Week 5 Homework Assignment (Ethical Issues in Clinical Supervision)

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  • #4490
    Patricia Burke
    Keymaster

    Exercise 1

    In substance abuse treatment contexts it has historically been reasonable and customary practice for clinicians to self-disclose their own status in recovery from addictions based on the idea that this self-disclosure might have a positive effect on the client and help him/her feel hopeful about the possibility of recovery. In mental health treatment contexts it has historically been reasonable and customary practice for clinicians to refrain from any disclosure of a personal nature with clients whether it be that the clinician is recovering from substance abuse or a mental health issue such as anxiety or depression.

    In this exercise take the position of a clinical supervisor in a treatment program serving people with co-occurring substance abuse and mental health issues. Your treatment team is made up of mental health professionals and substance abuse counselors with different training and beliefs about self-disclosure. You have just taken this course on Supervision and Ethics and have a new understanding of the difference between boundary crossings and boundary violations and that in any discussion about preventing boundary violations with regard to clinician self-disclosure you need to be concerned about 1) reasonable and customary practice for your particular treatment context 2) intent of the clinician 3) harm (and potential of harm) to the client with co-occurring conditions when the clinician self-discloses or withholds self-disclosure.

      A) What are some of the strategies you would employ to initiate and facilitate a discussion about the distinction between self-disclosure as a boundary crossing or boundary violation in your treatment team meeting?

      B) Which of the supervisor roles (consultant, advisor, guide, mentor, professional colleague, educator) fits with your values and supervisory style? Which of these stances would you take in the conversation with the team and why?

    Exercise 2

    Describe 2–3 useful ideas and/or strategies about supervision and ethics that you have learned or been reminded of over the course of the past 5 weeks that you would like to bring back to your colleagues, supervisees, supervisor, administrators, etc. How do you envision integrating these ideas into your work?


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    #16734
    bethandrews.hope
    Participant

    A) What are some of the strategies you would employ to initiate and facilitate a discussion about the distinction between self-disclosure as a boundary crossing or boundary violation in your treatment team meeting?
    I would be diligent in my efforts to create an open and safe space for conversation about difficult topics. I would work to communicate without judgment, and teach my supervisees communication skills that would allow them to do the same. I often enjoy hypothetical role plays, followed by open discussion of various points of view, as a way of stimulating conversations that do not feel pointed at any specific person. I would sometimes see myself proactively as a teacher, sharing information such as what this course offers, hopefully offering new ideas for supervisees to learn, such as the nuances that make a boundary crossing and a boundary violation so different from one another. I would lean towards having difficult conversations about a specific issue/problem with individuals, rather than in a team setting, in hopes of being able to have problem-solving discussion in an open and nonjudgmental fashion. I would definitely prefer a setting in which I do not have dual roles as clinical and administrative supervisor, as this does complicate the situation.
    B) Which of the supervisor roles (consultant, advisor, guide, mentor, professional colleague, educator) fits with your values and supervisory style? Which of these stances would you take in the conversation with the team and why?
    I tend to see myself as a guide. I prefer to help supervisees come to their own conclusions, as they puzzle through the situation. I would feel it necessary to make sure they have the necessary tools at their disposal (i.e., codes of ethics), but I do not like to give answers to them, as I feel this does not give them the opportunity to develop their own clinical judgment. I do enjoy teaching as well, but I would probably set aside specific times for sharing that type of information, and even then, it would be made relevant to the setting, so it can be put into practice.
    Exercise 2
    Describe 2–3 useful ideas and/or strategies about supervision and ethics that you have learned or been reminded of over the course of the past 5 weeks that you would like to bring back to your colleagues, supervisees, supervisor, administrators, etc. How do you envision integrating these ideas into your work?
    Because I have been in private practice, and haven’t been a supervisor in a long time, this course was a great reminder about the complexity of the supervisor/supervisee relationship, and the parallels it holds to the clinician/client relationship. It reminded me of past supervision experiences where I felt we successfully navigated difficult situations, as well as a time that I remember really feeling that I made a mistake as a supervisor, and the work I had to do to recreate an open and safe space in which we could trust our relationship again.
    I was reminded about how important it is to consult the codes of ethics when making difficult decisions. There are guidelines that are helpful, and there are people in the various professional organizations who are also guides when needed.
    Finally, I was reminded of the importance of healthy vs. unhealthy personal disclosure in treatment and in supervision. The question “who is this for?” is so important, and really such a simple guideline. Obviously we care for our clients. If we didn’t, we shouldn’t be in this line of work. It would be easy to overstep and become too personal. This simple question should always be in the back of our brains, and used on a regular basis.

