Supervisors' suggestions for enhancing counseling regulatory boards' sanctioned supervision practices.
State counseling regulatory boards protect the public by establishing and enforcing standards with which all licensees are expected to comply. Licensed counselors are required to adhere to standards that include ethics-related laws. Counselors who violate state laws are subject to formal discipline that may result in license revocation or suspension (Cobia & Pipes, 2002). To retain their license, counselors may also be required to engage in formal remediation efforts to address their deficiencies in skills and knowledge or issues that impair their ability to function effectively as counselors. Boards can impose the following sanctions, among others: personal counseling, continuing education (e.g., completion of an ethics course, topically focused continuing education), limitations on the scope of practice, and sanctioned supervision (Walzer & Miltimore, 1993). Counselors mandated to sanctioned supervision are permitted to practice only when supervised by a specified colleague.
Sanctioned, also called mandated, supervision, is typically defined as a board-mandated process in which a colleague oversees a counselor's practice (Rapisarda & Britton, 2007; Walzer & Miltimore, 1993). 'lire process is also sometimes referred to as monitoring (Cobia & Pipes, 2002; Thomas, 2010; Walzer & Miltimore). Although both supervision and monitoring are training-based interventions designed to reduce further violations, the remediation processes are actually different.
Sanctioned supervision as this article uses the term describes a working relationship that is designed to allow the supervisee to reflect upon new information in order to improve professional practice (Walzer & Miltimore, 1993). Thus, the ultimate goal of sanctioned supervision is to reduce the likelihood that the counselor will commit the same violations when no longer being supervised. Monitoring, however, is a process that calls upon a colleague to observe and evaluate the supervisee's professional practice to prevent further violations (Walzer & Miltimore, 1993). Mandated monitors do provide instructions about how to avoid future violations but are not necessarily responsible for producing any sort of change (Walzer & Miltimore, 1993).
Although the ultimate goal of both monitoring and supervising is correction of unethical counselor behavior, the relationship between the two has not been adequately defined. Walzer and Miltimore (1993) suggested that the policing function of mandated supervision might make this model more effective for other professions, such as the medical field. They suggested, however, that certain aspects of the monitoring process, such as reviewing the counselor's records and interviewing the counselor, should be integrated into the sanctioned supervision process. They also suggested that in sanctioned supervision licensees disclose their work with various clients and receive teaching and training to enhance their development. Monitoring is important because it helps to ensure that the counselor is not currently committing any violations, while sanctioned supervision that occurs over a series of meetings allows the supervisee to internalize new, more helpful ways of practicing as a violation-free counselor.
Although sanctioned supervisors and monitors are both obligated to intercede when they observe unethical practice, supervisors are charged with the duty to help counselors learn how to prevent such occurrences. State boards have an ethical duty to promote not only intervention but prevention of counselor infractions (Sawicki, 2010). Thus, it is imperative to explore the process of sanctioned supervision to give it the attention it deserves.
Sanctioned supervision has been touched upon in the literature, but whether it is effective has not been empirically demonstrated (Cobia & Pipes, 2002; Walzer & Miltimore, 1993(.Nevertheless, it is generally accepted in the counseling profession as a helpful intervention for those who have committed professional infractions (Cobia & Pipes, 2002). Theoretically, the concept is aligned with the values and ethical imperatives of the counseling profession, and the possibility of remediation of professional infractions rather than simple intervention is hopeful (Sawicki, 2010; Walzer & Miltimore, 1993). Our findings begin to explore the actual perceived effectiveness, rather than the conceptual validity, of sanctioned supervision.
The theory that supports the concept of sanctioned supervision is rooted in developmental models of supervision and incorporates social learning theory and social psychology constructs (Cobia & Pipes, 2002). Counselors believe that all people are able to change along a developmental continuum. The counseling profession also recognizes the importance of the social world in one's change process; sanctioned supervision provides a social context for professional improvement. In theory, then, sanctioned supervision creates an ideal environment for counselors to experience professional rehabilitation.
