[Gretchen Fall Sawyer]

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☺

[Gretchen Fall Sawyer]

Question 1. Client characteristics
Previous mental health major with anxiety/ relationship issues and childhood parental loss. A few months into treatment, client’s sibling died in an accident.

Question 2. Countertransference reactions from this therapist
I had extremely high empathy when the client. My body was very tense and I was very still, leaning forward and listening intently for the whole session. I felt slightly nauseous, even after the session.
She was usually self-directed in control of the session; however, this session she wanted direction on how to create a self-care plan for the next 24 hours as she went to see family. When we created this plan together, during a small section; I did a self-disclosure in increasing her awareness of an additional self-care coping skill specific to the situation.

Question 3. Facilitative or harmful?
I believed my reaction to the client was facilitative. In the next session, we briefly processed the creation of her self-care plan including my disclosure – and she said that it was extremely helpful because she had needed direction and would not have considered that skill on her own.

Question 4 – my experience
My countertransference was intensified because of my own similar experience. As an adult, my parent was killed suddenly in a car accident. Both my siblings chose to use some different self-care coping skills to quickly move through the burial process and subsequently had extremely long, intensive repercussions of this act. Through many discussions and reading more about this type of loss afterward, I became aware that this skill can be helpful for closure.
Other countertransference which was lesser was her similar field of study and that we had both had a parent die, although very different situations.

Question 5: Strategy
My strategy at the time was to respond to my client’s request for assistance at a time when she was not cognitively strong. My strategy after that time was to briefly process the disclosure in a following session to make sure A) no harm was done to the client B) to address any clarity issues regarding the disclosure and C) to be transparent about the rareness of this type of disclosure and why I chose to offer it to the client.
I do think my understanding of this type of out of control loss added to my understanding of the client’s position.
I think the way disclosure of the countertransference response would be harmful to the therapeutic relationship would be if we did not process the disclosure, if we did not set it apart as a different, rare action on the therapists’ part. I am also aware that I was working with a client who was thinking about being in the mental health field. Being transparent about my process in this disclosure may also be important in her own journey of becoming a helper.

Question 6: Self-care for the therapist
When I do or want to do a different intervention in session, I know that I need to process my feelings and choices with my supervisor. If a single session does not release my need to talk about this disclosure, I would go to a therapist to begin processing this issue. For lack of a clinical term, if the feelings continue to “stick” with me, I know I need take care of myself outside of my profession.

Question 7: Supervisor addresses the issue
I would be transparent about discussing the process of self-care for the therapist. Therapy is just one option for self-care when a clinician is dealing with a trigger from session.

Sometimes I say during that procesing “Hey, I go to a therapist when I need to….. helps me be a better clinician.” It conveys being genuine, normalizing the self-care process and helping the therapist learn their own self-care options.

I would also check in with the supervised about how they are doing with self-care in a later session.

[Gretchen Fall Sawyer]

1. Parties impacted
John (the supervisee), Steve (the supervisor), their satellite agency peer team, their families, John’s clients, the larger agency administrative staff including Steve’s clinical supervisor of his supervision.

2. Ethical Issues
There are multiple boundary issues that Steve and John are dealing with in this situation. Steve worked to minimize these possible pitfalls in discussing their dual relationship up front within their new relationship. It may have also been helpful to advocate for supervising in another office to minimize dual relationships.
Doing no harm to the client is another important ethical consideration. John’s heavy caseload seems to be increasing his stress responses to his clients and others around him.
Self-care is another ethical consideration when looking at John’s high risk of vicarious traumatization leading to relapse. All parties may be impacted by his unhealthy self-care choices. Steve may also be struggling with self-care due to his dual relationship.