    #16735
    dsinskie
    Participant

    A) What are some of the strategies you would employ to initiate and facilitate a discussion about the distinction between self-disclosure as a boundary crossing or boundary violation in your treatment team meeting?
    Having discussions about boundaries and ethics be a standard component of each team meeting/supervision so that it feels very natural to discuss these issues. Also, if team meetings are a safe place for all, then the discussion would be more open. These can be considered learning moments. I would also state that I am not an expert, that I am continuously learning as well as my team. Learning is lifelong and we don’t just learn these things and set them aside. Each day brings new teachings. I would ask if anyone wanted to share or we could use canned scenarios to discuss. I would also offer up some of my own dilemmas.
    B) Which of the supervisor roles (consultant, advisor, guide, mentor, professional colleague, educator) fits with your values and supervisory style? Which of these stances would you take in the conversation with the team and why? I think guide and mentor are aligned with my values. If I am supervising I am a little more than a professional colleague or consultant and don’t feel like an educator by any means. A guide and mentor means to me that we walk the journey together with my experience and role being able to help facilitate growth.
    Exercise 2
    Describe 2–3 useful ideas and/or strategies about supervision and ethics that you have learned or been reminded of over the course of the past 5 weeks that you would like to bring back to your colleagues, supervisees, supervisor, administrators, etc. How do you envision integrating these ideas into your work?
    Ive been reminded of the importance of discussing ethics and boundaries on a routine basis. I have already implemented a supervision note with topics as the header!!
    Also, careful document of what happened in supervision being as important as writing our session notes with clients.
    And last but not least, directly addressing issues of counter transference, even my own, and using these as more learning opportunities for growth.

    #16748

    1A) Strategies to initiate/facilitate discussion about self-disclosure
    Starting the discussion in a separate training could help increase the safety level on staff – for anyone struggling with the issue may not feel singled out. People can know in advance the format/expectations of this discussion and already be thinking about their feelings/thoughts on the issue. I think structure around ethics is helpful to increase the safety in the room as well as make sure everyone’s voice is heard.
    We’d start with maybe poster paper on 4 walls and get mixed groups(MH/SA) rotating through a brainstorm on each. Possible topics are types of disclosures that help increase the therapeutic relationship, types of disclosures that could potentially harm the relationship, “grey areas in ethics” regarding self-disclosure, possible reasons for self-disclosure, etc. I think discussion will come from these that could be very rich due to the diversity of staff and hopefully that would be validated by myself and others in the group. It would also be important to pull our discussion together by what we agree on as counseling professionals, hence our “co-occurring” work as well as valuing individual differences in the group.
    1B) Supervision role and style
    Most of my supervision roles come from my learnings about the Discrimination Model (Bernard and Goodyear) and also my more recent training in Gestalt facilitation. I feel comfortable in being a facilitator of their learning, being at times a consultant and in the teacher role. I feel that if the group was unclear about boundary violations, it is my role to be clear about them, what to do if a supervisee feels they want to disclose and what to do if a disclosure is made that may harm the therapeutic relationship. This would be consistent with my role as their team and individual supervisor. I would be hopeful that myself and the agency administrators would have already been working to promote an atmosphere where we are safe to explore ethical ideas AND be clear about what would be our administrative roles as well.
    2) Helpful strategies from class
    I think being reminded about the difference of transparency and self-disclosure has been very helpful to me. In the past, I have spent a lot of time on informed consent, but I now feel that I have gotten away from the amount of time spent on discussing the nature of the therapeutic relationship – just due to lack of time, requirements of the intake session, etc. This class and the responses have helped me remember how much I value the importance of informed consent – thank you!
    Taking time to normalize transference and countertransference is another reminder I have gotten from this class. Sometimes I tend to normalize these issues for my clients, my colleagues and my supervisees – and then forget to give myself that same validation. I skip over it by going directly to “what am I doing for self-care?” instead of spending my own reflection time increasing my awareness of self.
    Having a decision-making model is sooooo helpful for me – another great reminder in this world where we are making quick decisions with back to back clients dealing with complex issues. My daily intention of increasing awareness of using all of these strategies, including looking at the decision-making model I put on my cabinet – will be helpful for me as a counselor, a supervisor and as just a colleague who is working on being a better helper.
    Thank you, class and Pat, for all for your responses – I learned a lot from you☺