Cobia and Pipes (2002) explored theoretical issues associated with monitoring, and Rapisarda and Britton (2007) addressed supervisors' reactions to the concept of monitoring. However, no research to date has explored how sanctioned supervisors perceive the process. This unique form of supervision will be experienced differently by supervisor and counselor, and an in-depth understanding of supervisor reactions to the process may provide helpful information about how regulatory boards could improve it.
Rapisarda and Britton (2007) conducted a focus group in which counselors discussed their perceptions of the effectiveness of sanctioned supervision. However, since none of the members of the focus group had engaged in sanctioned supervision, their perceptions were only speculative, though the study did support suggestions for ways boards might enhance and improve the sanctioned supervision process. While the findings are helpful, Rapisarda and Britton (2007) suggested that further research be conducted on the perceptions of supervisors who have actually engaged in the process.
While counselor regulatory boards often use sanctioned supervision, little is documented about how they oversee it; the literature provides no discussion of supervision procedures. This study is an attempt to enhance understanding of how boards might design sanctioned supervision processes by identifying the reactions of supervisors themselves to the supervision experience. It addresses the question, "How do supervisors who provide sanctioned supervision think board-generated sanctioned supervision processes could be enhanced to optimally support the process?"
Since the purpose of the study was to learn about how participant supervisors understand their experiences, a qualitative research method was employed (Maxwell, 2013). The process of sanctioned supervision, while important to investigate, occurs rarely, with many boards sanctioning fewer than 10 licensees a year (W. Hegarty, personal communication, May 9th, 2014; W. Hegarty is deputy director of the Ohio Counselor, Social Worker and Marriage and Family Therapist Board). Because this population is small, qualitative methodology was a particularly useful approach (Hunt, 2010). Specifically, a single-case case study method was utilized to investigate how multiple participants had experienced sanctioned supervision (Yin, 2008). Qualitative inquiry provides a detailed account of a single area of focus and invites new understanding (Merriam, 1998). Though case-study research allows for flexibility in terms of methods of data collection and analysis (Merriam, 1998), for this study traditional interviewing and document analysis were used to collect data. Because the study investigated a specific event (serving as a sanctioned supervisor), the case study method is an appropriate approach (Patton, 2002).
Role of the Researcher
The role of the researchers and how they monitor preconceived assumptions are particularly important in qualitative research (Hays & Wood, 2011). The principal investigators (the research team) were a faculty member in a counselor education program, a clinical program director at a mental health agency, and a counseling graduate student completing her final year of training. The faculty member had also served on the state counseling board for six years and as its liaison for counselor ethics cases. The clinical program director and graduate student had no affiliation with the state counseling board or with ethics cases. The clinical program director conducted the interviews and the research team all independently reviewed the transcripts. Overall, the "experience, worldview and assumptions [of the research team] contributed to shaping the data" (Hunt, 2010, p. 70). The research team hypothesized that the sanctioned supervisors would have reactions and perceptions related to the experience of providing sanctioned supervision that were unique to that activity. As no members of the research team had such experience, they were uncertain as to what these reactions might be.
Qualitative researchers should engage in procedures that demonstrate trustworthiness (Creswell, 2007). To help the interviewer describe her immediate speculations, feelings, problems, hunches, impressions, and prejudices (see Bogdan & Biklen, 2006; Fassinger, 2005), she wrote up her process notes within 30 minutes after each interview. This contributed to a process referred to as bracketing researcher assumptions and expectations (Rennie, 1994). The research team also wrote process notes throughout the data analysis. Because the notes allowed members of the team to communicate their thoughts, feelings, and assumptions while reviewing the data, they helped facilitate their awareness of those thoughts and feelings throughout the data review process and also made the review process transparent.
Throughout the investigation, the research team also consulted a peer reviewer expert in supervision and qualitative research who was not affiliated with the study. The peer reviewer, the fourth author, provided feedback on the transcribed data, the analytic procedure, and the semi-structured interview protocols. This feedback was incorporated into the data analysis.