3&4. Viable courses of action, include benefits and risks
a. Meet with John to address his client load/stress issues and caseload management.
Benefits for John: helps him address work stress and possibly move toward his own self-care.
Risk for John: has to be self-motivated, doesn’t address relapse and therefore may affect friendship and further clinical work.
Benefits for Steve: helps his supervisee, avoids difficult conversation
Risks for Steve: avoiding issue reinforces maladaptive coping skills from Co-occurring patterns, no accountability for John’s actions, risk of Steve’s own professionalism and job if John continues drinking.
Benefits/risks for the clients/agency: continued compromised clinical care and legality issues.
b. Meet with John to address his relapse at work, including creating a restorative, corrective plan including being transparent about agency rules. Plan includes consequences of continuing behavior.
Benefits to John: clarity about agency regulations, supportive plan
Risks to John: no focus on the increased stressors or other personal self-care, may feel friendship is compromised.
Benefits to Steve: clarity about agency regulations
Risks to Steve: may feel punitive, compromised friendship, feeling torn about his dual roles. Client care may also be compromised in the long run if John’s client care is not addressed.
c. Hold John’s confidence while increasing support for his heavy load and plan for self-care.
Benefits for John: gives him another chance to get back on track personally, preserves the friendship, helps support his work stress for restoration.
Risk for John: at higher risk toward getting fired due to not knowing the agencies guidelines, easier to hide problem and not address root causes.
Benefits for Steve: hopeful to preserve friendship and still help him as a supervisee.
Risks for Steve: torn between friendship and clinical obligations
Risks for the clients/agency: compromised clinical care and legality issues.
d. Steve transfers to another satellite agency
Risks for John: continued risk of relapse, compromised clinical care and possible consequences in the future
Benefits for Steve: avoidance of losing his friendship, decreased further dual relationships
Risk for Steve: decrease in self-efficacy for not addressing the issue directly, decreased confidence from co-workers and within the agency.
e. Fire John directly.
Multiple Risks for all parties including client and co-worker loss of a clinician/team member, loss of friendship, unethical treatment of an employee, agency not supporting John in his recovery, as is their mission as a co-occurring treatment center, etc.

5. Consultation and why?
It is good that Steve consulted within agency, due to their specialty. Consultation can help Steve determine his professional plan of action to support John’s clients AND John, but also to help himself balance his own self-care and recovery progress.

6. Best possible course of action
I would say a combination of a and b above. Steve can meet with the client to address all issues: compromised clinical care, supervisee’s compromised self-care and relapse, a plan of corrective action and clear consequences if these are not addressed. Steve would continue supervision of supervision (or consultation) to manage his own professional ethical work with this supervisee as well as his own self-care.

7. Implementation, documentation of the decision making process and monitor/evaluate effects of the decision?
Implementation of the meeting is done with immediacy. Steve will communicate his concern for John professionally and personally. Focus of the supervision will be on John’s self-care, management of his caseload and restorative planning for ethical, clinical client care. Steve will be upfront with John about documenting this supervision as well as having John sign any restorative plan created in the meeting. The plan will also include the awareness of possible consequences if John continues to drink at work. Self-care planning will be discussed and may include Steve discussing possible further supportive referrals for John (AA meetings, his own counseling, etc.) Steve may offer to increase supervision to weekly for a short period of time (agency work can be group focused, bi-weekly or monthly) to make sure John feels supported in his work at the agency. All actions will be documented.
Steve may also bring up their dual relationship again, stressing supports and also being clear about boundaries.
Steve may decide to increase his own supervision of supervision for his own self-care, as well as his own outside supports.

[Gretchen Fall Sawyer]

