Episode 22: Clinical Supervision Agreements: What Should be Included? with Beth Rontal

Kayla: Welcome back to Your Clinical Supervisor’s Couch podcast, and I’m your host, Kayla Das.

In today’s episode, Beth Rontal, licensed clinical social worker, case note documentation specialist and owner of Documentation Wizard, will share what should be included in clinical supervision agreements.

Hi Beth. Welcome back to the show. I’m so glad to have you here again.

Beth: Thank you, Kayla. I love being interviewed by you. You’re a great interviewer and I love talking about supervision and consultation, so let’s go for it.

Kayla: Oh, thank you so much. And Beth, you were here just two weeks ago discussing case note, documentation considerations for clinical supervisors. And now you’re here to discuss another important administrative practice for clinical supervisors, which is clinical supervision agreements and what should be included in them.

Beth, for anyone who hasn’t yet listened to your last episode, please introduce yourself and tell us a little bit about your practice and clinical supervision journey.

Beth: Well, I am a psychotherapist. I still have a private practice. I founded the Documentation Wizard Company over 12 years ago, and I’ve been teaching thousands of therapists how to do their documentation since then. I teach them how to translate their skill and intuition into effective documentation that protects client confidentiality, protects therapists in a board complaint, and for Americans who take insurance helps us pass audits.

And I supervised over 50 therapists in 11 years when I worked for a clinic, and that’s when I really honed my skills as a supervisor and brought what I feel like is my worldview to what doing therapy is really all about, which is not just healing from the past traumas, but empowerment and living one’s best life. And being responsible as a therapist for one’s own stuff. If you’ll excuse the non-technical clinical word. And it was a second career for me, so I brought a lot of life experience that informs how I work. I want to teach that to the people I supervise and consult with. And it’s my goal to have documentation and supervision be clinically useful always.

Kayla: And I know there’s differences between what should be in agreement for supervisors versus clinical consultants. So, just for listeners to know what is the difference between clinical supervision. And how does it differ from clinical consultation? Just so we have an idea of why some of these things might be slightly different.

Beth: I think that’s a really important question that most people don’t fully understand and that lack of understanding could get them into trouble. So clinical supervision is providing supervision to an unlicensed therapist. And that means that the supervisor can be held responsible for the behaviors and actions of that unlicensed therapist. That is a big responsibility.

And if you’re working in a clinic or an agency or a hospital, the supervising clinician has some protection from that governing body, but only some, if there’s a complaint, the supervisor’s notes will most likely be demanded and you can try to claim confidentiality and privilege, but it’s really hard to do that.

When you are providing clinical consultation, you’re providing guidance to a fully licensed therapist who is legally responsible for themselves. It is assumed that since they passed the exam and they are working independently, that they have the skills to make their own decisions. So, as the consultant, we are not responsible. But we have influence.

Kayla: I love that you made that distinction because I just know here in Canada. And I’ve did a lot of research and looking at regulatory requirements for clinical supervision. And not all therapist regulatory body’s make that distinction and they kind of lump the clinical supervision with clinical consultation, or they briefly just say clinical supervision or consultation without really defining for people who may not necessarily know what that means.

Beth: That’s an oversight given our contentious cultures. That could be really problematic for people. We have to know the distinction.

Kayla: Absolutely. So, when it comes to clinical supervision agreements with unlicensed or unregistered practitioners, what should be included in those agreements?

Beth: Expectations and responsibilities of both the supervisee and the supervisor.

So, expectations for the supervisee. How many hours the supervisee needs towards licensure, and how many hours the supervisor is going to provide. The frequency. Is it going to be weekly or is it going to be every other week, or is it going to be monthly? I don’t suggest that it be monthly. For an unlicensed therapist, I highly suggest weekly.

And that there is an expectation that the therapist will come prepared to present a case or discuss a problem. That you will review documentation. That the supervisor will be assessing how open the supervisee is to feedback. Whether the supervisees following laws and ethics, professional ethics.

And I said last time in the previous interview, it’s so important to have your supervisee read the code of ethics. I think people take these codes for granted and don’t understand how much wisdom there is in them. And that they don’t always give really concrete guidance. So, there’s gray and that the therapist, whether they’re seasoned or new, really has to grapple with.

There also has to be an understanding of who the supervisee reports to and who has the final authority, it’s not always the same person. The final authority may be the agency. It may be the clinic director. It may not be the supervisor. I was not always the final authority. My opinions and assessments were taken into account, but there were times that I had to do things according to clinic standards and policies that I didn’t particularly like, but were not unethical. So, I would do them. And the supervisee needs to know where the buck stops.

The supervisee needs to know what unethical behavior is and what the consequences for unethical behaviors are.

And also, clinic policies and recommendations. So, for instance, there are some therapists and some clinics that say, no gifts, no touch. But gifts and touch maybe a soft recommendation based on the relationship that the therapist has and the kind of therapy that the therapist is doing.

For example, I did thousands of hours of home visits and I walked into a client’s home, she offered me a cup of tea and I refused it. Thank you. But no, I really appreciate it. But no, thank you. I lost her. She never showed up because she was offering me something and she felt like I refused her, and she couldn’t tolerate it and there was not even an opportunity to discuss it. Doesn’t mean I would have accepted the tea. It just means I might have already talked about that. I might have said, thank you so much. I don’t drink tea, but I really appreciate what you’ve offered me. I mean, these are the kinds of things we will wind up talking about in supervision.

The supervisor also needs to know how they’ll be evaluated. As I said before, how well is feedback received? Do they come prepared? Are they providing therapy in a culturally sensitive way? Do they appear to have bias in their work? And another one that I think a lot of supervisors don’t anticipate, but I had to because I worked in a clinic that did home visits. How are clinical emergencies handled? Not just clinical emergencies for the client, but emergencies for the therapist?

