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Unread September 17th, 2008, 05:58 PM
William Reid William Reid is offline
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Join Date: Jul 2004
Location: Texas
Posts: 105
Default Re: clinical autonomy in an agency

". . . Then I thought about the Egg Who Wants to Teach the Chicken here . . ." Very effective mental image, Sk8rgrl.

As usual, don't consider this to be legal advice, but it's how I'd think about the issue:

Supervisory situations are different from place to place, but if you are saying that supervisors in psychotherapy/counseling clinics and teaching settings should only accept such duties when they are confident that the (usually unlicensed) supervisee has the requisite basic skills and attitudes, then I agree with you. If I understand you correctly, your supervisee is allowed (or expected) to see patients/clients by herself/himself, then you review/discuss/critique the work in some way. That means the patient/client is alone with the supervisee, and both the patient and the agency are relying on the supervisee to do a reasonable job, not do any harm, etc.

From the patient's viewpoint, the supervisee is a professional clinician (even if the supervisee has notified the patient that he/she is still in training, is required to have a supervisor, etc., notification which should occur in such settings). The patient has a right to expect reasonable care from the supervisee, who is an agent of the agency, and the agency (in part through the supervisor and in part through other vetting) should do a reasonable job of making sure the supervisee is capable of providing that care.

Assuming that the supervisor is not in the room when counseling is being done (true in most such situations), the supervisor has an obligation to be reasonably sure the supervisee is qualified to do the above. That may mean interviewing the supervisee before starting the work, reviewing his/her background & training, observing a few sessions, etc. If the supervisor believes at some point that the supervisee is not qualified to act alone, or is not performing reasonably and safely, the supervisor has a duty to both the patient and the agency to intervene in some way (which may or may not entail stopping the supervisee from doing counseling).

In such a situation, the agency is generally responsible for the acts of both the supervisor and the supervisee, and may be criticized about either (e.g., in a complaint or lawsuit). The agency relies on the supervisor to notify it if the supervisee is unqualified or doing something wrong (assuming the supervisor reasonably should be aware of same). Thus the supervisor has a duty to keep the agency informed. By the same token, the agency has a duty to take appropriate action to protect patients if the supervisor puts it on notice that a supervisee's ability or behavior is problematic. It is dangerous and improper to accept supervision of a counselor or other supervisee who you believe may be unqualified, unless appropriate safeguards for the patient are in place.

Lots of us are too cavalier about what it means to be a supervisor of this sort, and are quick to agree to take on the role. In my view, one should carefully clarify the supervisor's substantial duties, which includes your duties to patients, to the supervisee, and to the agency, and undertstand what it will take to fulfill those duties. Do not be misled by a superior who says something like "don't worry, all you have to do is review the case and sign off on the notes." That doesn't erase the professional, ethical, and legal duties I just discussed. And in many cases, the supervisor is actually the person who is responsible for the patient's care. That's often what it REALLY means when you "sign off" on a supervisee's notes or reports.

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