The interview questions were drafted based on a review of the literature and the primary investigator's experience working with sanctioned supervisors. They were modified from a larger list of questions synthesized by the research team. From the basic research question, several sub-questions were drafted, such as "What, if anything, could the board do to help support your work as a sanctioned supervisor?" and "What suggestions, if any, would you recommend to the board for improving the process of providing sanctioned supervision?" Based upon the responses in the first round of interviews, questions that explored the themes that emerged in greater detail were drafted for the second round of interviews.
Four counselors who had each provided supervision as part of a state regulatory-board remediation process were selected and then interviewed about those experiences. A counseling, social worker, and marriage and family therapist board in the Midwest volunteered to provide a list of licensees who had provided sanctioned supervision. Criteria for the study were that (a) the participant had provided supervision within the past year; (b) the supervisor was licensed as a counselor; and (c) the supervisee was licensed as a counselor. Since the researchers were interested in the experiences of supervisors of licensed counselors, supervisors holding other licenses (e.g., social work) were excluded. The researchers assumed that those who had supervised fairly recently, within the past year, would be better able to recollect their reactions to the experience. Although 21 individuals had provided sanctioned supervision for the board, most had supervised social workers. Thus, only four met the inclusion criteria. Use of this purposive sampling technique responds to the recommendation of Polkinghorne (2005) that participants in a qualitative study "are not selected because they fulfill the representative requirements of statistical inference but because they can provide substantial contributions to filling out the structure and character of the experience under investigation" (p. 139).
All four of the supervisors who were initially approached agreed to participate. Because the topic was sensitive, informed consent and other ethical guidelines were followed and demonstrated in the procedures for data collection and analysis, and the study received Institutional Review Board approval. The research team sought to ensure the anonymity of the participants and of their supervisees. The four participants (2 female, 2 male) were assigned pseudonyms. Table 1 summarizes their qualifications.
Data Collection and Analysis
Based on Yin's recommendation (2008) for data collection, multiple sources of data were used in an effort to increase the credibility of the results. There were two independent audio-recorded interviews with each participant, which thus involved direct interaction and engagement with the participants over the course of the study. The interviews were transcribed by a graduate student and analyzed independently by the research team to determine how the sanctioned supervisors perceived their experience.
A secondary means of data collection was review of archival records (notes, evaluations, and records of interaction as documented by the supervisor participants). Again as recommended by Yin (2008), the archival records were used as a way of corroborating and expanding interview data. The research team used an emic approach (Mathison, 1993) to data collection, reviewing interview transcripts and archival data and grouping similar ideas into themes. The themes represented a thick description that reflected participants' experiences with sanctioned supervision.
After independently analyzing the data, the research team met to discuss the findings. The team had recorded analytic notes and questions that surfaced during interviews and documentation review, lire analysis incorporated the feedback of the peer reviewer, whose independence of the study provided a validity check.
For the participants in this study, two major themes emerged: Greater Board-Generated Communication and Ethics-Related Considerations. Greater Board-Generated Communication was defined as the perception that the participants could have benefited from more board-initiated communication while serving as a sanctioned supervisor: all four participants expressed a wish for having had more feedback related to the sanctioned supervision process. They also had desired more clarity about the board's expectations of them (e.g., via manuals or other written expectations); more information about specifics of their roles as sanctioned supervisors; and more detail about the reason the licensee was sanctioned. They also expressed a belief that more frequent communication from a board representative would have been helpful.
Ethics-Related Considerations were defined as the perception that the participants had encountered a number of ethics-related issues specific to the experience of providing sanctioned supervision. They expressed concerns about the board allowing licensees to select their own supervisees (a dual-relationship issue) and about such fiduciary issues as accepting payment from supervisees. Participants unanimously expressed a desire for more training opportunities to enhance their competence in conducting sanctioned supervision.
