervisor.
Plan of Action
If there is a problem with the professional relationship between the supervisee and supervisor (dual relationship), the latter may ask for help from another senior practitioner. Dr.Williams has to ensure that David informs his clients of all conditions of supervision and on their rights on privileged communication and confidentiality as well as their limits (ACS, 2016). In this particular case, the supervisor should prepare all documents for informed consent and ensure that the client is competent. Dr.Williams and David also need to set limits to the information shared regarding clients. The latter should be aware of being viewed or recorded during sessions for supervision purposes and fully understand what they are agreeing to. David has to follow confidentiality limits which can be included in the informed consent.
The Role of the Clinical Supervisor
In this case, the most crucial clinical supervisor’s obligation is to review and oversee the supervisee’s procedures. Dr.Williams should render assistance to David since he cannot address the already mentioned legal and ethical issues while providing his services to John. The problems with confidentiality and consent have to be solved with the help of the supervisor. Clinical supervisors also discuss treatment plans with practitioners and affect their decision-making (Francis & Turner, 2020). They also contribute to optimized treatment for clients, increasing the quality of counseling. According to the scenario, both responsibilities seem to be fully met by Dr.Williams.
The provided clinical supervision scenario revealed ethical and legal issues regarding confidentiality of the client’s data, informed consent, and the dual relationship between supervisor and supervisee. In this case, Arizona Revised Statutes, ACA, and ACS codes of ethics require documentation of consent and establishment of confidentiality boundaries. The clinical supervisor should prepare all needed documentation for informed consent and ensure that the supervisee provided all needed information to the client. Dr.Williams plays an essential role in counselor development since she helps him comply with counseling standards and teaches how to work with PTSD patients.
A. R. S. §32-3251 (2021). Web.
American Counseling Association. (2014). 2014 ACA code of ethics. Web.
Approved Clinical Supervisor. (2016). 2016 ACS code of ethics. Web.
Francis, M., & Turner, J. (2020). Clinical supervision in the real world. A practical guide to ethics, legal issues, and personal development. Routledge.