Episode 14: 4 Ethical Considerations for Clinical Supervisors with Sarah Binks

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

As a clinical supervisor, you’ll be helping supervisees manage ethical dilemmas regularly. However, you’ll also need to manage your own ethical situations as a clinical supervisor, but what exactly are these ethical considerations?

Well, in today’s episode, I’ll be sitting down with Sarah Banks registered social worker and psychotherapist who will share four ethical considerations for clinical supervisors.

Hi Sarah. Welcome to the show. I’m so glad to have you here today.

Sarah: Hi, Kayla. Thanks so much for having me.

Kayla: Sarah, before we dive into today’s episode, please introduce yourself. And tell us a little bit about your practice and clinical supervision journey.

Sarah: So originally, I’m from Australia, but I now live in Ontario with my family. My background is in school, social work and community mental health. Currently, I have a private practice where I specialize in providing clinical supervision and money mindset coaching for therapists.

And I also have an additional hat I wear. I also am a PhD candidate researching how to help social workers in schools. And I teach at a local community college as well.

Kayla: Amazing. So, first of all, when it comes to practice, what does it mean to be ethical? Like what is the word ethical?

Sarah: Yeah. At its core, being ethical means doing what is right and beneficial for the client while upholding professional standards and legal requirements. You know, as therapists, I’m sure we’re all closely familiar with our regulatory body’s codes of ethics, which guide our professional practice. But what we find when we move into our role as a clinical supervisor, we may be faced with some different ethical issues that we then haven’t anticipated when we were in the role of a therapist.

So, I definitely identify four key areas that clinical supervisors need to consider to ensure that ethical practice in their supervision practice.

Kayla: Well, let’s dive into those four ethical considerations. What are they?

Sarah: So, the first one is dual responsibility, dual relationships, and boundaries. Now, as supervisors, we have a dual responsibility for the wellbeing of the therapists and for the wellbeing of the clients being served.

We then won’t find ourselves having dual relationships within that relationship with our supervisees. So, for example, if you are a group practice owner who is also providing supervision to your therapists, whether they’re independent contractors or employees, you’ll have that dual role as practice owner and clinical supervisor.

So, there’s definitely a number of things you need to consider in that example of a dual relationship, such as how is supervision being provided? With whom is it included as part of the services provided within the split? Is it an extra fee? Is it individual? Is it group? How often. So, it’s really important that understanding the duality of that relationship is important.

And then my final thing under that first category is boundaries. So, for clinical supervision, making sure that we’re not blurring our supervision with therapy. So we are holistic people. We can’t separate ourselves out from the work. It is really important as supervisors that we do have solid boundaries around what is the work, what are we discussing in supervision versus what is something that would be better suited to a therapy context?

And then a second element is competency and scope of practice. And that’s being really clear as a supervisor about your limitations and your scope of practice. So, questions are really important. Are you willing to supervise clinicians working with children? You know, that can become particularly complex when you’re dealing with parental rights to information, mandatory reporting requirements. Informed consent, access to information and things like that. Thinking about your scope of practice, an important piece when you’re starting to build your private practice as a clinical supervisor is making sure that you’re staying within that scope of practice. You may feel a pressure to accept all requests for supervision, however, it’s essential you stay within your scope of practice.

Then if you are supervising people outside of your regulatory body, I know in Ontario where I am, I’m a member of the Ontario College of Social Work and Social Service Workers, but I’m also eligible to supervise people registered with the College of Registered Psychotherapists of Ontario. So, it’s really important that you understand the supervisory requirements to be able to supervise registrants of the different colleges.

The third area is around documentation and liability. Making sure that you are taking notes as a supervisor and advising your supervisees to also take notes. This is a really important ethical requirement.

You want to keep track of any recommendations, discussions, especially if they’re related to the code of ethics, confidentiality, mandatory reporting, assessments of risk. It’s also in terms of your documentation, really important to clearly identify what kind of supervision you’re providing. Is it clinical supervision where the supervisor holds legal liability for the supervising therapist caseload? Or is it supervision in a consultative manner where you might not have access or you don’t have access to client files? This can come up in situations like motor vehicle accidents or supervision if it’s required by your regulatory body as part of a disciplinary decision. So having a clear supervisory contract is really important.

And then making sure a number of supervises that I talk to who are also group practice owners, making sure that you have policies in place to respond to high-risk situations with clients. So, defining what your role is as the supervisor to respond when clients make statements of suicidal thinking or risk of harm in any way. So, what is your responsibility and obligations?

