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Who are the parties that will be impacted by whatever course of action is chosen?
John, Steve, clients of John, clinicians at the agency, friends and family of John and Steve
What are the ethical issues involved in this scenario, including conflicting and competing values of the parties involved?
Dual relationship of friendship and supervisory relationship between John and Steve
Agency/Mainecare requirements with large volume of documentation for John’s caseload versus ability to focus on client clinical care and potential competing interests of agency requiring completion of documentation with delivery of client care
Competency of John as counselor due to potential impairment from drinking
Agency mission to promote recovery for clients and how would that also be extended to John as a provider to be aligned with agency mission but competing with counselor requirements to not be impaired on the job
Vicarious trauma impact on John affecting his work, mental health and recovery, and whether agency has an obligation given the large high trauma caseload they assigned him
Questions 3 & 4
What are all the viable courses of action and the possible benefits and risks for each?
Please include the pros and cons of each course of action based on relevant codes of ethics, laws, agency policies, licensing board regulations, reasonable and customary clinical supervision theory and practice, and personal values including religious, cultural, ethical and political ideology.
1) Steve could talk to John about developing an action plan with disciplinary results if changes don’t occur. It might involve things like leave of absence to resume recovery and self-care and obtain treatment as needed, monitoring return and work performance, staff interaction, etc. I’d assume it really would have to involve HR. Pros are that John may get help and not lose job, cons are that he may feel singled out and exposed to his peers/colleagues at the agency, may interrupt client care. Cons are that it also may be difficult to monitor this kind of plan.
2) Steve could take more severe action and report John to licensing board, terminate him. Pros may be that he follows strict agency rules, cons are that John does not get a chance to rehabilitate, loses friendship and trust with Steve.
3) I can’t really imagine Steve not doing anything as a supervisor and friend. I know that’s simply put, but it would not serve either of them well. If Steve cares about John as a friend, he would want to see him get help for burnout, relapse, etc., and come up with a plan that may allow for John to keep his job with appropriate rehab, and ultimately John would see the position in which he place Steve and make amends about that as well.
Who should the clinical supervisor (Steve), consult regarding this scenario and why?
Steve should seek supervision of supervision with another supervisor and also consult with someone at his agency. He could consult with his professional organization as well; for instance, the ACA will offer ethical and legal consultation.
What is the best possible course of action for a clinical supervisor (Steve) to take in this situation?
My opinion is Steve should meet with John again when he is not impaired, come up with a probationary plan that would include some time off, reduced PTSD caseload, and some form of monitoring or check in to ensure he is performing unimpaired. Another consideration would be whether Steve should continue to supervise John going forward, given their friendship and dual relationship, and to consider whether this is in the best interest of John’s mental health/recovery/work performance. That should be a conversation between John and Steve at some point, if there is even another supervisor available. The relational repair that could happen I think would be far better than transferring to a different supervisor, but it is still a course of action potentially.
How should the clinical supervisor (Steve) implement the decision, document the decision making process, and monitor and evaluate the effects of the decision?
Steve should document all meetings he has with John, other supervisors, agency staff around this issue. If they make a plan of rehab or treatment, documentation may be required from John to Steve of attendance or completion. More frequent check-ins if Steve continues to supervise John would be important as part of monitoring/evaluation.