    #16750
    Esther Cyr
    Participant

    Week 5 Homework:
    1. (A) What are some of the strategies you would employ to initiate and facilitate a discussion about the distinction between self-disclosure as a boundary crossing or boundary violation in your treatment team?
    I would start with defining informed consent/boundary and role expectations/boundary crossing/boundary violation. Give examples of each. Give an example of a boundary violation per State Board and rational. Introduce guidelines to increase awareness of what might be a boundary crossing.
    (B) Which of the supervisor roles (consultant, advisor, guide, mentor, professional colleague, and educator) fits with your values and supervisory style? Guide, educator, professional colleague
    Which of these stances would you take in the conversation with the team and why? As a guide/educator/professional colleague I would use the code of ethics to guide and educate using the ethical standards and apply to case studies. Teach a problem solving model to utilize with ethical dilemmas. As a professional colleague seek skills of each clinician participating, listen to the discussion, and work as a team in applying ethical principles to an issue. Respect of each individual and create an environment of thoughtful exploration with an end result of learning new ways to practice ethically.
    2. Describe 2-3 useful ideas and/or strategies about supervision and ethics that you have learned or been reminded of over the course of the past 5 weeks that you would like to bring back to your colleagues, supervisees, supervisor, administrators, etc. How do you envision integrating these ideas into your work?
    1. The 5 levels of informed consent (Flavy) Especially #4 that the clinician is under the supervision of named individual. In supervision clients are deidenfied, however, while clients may be informed of consulting on a matter, the name of the consultant may not be idenfied. I am looking at adding the name of the consultant on the consent for treatment form. Giving the client opportunity to question what that might mean in the therapeutic relationship.
    2. Reviewing beneficence/malfeasance/justice regularly in resolving ethical dilemmas. Using the example of the social work board finding of the very vulnerable adult and the 4 indicators of potential boundary issues. Reinforcing the need to bring to supervision any issue that a supervisee has doubt about regardless of how simple or unimportant it might seem. The unimportant or small can be wonderful learning opportunities and are a very important part of professional growth and risk management.

    #16751
    CHELSEA SPEAR
    Participant

    A) What are some of the strategies you would employ to initiate and facilitate a discussion about the distinction between self-disclosure as a boundary crossing or boundary violation in your treatment team meeting?
    -First and foremost, I would ensure that ethics and boundaries are interwoven into every team meeting (i find it helpful to put it on the weekly agenda that is always discussed) so that everyone is comfortable with discussing the concepts and there is not understandable anxiety when the topic is brought up out of the blue.
    I find case studies to be a very effective tool and use role playing in this manner to show and discuss some of the differences between crossing and violations
    B) Which of the supervisor roles (consultant, advisor, guide, mentor, professional colleague, educator) fits with your values and supervisory style? Which of these stances would you take in the conversation with the team and why? I would say the roles of guide and educator most closely fit with the roles I would take in this context. Guide to help move the conversation to a robust discussion on the topic and ensure that everyone leaves with some concrete tips and ideas. I am also an educator when educating everyone on the different code of ethics and how it applies here.
    Exercise 2
    Describe 2–3 useful ideas and/or strategies about supervision and ethics that you have learned or been reminded of over the course of the past 5 weeks that you would like to bring back to your colleagues, supervisees, supervisor, administrators, etc. How do you envision integrating these ideas into your work?
    Probably the biggest reminder/ take away I am taking from this training has to do with the effects of counter transference not only for the clinicians I supervise but also for myself. As supervisors, I think we too often forget that our own counter transference issues can arise.
    Another strategy that I have learned from this training is the importance of educating the other managers that I work with on the concept of vicarious responsibility and this is why clinical supervision needs to be honored as highly as client appointments.

    #16764
    melissa cormier
    Participant

    In substance abuse treatment contexts it has historically been reasonable and customary practice for clinicians to self-disclose their own status in recovery from addictions based on the idea that this self-disclosure might have a positive effect on the client and help him/her feel hopeful about the possibility of recovery. In mental health treatment contexts it has historically been reasonable and customary practice for clinicians to refrain from any disclosure of a personal nature with clients whether it be that the clinician is recovering from substance abuse or a mental health issue such as anxiety or depression.