All participants said they would have preferred more communication with the regulator)' board during the supervision process. They reported that none of them had a sound understanding of the nature of the supervisee's violation and believed this limited their ability to fully remediate supervisee deficiencies. They also stated that they sometimes felt alone and disconnected from the board. As Ron noted, "I felt I was completely out there on my own."
Regular communications. Enhanced communication was a topic that recurred with some frequency. Leslie expressed a desire for both additional communication with and more feedback from the board: "I just feel like you send in a report ... and even if you write something of concern, you really don't get much follow-through. It would have been helpful if the board sent out reminders of when the report was due. It would be helpful to have a form to fill out, instead of [the supervisor] making it up." Tammy characterized her relationship with the board as "indifferent." She explained: "I personally did not have a lot of contact with the board. I might have expected more one-to-one [communication] from them."
Participants also noted that it would be helpful for the board to provide follow-up communications about the long-term success of the sanctioned supervision. Tammy explained that she would have liked additional detail about the final result: "It may be my need for detail but something at the end saying that she had completed [the sanctioned supervision] successfully in their mind. I handed in [my evaluation] and did not hear anything back from them so I am sure it must have been okay, but I did not hear that it was." Leslie echoed Tammy's concerns: "The other piece that I do not understand is what if I give a bad report? I never know w hat happens to that? It is just kind of out there."
More information about the violation. Leslie conceptualized her disconnection from the board as it related to her understanding of the supervisee's violation: she did not feel clear about expectations and would have appreciated more guidance. She said, "I'm only hearing the person who's being sanctioned side of the story. So that's a little concerning to me. The other piece that's concerning to me is that there's no guidance given to me [from the regulatory board]."
Leslie would also have preferred to receive additional investigatory information: "If the person signs an agreement that I'm going to be their supervising counselor, then I think I should be entitled to a copy of the investigation file to be able to know what they know because what sometimes ends up on the public records site is just what they admitted to.... There may be other allegations in there that might be helpful for me to know that might also be a concern." Like Leslie, Tammy expressed concern that she did not receive any formal documentation from the board as it related to her supervisee's offenses: "I was dependent on what [the supervisee] told me. I did not get anything written from the board."
Better understanding of expectations. Participants also noted that they would have liked more guidance about the board's expectations or the goals of sanctioned supervision. Tom stated that he would have preferred for the board to make their expectations for remediation transparent: "I would have preferred to have the expectations for the end of this process. Just some long-term goals so I can say yes, we accomplished this." Ron said he was not clear on the exact process of sanctioned supervision: "I did not think that there was a model out there other than the standard training model that better specified how you might [remediate supervisee issues]," adding, "It would have been nice to have feedback." Tammy echoed Ron's statements; she would have liked "[Additional feedback from the board] so that I'm not just doing this for her but I am doing it the way the board wants it done." She specified, "It would have been nice to just have a general overview in hand of what is expected, how many weeks or how many hours, if there is ever a monetary charge. Just kind of a general overview of guidelines so that we're sure we are on track." Leslie echoed this concern: "The other piece that is concerning to me is 'you're going to supervise this person' but there is no guidance given to me."
Although Tom reported that he felt unclear about the expectations for his supervisee, he did not express dissatisfaction with communications from the board: "As we went along, I got feedback from [the Board] about what I wanted. I said is there anything else that you need and I felt the individual would at least communicate that to me if there were some other needs." He did note, however, that he felt there could have been additional information related to the final evaluation: "Maybe as you're approaching the end, there might be some discussion.... 'there are some things that we want to accomplish with X amount of time left and here is where we'd like to see the individual.'"
Participants also identified ethical issues inherent in their work with sanctioned supervisees. Specifically, they spoke of concerns about dual relationships, fiduciary issues, supervisees selecting their own supervisors, and their own training and competence for sanctioned supervision.
Dual relationships. Dual relationships were characterized in a number of ways. First, participants suggested that by working with the board, the supervisor had an obligation to someone other than the supervisee. Leslie explained her concerns about inadvertently violating supervisees' confidentiality: "I had a person who was supposed to be sanctioned and they just didn't show up. I'm not sure if I still file a consent to report because you know it's a liability issue for me." Leslie continued: "It would be a little easier if the board were saying: 'Here's a copy of the consent that they can't revoke.' So that's concerning, especially when the sanctioned supervision isn't going well."