For example, I had a supervisee who got attacked at her car when she came out of the home of a client. And I was the first person called; how does the supervisor handle that? So, the supervisor needs to have some understanding and maybe even some training on how to do that. I did not, fortunately, I did a good job, but it took a huge toll on me emotionally and because I was worried, I was terrified for this woman’s life. She wound up being okay just to put all your listeners at ease.

But those are the kinds of things that we need to keep in mind and discuss with our supervisees. Who do We contact in case the therapist has an emergency? And if the supervisor is an outside supervisor, in other words, contracted, not employed by the agency, how does that supervisor get paid?

Then there’s the supervisees rights. It’s like an informed consent for a client. What are their responsibilities? What are their rights? Well, we just went through what the supervisees responsibilities are, but their rights, they have a right to regular and consistent meetings to professionally provided feedback with no harassment, no exploitation. Where the supervisor is not trying to get their own needs met, they have a right to co-creating their learning objectives. They have a right to a regular performance evaluation and a right to make a complaint. And knowing how to make a complaint and the supervisor’s responsibility is to keep records of each session, and do a formal performance evaluation to provide guidance in professional ethics. Work with transference and countertransference, work with professional boundaries. And, of course, clinical documentation. And it is also the supervisor’s responsibility to provide professional and culturally sensitive feedback that is informed by how race, class, gender, poverty, sexual orientation, age, ability, disability, how all of those things affect a client’s mental health and the supervisee’s mental health. So, these responsibilities are not lightweight.

As supervisors, we take on a lot of risk. As therapists, we take on a lot of risk. I think we downplay the level of risk that we take on every day with every session.

Kayla: I absolutely agree with you, and there’s a few considerations and maybe even additions I’d like to add as well. Like when we’re thinking of obviously unlicensed or unregistered therapists, they could either be in the qualifying stage, the probationary stage of their regulatory body or licensing board, or they could be students who are working under you.

And it’s also important to identify the limits of confidentiality to their sessions. Meaning, as clinical supervisors, you are the gatekeeper of the profession. So that is a huge power imbalance. Meaning what are you going to do if you believe after all of the support you have provided that? A report either to the institution or the regulatory body needs to occur. I think that’s important to highlight in an agreement as well.

Beth: I agree with you. A hundred percent.

Kayla: So, when it comes to clinical consultation agreements with licensed or registered practitioners, what should be included in those agreements and how do they differ, say from clinical supervision agreements?

Beth: The consultation agreement is less involved, but just as important because it’s assumed that the Consultee is able to make their own decisions. It’s assumed that the Consultee knows their codes of ethics.

So, it’s not as important to lay that out at the very beginning. But it is important to have in the agreement that the consultant is not legally responsible for the Consultee because they’re fully licensed and that the Consultee has the final word on what to do and how to do it.

I once did some consulting with a therapist who wanted me to have a list of all his clients and read all his treatment plans and all his session notes because he thought that I was going to be responsible, and he got a pretty hard awakening when I said, that is not my job. That is your job. Where does this come from? Why do you want me to have this? And it came from his own insecurity as a relatively newly licensed therapist.

The other things that need to be included in the agreement is what is the fee? Who’s responsible for paying the fee? When is it expected? What are the methods of payments? What are the consequences for non-payment or late payment? The frequency of consultation. Cancellation policies. Therapists cancel on their consultants just like clients cancel on their therapists. So that’s an hour out of our schedules that is not getting paid for. How do you as the consultant want to handle that?

Just like with a supervisee, it’s our job to provide professional and culturally sensitive feedback informed by the same things by how race, class, gender, poverty, sexual orientation, immigration status, age, ability, disability, how all of that affects mental health, particularly now when all of this stuff is going on. All this stuff going on politically and culturally in the US and the Canadians are not immune to it. And they see what’s happening and it’s alarming for everyone in some way. And we take the brunt of a lot of it, and we have to be able to handle it, and we have to be able to get support for handling it. But that’s a whole other topic.

Just like with a supervisee, who do we call in case of an emergency? That should be in the agreement. And the protocol of how to deal with unethical behavior or behavior we suspect is unethical. We are mandated reporters. So how do we deal with that? And the consultee needs to know that.

Unfortunately, there are therapists who violate some very sacred boundaries. I’ve unfortunately worked with them, so I know it happens. It’s not just something I read in a book, and that all needs to be out there upfront. If it’s not, then the therapist, that fully licensed therapist might consider reporting you as an unethical consultant, so you need to protect yourself.

Kayla: That’s really helpful. Beth, you sell clinical supervision and consultation forms. Can you tell us about the forms and how listeners can purchase them?

Oh, sure. I have an agreement for supervision. I have an agreement for consultation and, a way to document each one of those. And people can get them on my website. And for your listeners, they have a 10% discount.

Kayla: Absolutely. So, to purchase Beth’s clinical supervision and consultation forms, check out canadianclinicalsupervision.ca/bethrontalforms,

Or you can simply scroll down to the show notes and click on the link.

Also, as a special bonus for listening to today’s episode, when you used a coupon code CSCSAVE10, you’ll receive 10% off at cart.

You can also scroll down through the show notes and get the coupon code as well.

Beth, thank you so much for joining us on the podcast today to share what should be included in clinical supervision agreements.

Beth: You’re welcome, Kayla. Thanks for having me. It’s always a pleasure.

Kayla: And thank you everyone for tuning into today’s episode, and I hope you join me again soon on your Clinical Supervisor’s Couch podcast.

Until next time, bye for now.