[CHELSEA SPEAR]

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.

[CHELSEA SPEAR]

Question 1

This client has been accused of being domestically and sexually violent but vehemently denies it. This client is also very persuasive and prides himself on being assertive

Question 2

I began dreading client appointments and began losing sleep the night before sessions

Question 3

My reactions inhibited empathy for him and caused me to struggle with unconditional positive regard

Question 4

It was definitely greatly impacted by my own history of being abused

Question 5

I do not think disclosing the countertransference issue directly would be beneficial for the client. However, I think getting more support for processing my own reaction would help me to be more empathic and regain my unconditional positive regard for the client. So I think the plan would be to get increased supervision, increased self care, my own therapy if needed, and transfer the client if this wasn’t successful

Question 6

I would know I needed my own therapist if my countertransference reactions were impairing my life- affecting sleep, interpersonal relationships, etc.

Question 7

I would do so by coming at the conversation from a place of empathy and gently point our discrepancy between the clinician’s desire to have unconditional positive regard and inability to do so due to current struggles

[CHELSEA SPEAR]

Question 1

-John
-john’s clients
-Steve
-Other staff members at the agency

Question 2

-Steve’s ethical duty to address colleagues’ and/or supervisees’ impairment in order to ensure clients are not harmed

-john’s right to privacy

Questions 3 & 4

1. Steve could do as John asked and say nothing.
Pros- It might preserve friendship
Cons- high risk of leading to further impairment and clients being harmed
John not getting the help he needs

2. Steve could have a direct conversation with John about his concerns and urge him to get help
Pros- might lower John’s defensiveness and increase likelihood to get the help he needs
Cons- This could be seen as Steve not handling the situation seriously enough and violating NASW code of ethics

3. Steve could involve Human Resources as needed and urge John to take a leave to get help
Pros- clients will be protected
John might get help he needs
Follows ethical codes
Cons- could easily end working and personal relationship between the two

Question 5

-his own supervisor
-Human Resources
-board if needed (if John continues behavior)
-peers

Question 6

Third option- sit down with John and HR. John didn’t respond well to Steve’s first attempts to handle the situation and it is clear in order to do ethical duty of assessing clinician impairment, a higher level of intervention is needed

Question 7

He should document all noted concerns from staff and himself, document the incident where Steve was drinking on the job and his subsequent reaction, and document all supervision he receives on the matter.
Steve should have a witness to the conversation he has with Steve and should have follow up meetings to ensure needed plan is in being followed

[CHELSEA SPEAR]

Question 1

Who are the parties that will be impacted by whatever course of action is chosen?

Larry (the client), Janet (the counselor), clinical supervisor, other agency staff, and potentially other clients

Question 2

What are the ethical issues involved in this clinical scenario, including conflicting and competing values of the parties involved?

Dual relationship- Larry has begun to participate in AA meetings that Janet attends

Non maleficence- Larry could potentially be harmed by possible options to address the issue

Boundary violations- Larry’s boundary violations caused an ethical conflict for Janet

Counselor’s competence- since Janet is an LADC, it is outside her scope of practice to directly treat personality disorders

Questions 3 & 4

What are all the viable courses of action and what 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 theory and practice, and personal values including religious, cultural, ethical and political ideology.

Option 1- Transfer Larry to another agency
Pros- Janet feels safe and supported
Larry might get treatment better tailored to his diagnosis
Larry might understand there was a boundary crossing
Cons- Larry would likely feel abandoned
Larry might not understand his own role in the decision

Option 2- have Janet sit with Larry alone and explain her own discomfort with his pushing of boundaries and set firm limits
Pros- The situation might take on less intensity if dealt with by the initial two parties
Cons- Janet might be operating outside her scope of practice by handling it on her own
Larry might not understand and continue to escalate
Janet might feel unsupported

Option 3- Clinical supervisor and Janet could meet with Larry to share concerns about what had occurred, set boundaries going forward, and attempt to repair working relationship
Pros- Larry can have limits set without feeling abandoned
Janet might feel supported by having her supervisor help in vivo
Cons- Janet might not be able to continue to address the issue on her own after the initial session
Larry might see supervisor’s presence as a threat

Option 4- Larry could be transferred to a clinician within the agency who treats mental health disorders
Pros- Larry gets tailored treatment
Janet feels safe and supported
Cons- Larry feels abandoned
Larry might not understand his role in the matter

Option 5- agency gets a PFA on Larry
Pros- Janet feels safe
Cons- Violation of HIPAA when it is unclear if he broke the law
Would escalate situation

Question 5

Who will you, as a supervisor, consult regarding this clinical scenario and why?

I would consult with my own clinical supervisor and my peer group

Question 6

What is the best possible course of action to take in this clinical situation?

I would choose option 3, placing non maleficence as highest priority while also ensuring Janet felt safe and supported. I would attempt to use the situation as a learning experience for Larry and our firm boundaries into place to ensure safety was maintained. I would explore adding mental health counseling to his team

Question 7

How will you implement the decision, document the decision making process, and monitor and evaluate the effects of the decision?

I would document my supervisions with Janet leading to the decision, all of my own supervision meetings and peer supervision meetings, and the written plan for implementation
After we met with Larry, I would create an ongoing safety plan to review weekly with Janet to ensure that the decision had been successful and no further action was needed

[CHELSEA SPEAR]

Question 1
What is it like for you to know that you have taken or might take on the duty and responsibility of vicarious liability as a clinical supervisor?

Answer- To be honest, it is something that creates anxiety for me. I pride myself on adhering highly to ethical standards and though I also strive to be the best clinical supervisor I can be, at the end of the day I do not have control over another’s behavior. This anxiety does not overwhelm for the most part, though, as it just fuels me to be sure I am keeping detailed documentation and providing the best clinical supervision possible.

Question 2
Describe 3 strategies you have already employed or have thought about employing to manage this sense of responsibility so it doesn’t impact your clinical and supervisory work negatively and/or does impact your work in a positive way?
Answer:
1. vicarious liability fuels me to ensure that my staff are adequately trained. In addition to helping them secure outside training, I also implement training as a part of my weekly group supervision
2. I have become an over the top documenter of any potential supervisory issues. This has enabled me to feel more secure in knowing that if anything were to occur, I have enough to support that I was doing my job ethically
3. I have increased direct in vivo supervision as well as regular quality assurance calls to clients to make sure that

Question 3
How does your agency support/not support you to manage the legal and ethical responsibility of vicarious liability and how can you advocate for more support if it is lacking?
Answer:
Honestly, my agency does not do the best job of giving me space to manage the responsibility of vicarious liability. I do not let this deter me, however, and I continue to push back and link the need for me to provide increased clinical supervision as necessary for ethical client care as a whole.

[CHELSEA SPEAR]

My name is Chelsea Spear, LMFT, LADC, CCS. I work as a clinical supervisor at SMART CFS in windham and biddeford and supervise case management for adults and children, provide outpatient and substance use counseling, as well as run an aftercare group. I am interested in learning about new topics in the field of clinical supervision and making new connections

[Author]

Posts