In the present study, all participants became a sanctioned supervisor after being approached directly by the supervisee. In other words, the supervisee requested that the participant provide supervision of the remediation process. Participants had mixed feelings about supervisees being allowed to choose their own supervisors. According to Tammy: "There could be an issue that we had a previous relationship. I can see how it would be lovely to choose someone who you knew really wasn't going to hold you accountable. There is a power differential thing ... if you know the [supervisee] ahead of time or have some semi-regular connection with them." She also suggested that supervisees might choose as a supervisor someone who "could feel sorry for them" or "wouldn't really make them do what they need to do."
Leslie expressed similar concerns: "I don't like it. I would prefer if the board matched people based on the supervisor's competency and then as a part of the agreed upon entry they couldn't revoke consent [to the board]. My suggestion would be that there be approved people and that you could not have established relationships ahead of time." Tom explained: "The board should explore with the individual who is going to do supervision: 'What relationship do you have currently?' since we are looking at something very long-term. I suppose a relationship that precedes the supervision would be a concern." Ron concurred in the other participants' concerns: "I certainly agree. I think [the sanctioned supervisor] should be qualified. A pool [of sanctioned supervisors] would make it easier."
Leslie did think that it might be helpful to have a sanctioned supervisor who works with the supervisee because that person could have access to the supervisees' records, but she recognized the potential for problems: "Does it make sense that the supervisee is part of their employment or not? ... because there is a natural conflict there." Several participants also expressed concern that supervisees might select supervisors with whom they had a social or friendly relationship. Leslie thought that "You are going to tend to select a friend and so the hope may be the friend is going to be more lenient on you.... My suggestion would be that there are approved people and that you also could not have an established relationship ahead of time with that person."
Fiduciary issues. Fiduciary issues also represent a potential dual-relationship issue for supervisors; the decision whether to accept remuneration adds a significant dynamic to the sanctioned supervision process. All participants noted the difficulty associated with accepting payment for their supervisory services. Although only two of the four did accept payment, all four noted that they felt it was appropriate to be paid for their time. What was less clear, however, was whether accepting money from a supervisee constituted a dual relationship. Tammy explained: "I hated to ask her to pay me because I didn't really think it was a good thing."
Ron suggested that it would be helpful for the regulatory board to perhaps serve as an intermediary for payment: "Another thing that was an obstacle for me was the fact that it would have been great if the board was paying for this rather than the individual.... things really fell apart for my person in her financial life.... she never forgot to pay me on time, but it still felt a bit awkward at times." Leslie stated: "I think if your [supervisee] is paying for supervision it puts you in a dual relationship and that makes it difficult." Leslie agreed with Ron's thoughts on the board as intermediary: "In an ideal situation the easiest solution is when someone ends up in ethics violations they're hooked with a monetary sanction amount and that pool of money goes to pay for people to do supervision and it's the board paying them, not the supervisee. So then it's clear that the supervisee is not hiring you, the board is hiring you."
Neither Tom nor Leslie accepted payment for their sanctioned supervision. Tom reported that he had supervised an employee of his own agency so he did not expect compensation. However, he stated that he would "expect to be paid" if he had supervised someone outside his agency.
Although Tom did not require his supervisee to compensate him, he did note that he felt he should be paid for his time: "I have some extra costs associated with [sanctioned supervision]. Takes my time, takes my agency time." He explained: "I think it should be handled through a contract of some kind and should be spelled out very clearly how those issues are handled, late payments and so on." Tammy mentioned that the board should have some standard in place for issues related to payment: "It might be nice if there was some type of standard of how much [to charge for sanctioned supervision]. I do not do that much supervision and I didn't know what to charge."