1. The parties impacted are Janet, Larry, the clinical supervisor, the Agency, Agency Staff and AA attendees. The social realms(families, community members, the recovery community) which are connected to these individuals may also be affected indirectly.
2. Boundary violations, non-maleficence, breaking confidentiality and client rights to treatment…… Conflict between the supervisee’s safety and the client rights to treatment complicate these ethical issues.
3 and 4. Four viable courses of action would be having a
1. meeting with a client to discuss further treatment options,
2. meeting the client to transfer him to another clinician,
3. written or phone communication terminating treatment and subsequent referral
4. involving Law enforcement.
Complicating this decision is how the processing with the supervisee helps her make this decision. Honoring her valid feelings of being unsafe while balancing the client’s rights to treatment and clarity around the therapeutic relationship may be challenging. It may help to focus on the client before the counselor in making the decision.
Possible risks for the client are that he may continue his confusion and inapropriate behaviors, challenging his social connections, mental health and efforts at recovery. Possible risks for the counselor include her safety, her efficacy in managing challenging clients, her professional work and her own recovery. The agency and supervisor are at risk for helping the client and the supervisee with professional treatment/ supervision. Without making ethical choices supporting professional treatment, the agency may also be inadvertently putting the outside community at risk.
Benefits to all are in having client, counselor, the supervisor and agency staff feel safer and to have clear boundaries and guidelines for being successful. The efficacy of all these parties can be increased when all are supported by ethical and professional treatment, including informed consent, confidentiality guidelines, etc.
5. My hope would be that within the agency, I would have my own supervisor of supervision who is experienced in both supervision-of-supervision as well as treatment of co-occurring disorders. If not, I would seek my own outside clinical supervisor or experienced professional to consult with on this matter – either with similar experience. I may also end up consulting law enforcement with a scenario to see what options they may have of support for this situation – without breaking confidentiality.
6. To address the boundary violations, client rights to treatment, safety concerns for all parties – I would focus on meeting with the client to clarify innapropriate boundaries, illuminate further possible consequences and offer referral options within and beyond the Agency. It would be crucial to know the clinician’s decision about involving herself in this meeting (clinician with supervisor, just the clinician, just the supervisor) because she has been the main interventionist.
7. After that decision has been made about the counselor’s involvement, if any at all, I woud proceed with the meeting, including sharing supporting documentation of inappropriate behavior and consequences. Discussion could include how law enforcement involvement may be involved if the boundaries are not held. The client would then chose his further treatment within or outside of the Agency. Harm reduction during this stressful time of change would be discussed to help client maintain his recovery. If the client continued treatment here, reviewing how the client is managing boundaries may be reviewed in session regularly (monthly).
A written document clarifying what is discussed may be helpful to the client and will be kept in the client’s file. Myself, the counselor and whomever I consult with will also be keeping our own documentation about this incident.
I will follow up with the counselor (possibly past and current now) to monitor the interations with the client. Treatment will also be reviewed regularly. I may also continue to process my continued supervision within my own supervision.

[Gretchen Fall Sawyer]

1) Awareness question:
For me, the experience of being a supervisor has been heavy at times but also rewarding. I take this role very seriously, and due to that, I have actually stopped supervising for the past 5 years. I did not feel I had adequate supports (my own supervision, being on the cutting edge on the field, increased risks in our populations) to sustain my work and supervisees. I am looking at taking on that duty again – and this reading has validated my choices, now and in the past.
What I loved about supervision was its’ complexity and impact on others. Watching supervisees grow and change professionally was very rewarding. I know that by doing this supervisory work, I am also helping “30 – 40 – 50” clients, their families and their worlds by supporting the counselor – makes a positive dent in their world☺
2) Strategies question:
I put a lot of structure in my supervision for clarity within the supervisory relationship. My disclosure statement gets longer every year, especially with more play therapy and technology information regarding the supervisory relationship. I sent an intake form to the supervisee with the request that they return it the first time. Supervisees needed to document their own liability insurance as well as their strengths, challenges and goals. We reviewed these goals and the supervisory relationship periodically (informally) and yearly(formally) to continue our professional structure. Having structure helped the counselor remember their professional obligations and improvement while they were engaged in working day-to-day “in the trenches.” Having structure also helped me to manage my responsibilities as their supervisor.
I would also engage in regular supervision-of-supervision on a regular basis. EXTREMELY IMPORTANT for me to reduce negative impacts of vicarious traumatization and the increased responsibility of managing their high risk clientele.
3. Agency support question.
Agencies can support with regular supervision-of-supervision, standardized documents and helping their supervisors be cutting edge in professional information. Agencies can send their staff to trainings and workshops, especially by sending more than one staff member to increase sharing and communication of information within the agency.
My agency is very supportive financially about trainings and when staff returns from workshops, information is shared among the staff for a positive benefit to all. They promote a culture of learning and shared common language regarding our professional work.

[Gretchen Fall Sawyer]

Hello, all! My name is Gretchen Fall Sawyer. I work as a clinical counselor at UMA on the Augusta Campus as well as being the Acohol and Drug Counselor for middle and high school students in Poland. I have in the past supervised play therapists, clinicians, school counselors and master’s level students. I have been thinking about opening up my private practice in supervision again and wanted to immerse myself in that world again. Managing dual relationships, counseling in school settings and helping counselors do their best work are some of the supervision topics of interest to me. Really looking forward to learning with and from all of you!

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