Title: LEGAL
1LEGAL ETHICAL ISSUES FOR COUNSELING CENTER
TRAINING PROGRAMS
- Gloria C. Saito, Ph.D.
- University of California,
- Berkeley
2Introduction and Overview
- Counseling Center settings agency issues to
consider in training unlicensed professionals - Legal and ethical issues for supervisors
- Guidelines for ethical decision-making
- Case vignettes
3Definitions Law and Ethics
- Ethical standards are conceptually broad in
nature, few in number and open to interpretation
by the practitioner. . . . They are . . . A call
to ethical excellence. Ethical standards are a
statement from a particular profession to the
general public regarding what they stand for. - (Bernard and Goodyear, 1998)
4Definitions Law and Ethics
- The law . . . is specific in nature and is
introduced when a particular act has been
perceived to have endangered or harmed those whom
the profession serves. . . . The law is not
concerned with the highest standards of
professional practice when judging someone, but
only in minimally acceptable behavior. - (Bernard and Goodyear, 1998)
5Agency Issues for Counseling Center Training
Programs
- Selection Issues
- APPIC Match Policies (www.appic.org)
- CAPIC Guidelines (www.capic.net)
- University personnel and human resources policies
- Local, state and federal regulations
- Americans with Disabilities Act (ADA) regulations
6Agency Issues, contd
- Parameters for Employment and Informed Consent
- Conditions of employment
- Requirements for criminal background checks
- Stipends, number of hours per week, evaluation
process -
7Agency Issues, contd
- Truth in Advertising about the program and
training offered. - Is the program designed to provide appropriate
training experiences and to meet requirements for
academic programs, licensure and/or
certification? - Is the description of the program in publicized
materials current and accurate, providing
information on the training goals and objectives,
requirements, stipends, benefits, etc.?
8Agency Issues, contd
- Expectation of trainees clear statement about
what is expected of trainees - Competency issues agency has the duty to assign
only those clients whom the trainee is competent
to treat - Confidentiality and limits to confidentiality
- Written policies and procedures to guide the
agency, supervisors and trainees in the
management of clients who are dangerous or at
risk. - Due process and grievance procedures
- Contextual issues budget and staffing,
licensing laws and regulations, agency pressures
and the service delivery vs. training balance
9Supervision Issues
- Supervision defined
- An interpersonal process that typically involves
a more experienced clinician (master) with
oversight and evaluative responsibility for a
less experienced clinician (apprentice) who
shares educational and therapeutic goals. The
educational goal primarily concerns the growth
and development of professional competence by the
trainee. . . Therapeutically, supervisor and
supervisee collaborate to ensure the welfare of
the client. (Holloway, 1992)
10Supervision Issues
- Supervision defined (again)
- An intervention that is provided by a senior
member of a profession to a junior member of that
same profession. This relationship is
evaluative, extends over time and has the
simultaneous function/purposes of enhancing the
function of the junior member, monitoring the
quality of professional services offered to
clients and serving as a gatekeeper for those who
are to enter the profession. - (Bernard and Goodyear, 1998)
11Legal and Ethical Issues for Supervisors
- Getting started nuts and bolts (Board of
Psychology requirements) - Supervisory Agreement form
- Supervision Disclosure form
- Weekly log of activities
- Verification of Experience form
12Legal and Ethical Issues for Supervisors
- Qualifications of supervisors
- demonstrated professional training and competence
in areas in which supervision is being provided
(supervisor must be competent to see a client to
whom trainee is assigned.) - formal training in supervision (Board of
Psychology regulations) - meet continuing education requirements and have a
current license -
13Legal and Ethical Issues for Supervisors, contd
- Duties and responsibilities of supervisors
- Heavy obligation to protect the welfare of the
consumer/client - Have sufficient knowledge of each client to
monitor the work of the trainee, i.e., client
care - Oversight of therapeutic behavior of a less
experienced, unlicensed professional whose skills
may not be well-known or well-developed - Review and countersign client records
-
14Legal and Ethical Issues for Supervisors, contd
- Duties and responsibilities of supervisors,
contd - Availability in case of emergencies (be available
100 of the time either on site or by other
means) - Keep records of supervision
- Obligation to further the professional
development of the trainee by focus on skill
development as well as professional identity
issues - Provide ongoing and timely feedback as well as
formal evaluations based on actual performance
and established program requirements - Avoid abuses of power in supervision that may
potentially result in exploitation or harm
15Legal and Ethical Issues for Supervisors, contd
- Duties and responsibilities of supervisors,
contd - Challenge supervisee about issues that may
interfere with quality care while setting
appropriate boundaries and limits (supervision is
not therapy) - Special responsibility to structure and maintain
a supervisory relationship that demonstrates
ethically appropriate behavior and minimizes the
potential negative quality of transference
issues. (Upchurch, 1985)
16Legal and Ethical Issues for Supervisors, contd
- Informed consent for supervision
- Do trainees have a choice of supervisor, and what
are the choices? Are trainees aware of how
supervisory assignments are made? - Need for clear specification of duties,
supervision philosophy/approach, goals,
requirements, expectations, evaluation procedures
17Legal and Ethical Issues for Supervisors, contd
- Informed consent of clients
- Clients must be informed about the trainees
status and about the supervisors oversight of
the treatment - Supervisors must be available to clients if
necessary - Supervisors must insure that trainees have
informed their clients about the parameters of
counseling - Clients must give consent for procedures
necessary or required for supervision, e.g.,
audio or videotaping
18Legal and Ethical Issues for Supervisors, contd
- Confidentiality
- Whats confidential in supervision?