And then finally number four is around confidentiality. So, this is really important to outline what is the Supervisee supervisor confidentiality? What is the confidentiality between the client and the supervisee as well? So, if you are providing clinical supervision where you actually do have access to client files, that needs to be clearly documented in the informed consent that your client is signing.

If you provide clinical supervision where you may be looking at videotapes of the session as part of that supervision, the video recording and the sharing of that with the supervisor also needs to be part of that informed consent process as well. Now, depending on your supervisory role, client confidentiality also needs to be clearly outlined.

And making sure that, for example, in Ontario, if you’re providing supervision as a group practice owner, have you clearly identified and outlined who is a health information custodian for your independent contractor agreements? So, this is really making sure you’re identifying who has access to client information and client files.

Then just two final points. If providing external supervision. Supervisors need to ensure clinicians have information in their informed consent process, and if you are signing off, for example, if Registered Psychotherapists in the qualifying stages, is the supervisor signing off on direct client contact hours? There might be many registered psychotherapists who are in the qualifying phase who are actually in solo private practice. So, they need to make sure that they’ve discussed with their supervisor, can they ethically sign off that the qualifying RP has met those supervision hours.

So, it’s just really important. There’s a lot of things to take into consideration as a supervisor, whether you’re a group practice owner, supervisor, whether you’re an external supervisor. Or even an internal supervisor with an agency, these four areas are really key to making sure that you’re practicing ethically.

Kayla: I love that. Some considerations that even I didn’t really think of. Not that I provide clinical supervision, but really being clear about what the dual relationships are, what the confidentiality regulations are, making sure you understand– are you providing clinical supervision or clinical consultation and what’s included under those umbrellas. I think that’s really important.

And you mentioned dual relationships and I’d love for us to dive in a little bit with that. And do you have practical examples of what might be considered a dual relationship when it comes to clinical supervisors and their supervisees?

Sarah: Yes, absolutely. Supervisors ethically may enter dual or multiple relationships, and there’s many situations. As I mentioned before, the group practice owners with their independent contractors. You may be providing external supervision to two members of the same group practice. So, you might be providing supervision to the clinic owner and to an independent contractor from the same clinic. You might be an internal supervisor for a therapist that you’ve been promoted to the role of supervisor and they were previously maybe you are now in a supervisor relationship with someone who was previously a colleague and a friend.

With external supervision, you may be providing supervision to someone who you previously worked with at another location, but then you may no longer work together anymore. And in smaller towns we see this just like we see similar with therapists and their clients. You may have dual relationships where you have current or previous work or personal connections with the supervisor as well.

But as with all dual relationships, it’s essential that the supervisor recognizes that power dynamic. And ensures that they’re constantly reevaluating the risks and benefits and having that open dialogue with the supervisee just to ensure that the supervisee’s needs are being met and they’re being respected in that situation.

Kayla: I love that. Is there ethical considerations with respect to providing peer consultation and clinical supervision? And let me give an example. Let’s say that a clinical supervisor is providing clinical or has provided clinical supervision to someone in the past, and now there’s a peer consultation group and everyone is in that same group. What are some of the ethical considerations there? Are there any?

Sarah: Oh, that is a fantastic example of a multiple relationship. I think when it’s peer consultation, there isn’t a hierarchy. It is very much people sharing their opinions, how they will practice. And so, if that’s a situation where you were a clinical supervisor and now your peers together in a supervision group. You would be navigating that because that power dynamic definitely has changed.

So, for the clinical supervisor in that peer supervision role, that would be an interesting question. Can you be vulnerable because of that power dynamic? So that would be, I think, an important critical reflection piece to think, is this a safe space for me to be vulnerable? Because when I’m in my clinical supervisor role outside of this peer consultation group, I’m an expert. And if I’ve got the expert hat here, can I be the vulnerable, ah, I don’t know what I’m talking about, hat over here. So, I think that that’s a really interesting, and definitely thinking about is there options, are there other options for peer? But I think definitely thinking about that power dynamic within that situation would be really important.

Kayla: I like how you also highlighted not only about the dual relationship between the clinical supervisor and the supervisee. But also, the clinical supervisor’s ability to fully immerse and grow in that particular environment. Because there’s some environments where we just may not feel that, for whatever reason is a fit, and in this case, it may not allow the clinical supervisor to get what they were hoping out of that group.