    In this exercise take the position of a clinical supervisor in a treatment program serving people with co-occurring substance abuse and mental health issues. Your treatment team is made up of mental health professionals and substance abuse counselors with different training and beliefs about self-disclosure. You have just taken this course on Supervision and Ethics and have a new understanding of the difference between boundary crossings and boundary violations and that in any discussion about preventing boundary violations with regard to clinician self-disclosure you need to be concerned about 1) reasonable and customary practice for your particular treatment context 2) intent of the clinician 3) harm (and potential of harm) to the client with co-occurring conditions when the clinician self-discloses or withholds self-disclosure.
    A) What are some of the strategies you would employ to initiate and facilitate a discussion about the distinction between self-disclosure as a boundary crossing or boundary violation in your treatment team meeting?

    I believe it is good practice to discuss openly the different lenses different professions use. I would bring the conversation back to the reason for a disclosure. Our treatment should focus on the clinical benefit for a disclosure and weigh it against any clinical harm that would occur from the disclosure.

    B) Which of the supervisor roles (consultant, advisor, guide, mentor, professional colleague, educator) fits with your values and supervisory style? Which of these stances would you take in the conversation with the team and why?
    I prefer the consultant role. I would help sort through reasons why or why not do disclose and help the clinician come to a resolution that feels comfortable and supported by best practices.
    Exercise 2

    Describe 2–3 useful ideas and/or strategies about supervision and ethics that you have learned or been reminded of over the course of the past 5 weeks that you would like to bring back to your colleagues, supervisees, supervisor, administrators, etc. How do you envision integrating these ideas into your work.

    Systematic method for working through ethical dilemmas’. I enjoyed the framework that we used in the earlier lessons of how to weigh out risks and benefits for different options.

    I also appreciated the conversations about transference and counter transference. It is helpful for newer clinicians to be reminded that this occurs and how to notice when this is happening.

    The last lesson on boundaries is also a good reminder that different professions have different norms and values. When you are supervising a multidisciplinary team, it is good to remember that not everyone on the team may act in the same way you would act in accordance with your license.

    Thanks 🙂

    #16769
    Sindee Gozansky
    Participant

    Exercise 1
    A) What are some of the strategies you would employ to initiate and facilitate a discussion about the distinction between self-disclosure as a boundary crossing or boundary violation in your treatment team meeting?
    I would incorporate it as a clinical vignette type of training within the meeting to highlight the difference of boundary crossing as sharing the clinician’s response in the here-and-now to the client’s material. The response of the clinician could be experiencing an emotion, physical sensation or thought and sharing that in the service of the client to see if it increases resonance or awareness is a therapeutic intervention. As a Gestalt trained clinician, I am familiar with this exercise and believe it has great therapeutic value. I am also familiar with how to downgrade such an experiment if it’s too much for the client and would share that as well. I would then share more examples of boundary violations which would be unwanted by the client, not in service of the client, potentially damaging or exploitative and focus on the intent of the clinician. I would encourage group discussion, role play and case examples to help the treatment team better understand the difference. I would keep this as a learning and open environment so the team would feel safe to bring up questions or seek consultation about this in the future.
    B) Which of the supervisor roles (consultant, advisor, guide, mentor, professional colleague, educator) fits with your values and supervisory style? Which of these stances would you take in the conversation with the team and why?
    My supervisory style is more of a mentor/guide and also educator, and it also depends on the experience of the clinician with whom I’m working. When I’m supervising master’s level student interns, they often need more of an educator role in order to learn new skills and concepts whereas an experienced clinician is usually seeking supervision that is more collaborative as a mentor/guide. There are times when I also shift into an advisor role, particularly when supervising conditionally licensed therapists who may need specific direction around clinical and administrative issues, or requirements of the Board.
    Exercise 2
    Describe 2–3 useful ideas and/or strategies about supervision and ethics that you have learned or been reminded of over the course of the past 5 weeks that you would like to bring back to your colleagues, supervisees, supervisor, administrators, etc. How do you envision integrating these ideas into your work?
    I found this course very useful given that I’m currently supervising two student interns and other conditionally licensed therapists at this time. I will definitely continue to bring forth more of the strategies. The chapter on countertransference/transference was especially helpful and I will continue to address this, as well as boundary violation/crossings. Reviewing codes of ethics is an important reminder as part of regular practice. I would use some of the questions we were presented with in homework as potential discussion points or queries for my supervisees as learning opportunities as well.

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