- The trainees rights to privacy
- What about group supervision, supervisors
meetings, training committee meetings? - Do not require supervisee to disclose personal
information about sexual history, history of
abuse/neglect, psychotherapy, relationships with
family, peers, etc., unless this is specified
clearly in program admissions and training
materials
19Legal and Ethical Issues for Supervisors, contd
- Multiple Relationships
- Supervisor is guided by the principle of DO NO
HARM - Supervisor is in the position of power and
trainees have limited power in the relationship - Sexual Relationships between supervisor and
supervisee prohibited - Sexual attraction is inevitable and important to
discuss - Supervisors responsibility to teach trainees how
to handle sexual attraction issues
20Legal and Ethical Issues for Supervisors, contd
- Multiple Relationships, contd
- Supervisors should not provide psychotherapy
services to supervisees and should avoid
conflicts of interest which may impair their
judgment - Supervisors avoid dual relationships where there
is the potential for abuse of power and/or
exploitation - Supervisors avoid actions that may impair their
judgment and ability to objectively supervise and
evaluate the trainee (e.g., supervising a friend
or relative)
21Legal and Ethical Issues for Supervisors, contd
- Multiple Relationships, contd
- Supervisors maintain appropriate boundaries (what
about professional lunches, office parties,
workshops, conferences?) - Differentiate between multiple relationships that
abuse power, exploit or harm the supervisee and
those that occur in the positive context of a
developing professional relationship - Supervision and therapy and the distinction
between them how to explore personal issues
related to client care without crossing privacy
boundaries - Conflicting roles inherent in the supervisor
role mentor, supporter, evaluator, colleague,
reference
22Legal and Ethical Issues for Supervisors, contd
- Due Process Issues
- Policies and procedures are provided to the
supervisee by the training program and the
supervisor in writing at the beginning of the
traineeship. These include - Trainee rights and responsibilities
- Expectations, roles, rules, requirements
- Procedures and process for feedback and
evaluation - Formal guidelines for what happens when a trainee
is impaired, including definitions of impairment
and processes for notice, warning and appeal,
remediation, time frame for notice and appeal - Primary goal is to avoid arbitrary or capricious
actions on the part of the training program and
the supervisor
23Legal and Ethical Issues for Supervisors, contd
- Liability Issues
- Malpractice defined
- harm to another individual due to negligence
consisting of the breach of a professional duty
or standard of care. (Disney Stephens, 1994) - The Good News
- Why It Pays to Pay Attention
- Supervisor is held responsible for supervisees
actions and quality of client care
24Legal and Ethical Issues for Supervisors, contd
- Liability Issues
- Direct Liability
- Negligent supervision supervisors inattention
or negligence caused the clients damages - Supervisor or training program assigned tasks
which the trainee was not adequately trained or
prepared to carry out, and the client was harmed
25Legal and Ethical Issues for Supervisors, contd
- Liability Issues, contd
- Vicarious Liability supervisors can be sued and
held liable even if they did nothing wrong under
the concept of respondeat superior (let the
master respond) - Final responsibility for client welfare rests
with the supervisor, not the trainee
26Legal and Ethical Issues for Supervisors, contd
- Liability Issues Vicarious Liability, contd
- Criteria
- Trainee voluntarily agrees to work under the
direction and control of the supervisor - Trainee acts within the scope of tasks permitted
by the supervisor - Supervisor has the power to control and direct
the supervisees work - The act that injured the client is within the
supervisees scope of employment - Client has the burden to prove that an actual
injury occurred
27Legal and Ethical Issues for Supervisors, contd
- Areas of Vulnerability for Supervisors
- (from Campbell, 2000)
- Client is not informed of supervisees trainee
status and the limits of confidentiality - Supervisor has incomplete information about the
client due to multiple factors (workload issues,
incomplete/inadequate communication, trainee
withholds information) - Trainee does not follow supervisors
recommendations, but does not disclose this
28To Summarize Dilemmas for Supervisors
