Ethics Rounds

One of the great pleasures of serving as APA's ethics director is that I have the opportunity to meet and speak with psychologists throughout the country about the ethical dimensions of their work. Recently Division II (Education and Training) of the California Psychological Association invited me to speak on "The supervisor as gatekeeper: Dealing with ethical and legal dilemmas." I was delighted to see the interest in this topic; on a beautiful Saturday in Manhattan Beach, Calif., training directors and supervisors from across the state filled a conference center to discuss these important and challenging issues.

The concept of gatekeeping

As I reflected on the topic of gatekeeping, it struck me that Division II had chosen a particularly rich concept, one with several core elements. Gatekeeping implies passage, or movement, between two (or more) places. Certain criteria govern when passage is appropriate. Authority rests with the gatekeeper to apply the criteria and so to allow, or not allow, passage. The gatekeeper must take responsibility for that decision. Many of the ethical and legal dilemmas that arise in supervision stem from the gatekeeping function --for example the manner in which supervisors apply the criteria that govern passage (such as from noncompetence to competence), and the circumstances under which supervisors are held responsible for their decisions to allow passage, or not.

Five questions

Five questions seemed helpful as starting points in thinking about the elements implicit in the concept of gatekeeping in a supervisory context.

1.) What is the nature of the supervisory role, and how does this role differ from other important roles such as consultant and therapist?

A role establishes a particular kind of relationship. Subtle differences in a psychologist's role can significantly affect whether an interaction is likely to be helpful or harmful in a given context. Ethical Standard 7.05 provides an example of how the Code emphasizes the importance of keeping roles central to training separate, in this instance the roles of evaluator and therapist:

7.05 MANDATORY INDIVIDUAL OR GROUP THERAPY

(a) When individual or group therapy is a program or course requirement, psychologists responsible for that program allow students in undergraduate and graduate programs the option of selecting such therapy from practitioners unaffiliated with the program.

(b) Faculty who are or are likely to be responsible for evaluating students' academic performance do not themselves provide that therapy.

The starting point for thinking through the ethics of supervision is clarifying the nature of the role.

2.) What is the nature of the relationship between a supervisor and a client?

Both our Ethics Code and many state laws directly connect the supervisor and the client:

10.01 INFORMED CONSENT TO THERAPY

(c) When the therapist is a trainee and the legal responsibility for the treatment provided resides with the supervisor, the client/patient, as part of the informed consent procedure, is informed that the therapist is in training and is being supervised and is given the name of the supervisor.

In addition to the ethical and legal dimensions of the relationship identified in Ehthical Standard 10.01, clinical responsibility for the client's welfare rests with the supervisor as well. The relationship between the supervisor and the client thus has clinical, ethical and legal aspects, all of which the supervisor must hold in mind during the process of supervision.

3.) Does supervision, by definition, create a multiple relationship and a conflict of interest?

Supervision is one of the many facets of psychological training. Our supervisees are also our students, research assistants, co-authors, and sometimes our friends. Supervisors protect a client's welfare and help a trainee attain competence, while at the same time maintaining boundaries that respect everyone's best interests. These multiple roles often coexist productively, but when they do not the supervisor must explore competing values and interests to resolve potentially harmful tensions.

4.) How does a supervisor assess a supervisee's competence?

Can we ever really know what our supervisees are doing? Supervisors use a variety of teaching methods, including direct observation, videotapes, audiotapes, and having a trainee as co-therapist. The particular technique chosen is placed in the context of Ethical Standard 7.06:

7.06 ASSESSING STUDENT AND SUPERVISEE PERFORMANCE

(a) In academic and supervisory relationships, psychologists establish a timely and specific process for providing feedback to students and supervisees. Information regarding the process is provided to the student at the beginning of supervision.

(b) Psychologists evaluate students and supervisees on the basis of their actual performance on relevant and established program requirements.

Ethical Standard 7.06 gives supervisors both the discretion to determine how best to assess a supervisee's performance, and the responsibility to make clear to the supervisee how the "timely and specific" process of assessment will work.

5.) How does a supervisor know when to invoke a remedial process?

Supervisors invoke a remedial process when a trainee falls short. Trainees, for their part, must be clear what is expected along all dimensions of their training: academic, professional, personal, interpersonal, and so forth. In the language of ethics and law, applicants must be put on notice of what is expected of them:

7.02 DESCRIPTIONS OF EDUCATION AND TRAINING PROGRAMS

Psychologists responsible for education and training programs take reasonable steps to ensure that there is a current and accurate description of the program content (including participation in required course- or program-related counseling, psychotherapy, experiential groups, consulting projects, or community service), training goals and objectives, stipends and benefits, and requirements that must be met for satisfactory completion of the program. This information must be made readily available to all interested parties.

In addition to the importance of notice, there must be a process that is followed in order to address a trainee's particular challenges. Ethical Standard 7.04, which contains aspects of notice, sets forth conditions under which a program may invoke a process that requires disclosing certain types of information:

7.04 STUDENT DISCLOSURE OF PERSONAL INFORMATION

Psychologists do not require students or supervisees to disclose personal information in course- or program-related activities, either orally or in writing, regarding sexual history, history of abuse and neglect, psychological treatment, and relationships with parents, peers, and spouses or significant others except if (1) the program or training facility has clearly identified this requirement in its admissions and program materials or (2) the information is necessary to evaluate or obtain assistance for students whose personal problems could reasonably be judged to be preventing them from performing their training- or professionally related activities in a competent manner or posing a threat to the students or others.

In their gatekeeping role, supervisors will become familiar with what notice programs give students regarding what is expected, and what process follows when those expectations are not met. Supervisors will want to avoid what I refer to as the promoveatur ut amoveatur principle, loosely translated from Latin as, "Let us move this supervisee along in order to have the supervisee gone from our placement." While some times tempting, that approach does not give the supervisee, the profession or the public their due.

I am grateful to CPA for having included the APA Ethics Office in their day. Particularly satisfying was the tone of the conference, in which ethics was discussed not as a problem to be solved, but as an integral part of how supervising psychologists approach their work. That tone bodes well for the next generation of psychologists to experience ethics as part of the fabric of their work and their professional identities.

Further Reading

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