Eye on Ethics
Supervision Protecting Practitioners and Their Clients
Alma B., MSW, was a supervisor at the Woodholme Community Mental Health Center. She supervised three clinical social workers who provided counseling services to individual clients, couples, and families.
One of Alma’s supervisees, Bruce R., provided outpatient counseling to a young man, Dennis H., who was required by the local court to receive domestic violence counseling as a condition of his probation. Dennis had been charged in criminal court with assaulting his wife following a dispute.
During one counseling session with Bruce, Dennis seemed agitated and spoke about how much he resented his wife’s accusations. Dennis accused his wife of adultery and made a number of threatening comments about her.
Although Dennis’ threatening comments were somewhat vague, Bruce was concerned about the possibility that Dennis might harm his wife. Bruce asked Dennis a number of questions to assess the risk. Bruce eventually concluded that Dennis was “blowing off steam” and did not plan to harm his wife. Sadly, two days later, Dennis assaulted his wife with a knife during a heated dispute. Dennis’ wife was seriously injured. Eventually, she filed an ethics complaint and a lawsuit against Bruce, Alma, and their employer, Woodholme Community Mental Health Center. The complaints alleged that Bruce failed in his duty to disclose information to the victim about Dennis’ threat and, further, that Alma failed to supervise Bruce properly. Among the complaints were allegations that proper supervision of Bruce by Alma would have prevented the harm to Dennis’ wife.
It is not unusual for legal complaints filed against social workers to claim that proper supervision of staff would have prevented unethical or negligent conduct on the part of a practitioner. Ordinarily, these claims are based on the legal principles of respondeat superior (Latin for “let the master respond”) and vicarious liability. According to these concepts, supervisors may be held partly responsible for the actions or inactions of their supervisees, although the supervisors were involved only indirectly.
Whether or not supervisors provided proper oversight in such cases depends on their adherence to widely accepted norms or standards in the profession. Supervision guidelines appear in a number of social work publications and in guidelines established by social work organizations, such as the National Association of Social Workers (NASW). Although these standards do not have the force of law, they are often consulted by ethics panels, attorneys, and judges when questions are raised about the adequacy of supervision that was (or was not) provided to social workers who have had complaints filed against them.
For example, the NASW’s National Council on the Practice of Clinical Social Work promulgated guidelines for clinical social work supervision. These guidelines describe the purpose and intent of supervision; distinguish among supervision, consultation, and education; describe the ideal qualifications of a clinical social work supervisor; and discuss issues such as supervisors’ and supervisees’ responsibilities, accountability, documentation and reporting, duration of supervision, and termination of supervision. The guidelines include specific recommendations, for example, that, during the first two years of professional experience, social workers should receive at least one hour of supervision for every 15 hours of face-to-face contact with clients. After the first two years, the ratio may be changed to one hour of supervision—or consultation for the social worker in independent practice—for every 30 hours of face-to-face contact with clients. The guidelines state that clinical social workers with five or more years of experience should obtain supervision when needed.
Supervisors can take a number of steps to enhance the quality of their supervision and the quality of supervisees’ ethical decisions. Supervisors should do the following:
• Ensure that supervisees are familiar with prominent ethical standards in the profession, especially related to issues such as confidentiality, informed consent, conflicts of interest, dual relationships, boundary issues, documentation, consultation, referral, and termination of services.
• Discuss the steps that supervisees should take if they encounter a difficult ethical decision—for example, when and how to seek consultation and supervision.
• Ensure that supervisees are acquainted with ethics-related regulations; guidelines; laws and agency policies, such as the NASW Code of Ethics; state and federal laws governing the release of confidential information; agency policy concerning informed consent and the client’s right to inspect his or her records; and licensing regulations concerning reporting of ethical misconduct by colleagues.
• Monitor supervisees’ efforts to develop and implement treatment and intervention plans. More specifically, supervisors should identify and respond to supervisees’ errors in all phases of client contact; know when supervisees’ clients need to be reassigned, transferred, or have their treatment terminated; monitor supervisees’ competence and willingness or ability to address any issues concerning incompetence, impairment, and unethical behavior; detect or stop a negligent treatment plan or treatment carried out longer than necessary; determine when a specialist is needed for a particular client; and ensure that supervisees maintain proper boundaries in relationships with clients.
• Devote special attention to various aspects of their contact with supervisees. In particular, supervisors should meet with supervisees regularly; review and approve supervisees’ records, decisions, and actions; provide adequate coverage in supervisees’ absence; document supervision provided; maintain proper boundaries in their relationships with supervisees; and provide supervisees with periodic and informative performance evaluations and feedback.
The NASW Code of Ethics includes several standards specifically on the subject of supervision. The most relevant are as follows:
• “Social workers who provide supervision or consultation should have the necessary knowledge and skill to supervise or consult appropriately and should do so only within their areas of knowledge and competence.” (Standard 3.01[a])
• “Social workers who provide supervision or consultation are responsible for setting clear, appropriate, and culturally sensitive boundaries.” (Standard 3.01[b])
• “Social workers should not engage in any dual or multiple relationships with supervisees in which there is a risk of exploitation of or potential harm to the supervisee.” (Standard 3.01[c])
• “Social workers who provide supervision should evaluate supervisees’ performance in a manner that is fair and respectful.” (Standard 3.01[d])
Complex ethical decisions require sound judgment. Supervisors are in a unique position to enhance the quality of a supervisee’s handling of complex ethical circumstances. In the end, quality supervision can go a long way toward protecting clients and the practitioners who make ethical decisions about them.