- Issues of Hierarchy and Power
- Conflicting Roles and Multiple Hats
- Negotiating Boundaries
- Confidentiality
29Guidelines for Ethical Decision-Making
- Provide current and accurate information about
your program - Set standards for training and performance in
writing and communicate and discuss these with
your trainees - Provide a timely and specific process for
providing feedback and evaluation - Develop good record-keeping practices, both for
client work and for supervision - Apply standards early and consistently
- Base decisions on facts, not opinion or bias, and
document behaviors - Document, document, document, but beware of email
communication - Seek consultation
30Guidelines for Ethical Decision-Making, contd
- Bernard and Goodyear (1998) suggest the following
cognitive map for resolving ethical dilemmas - 1. Identify the problem or dilemma
- 2. Identify the potential issues involved
- 3. Review relevant ethical guidelines
- 4. Obtain consultation
- 5. Consider possible and probably courses of
action - 6. Enumerate the consequences of various
decisions - 7. Decide what appears to be the best course of
action
31Case Vignettes
- Vignette 1
- The client is a 19 year-old Caucasian
undergraduate woman with a severe eating disorder
(anorexia). The supervisee is a 28 year old
Caucasian woman on her predoctoral internship.
The intern has had some experience in treating
eating disorders and would like to specialize in
this area. She has done an assessment of the
students concerns and in addition to counseling
at the University Counseling Center, has referred
the student for medical care and follow-up.
During supervision, the intern has down-played
the severity of the eating disorder, and has
assured the supervisor that the student has
followed through with medical care. - While the intern is on vacation, the student
comes into the CC in crisis. It is apparent that
she has not in fact followed through with medical
care. Moreover, the supervisor reviews the
record and, in her assessment, the student is
more severely impaired than the intern had
indicated. The supervisor decides to involve the
students parents, and in so doing, breaks
confidentiality. - What are the legal and ethical issues involved in
this case?
32Case Vignettes
- Vignette 2
- The student is a 22 year old African American
male graduate student in Physics who comes into
the Counseling Center for an emergency drop-in
appointment. The supervisee is a 30 year old
Asian American male postdoctoral fellow. In
doing the assessment, it is clear to the postdoc
fellow that the student is experiencing manic and
psychotic symptoms and is potentially suicidal.
The postdoc seeks consultation from senior staff
members, who strongly advise him to pursue
hospitalization for the student. The postdoc
feels great empathy for the student who is
adamant that he does not want to be in the
hospital. As a result, the postdoc is reluctant
to hospitalize the student, but finally does so
after many hours and numerous consultations with
staff. Senior staff are concerned that the
postdoc has let his countertransference reactions
guide his behavior, thereby prolonging the
process of getting the student to the hospital.
They try to give the postdoc feedback about this,
but the postdoc feels invalidated and wronged and
cannot take in the feedback. - What are the ethical and liability issues in this
case?
33References
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Fundamentals of clinical supervision. Needham
Heights, MA Allyn Bacon. Campbell,J.M.
(2000). Becoming an effective supervisor. Ann
Arbor, MI Sheridan Books.Frankel, A.S.
(2000). Laws ethics beyond the basics.
Huntinton Beach, CA Psycho-Legal Associates,
Inc.Harrar, W., VandeCreek, L. Knapp, S.
(1990). Ethical and legal aspects of clinical
supervision. Professional Psychology Research
and Practice. 21, 37-41.Nagy, T.F. (2005).
Ethics in plain english. Washington D.C.
American Psychological Association.Roberts,
G.T., Murrell, P.H., Thomas, R.E. Claxton, C.S.
(1982). Ethical concerns for counseling
educators. Counselor Education and Supervision,
22, 8-14. -
- State of California, Department of Consumer
Affairs, Board of Psychology. (2005). Laws and
regulations relating to the practice of
psychology. Sacramento, CA Department of
Consumer Affairs.Upchurch, D.W., (1985)
Ethical standards and the supervisiory process.
Counselor Education and Supervision, 25, 90-98. - Wise, P.S., Lowery, S. Silverglade, L.
(1989) Personal Counseling for Counselors in
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