Sarah: Yeah, absolutely. It is so important. Vulnerability for me is such a key part of the supervisory relationship, and I think that’s why a number of people opt to have external supervision because they don’t necessarily feel like they can have that vulnerability when they have a dual relationship. Whether it’s somebody who makes hiring and firing decisions, or allocation of referral decisions. Or making sure that your needs being met, when you are in an expert, you’re supposed to be the leader. That you’re supposed to be the one who knows things. So definitely, that vulnerability is such an important point.

Kayla: I would agree a hundred percent. I. You also mentioned confidentiality being an ethical consideration. I’m wondering if you have any tips or strategies for clinical supervisors who are required to disclose professional concerns about a supervisee, whether it’s to their educational institution, if they’re a student, or regulatory body for newly or qualifying registered practitioners? But also, how can clinical supervisors create a safe and open space for therapists to be vulnerable when this obvious power differential exists?

Sarah: Yeah, I think that just ties in with what we were saying about having a safe space for people to be vulnerable. I think the first thing we need to do is be completely transparent. Be transparent when entering a supervisory relationship. Having a clear supervision agreement in place that outlines informed consent, confidentiality, and reporting obligations. So, I think that is the foundation of creating that safety and that space because then you are minimizing any surprises. It is not impossible, but it hopefully does minimize surprises if you need to report.

For me, I work from an empowerment feminist approach. So, if I do feel like I need to disclose professional concerns about a supervisee, I will always, if I can, as long as I’m not increasing harm, disclose that to the supervisee and just discuss what my concerns are. And be clear about what I would and would not need to share with regulatory body or with the institution.

So, it really, for supervisors, you really need to be clear on what the reporting requirements are. So, like I mentioned before, if you supervise people across different regulatory bodies, really being clear what that particular body requires.

And then I think it’s really important for supervisors to focus on therapists’ growth rather than on judgment. Engaging in our reflective practice that we are so good at as therapists, and really focusing on what can be learned from this situation and how do we move forward to ensure that ethical practice in future as well.

One final thought. It’s also really important that supervisors seek supervision for their supervisees. So, it is consultation in these cases is really important as well. So as clinical supervisors, we ourselves should be involved in supervision for our supervision practice.

Kayla: I love that you mentioned that. And it doesn’t matter if you’ve been in practice for five years, 10 years, 20 years, we can all benefit from clinical consultation.

Sarah: Absolutely. It is so important that we have a space where we can admit sometimes, we don’t know what we are doing because that is going to make us better clinicians, because if we overwhelmed by fear and uncertainty, that will impact our clinical work. And then that’s where we start to question ethical practice. So, it is really important that we do constantly engage in our own work as supervisors, just like we expect our supervisees to do as well.

Kayla: Sarah, you have a unique service where you provide clinical supervision for clinical supervisors. Can you share with listeners what they can expect when working with you. And also include the jurisdictions that you can practice in, also the professions you can practice in and your contact information.

Sarah: Oh, I’d love to. So, for me, I definitely saw this need for providing a safe space for supervisors and group practice owners to feel vulnerable and I identified a need where clinical supervisors and group practice owners could connect, because clinical supervisors and group practice owners can feel particularly isolated in their work. Many supervisors find it difficult to be vulnerable as they’re the ones who are seen as the experts in their own practices. They’re the ones who have the answers that are the go-to people. So, I run a closed group supervision series specifically for group practice owners and supervisors. So they have a dedicated space to discuss practice concerns with peers who can also understand and appreciate the unique challenges that you experience in that role. And it’s also a space where you don’t need to have all the answers, right? So that’s a really welcoming and strength-based approach.

I’m registered to work with social workers in Ontario, Alberta, Saskatchewan, Newfoundland and Labrador and Nova Scotia. And at the time of recording, my registration for Manitoba is in processing. I’m also eligible to supervise and work with supervisors who are registrants with the CRPO, the CCPA, and nurse psychotherapists. So, the CNO in Ontario.

The best way to get in contact with me is through my website. It’s www.banksiasupervision.com. Or you can find me on social media at sarah.binks.therapist

Kayla: So, to connect with Sarah, check out banksiacounselling.com.

That’s B-A-N-K-S-I-A-C-O-U-N-S-E-L-L-I-N-G.com.

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

Sarah, thank you so much for joining us on the podcast today to discuss these four ethical considerations for clinical supervisors.

Sarah: Well, thank you so much for having me. It’s been wonderful.

Kayla: Thank you everyone for tuning into today’s episode, and I hope you join me again soon on Your Clinical Supervisor’s Coach podcast.

Until next time. Bye for now.