Competence and training on sanctioned supervision. The last ethical concern was related to competence and proper training and orientation to the process of being a sanctioned supervisor. All participants felt it would be helpful to complete specific training in sanctioned supervision. Ron stated, "I never ran across anybody who's done sanctioned work.... It would have been nice to have other information. I would have loved to have had more guidance in terms of other people's experience." Leslie expressed a belief that "training and expectations" on sanctioned supervision were "pretty vague" and that "training around a proven effective method [of] supervising someone who had ethical violations" would be helpful. She added that "It would be helpful if the board came out with an approved list of sanctioned supervisors who went through at least a one-time training. I really think having a guidebook would be helpful." Ron agreed there should be "some training in the specific area [that the supervisee had violated]." "If the board inquired about background [in a] specific area and if there is anything that the [sanctioned supervisor lacked] they could provide that training." Tammy also noted that she would have preferred training specific to sanctioned supervision--"training specifically on that type of supervision. Because most of the trainings that are put out there for supervision really aren't specifically for [sanctioned supervision]."
In terms of training to become a sanctioned supervisor, Tom noted that an orientation would have been helpful for understanding "what the board is looking for, and what needs to be done by the end of the supervision process. Additional training, maybe a handbook, might be good; maybe that would accomplish the issue of orientation." However, in addition to training, Tom also explained that he felt the sanctioned supervisor needed to have clinical experience: "I think for the very relatively new supervisor to take on this task would be very difficult. So I think to me it is just a matter of experience." His colleagues also said that generic ethics training helped inform their work in providing sanctioned supervision, and additional ethics training would be helpful for everyone providing sanctioned supervision.
This research offers a unique perspective on what sanctioned supervisors believe the state regulatory board could do to enhance the supervision process. Participants who had served as sanctioned supervisors valued the process for the most part but had two major concerns: they desired (a) greater board-generated communication, and (b) clarification of ethics-related considerations.
Greater Hoard-Generated Communication
A major theme emerged from the belief of participants that they would benefit from more board-generated communication. All participants expressed a desire for more feedback related to the supervision process, more clarity about what the regulatory board expected, additional information about the supervisee's violation, and more frequent communication with the board about the case. Unfortunately, state regulatory' boards rarely formulate published guidelines that detail methods of oversight or expectations for the sanctioned supervision relationship (Walzer & Miltimore, 1993). Consistent with that finding, participants reported a general disconnect with the state board during the sanctioned supervision process, and one perceived the state regulatory' board as being "indifferent" to the supervision work. Given the lack of training in sanctioned supervision and the absence of clear expectations about the process, participants reported that they relied on their standard supervision model.
The participants believed that the lack of communication from the board about the nature of the violation reduced their ability to remediate the deficiencies because they had to rely on supervisee self-reports about why they were disciplined. As the process concluded, the participants would have also welcomed follow-up from the board about whether remediation of the supervisee was or was not successful (no future disciplinary actions) and feedback that the sanctioned supervision they provided was useful to the board.
Rapisarda and Britton (2007) found consensus among supervision experts that additional training was needed in the specific responsibilities of sanctioned supervisors and the legal and ethical issues they face. Beneficial initial training could cover (a) the consent agreement between the regulatory board and the supervisee; (b) objectives of the board for sanctioned supervision (e.g., length of process); (c) information that will be regularly requested during the process; (d) attitudes and behaviors of the supervisee during supervision that may need to be reported; (e) expectations for professionalism; (f) ethical conduct of the sanctioned supervisor (e.g., confidentiality, dual-role relationships); (g) duty to warn; (h) process for closing the supervision and making a final recommendation; (i) supervisor remuneration; and (j) opportunity for supervisors to ask additional questions (Walzer & Miltimore, 1993).
Board-generated communication throughout the process could then supplement the initial description of expectations (e.g., progress report forms sent every quarter to all supervisors). Unfortunately, state boards may have limited staff and resources (Walzer & Miltimore, 1993) to provide all the support supervisors desire. In any given state, counseling associations and supervising counselors who work together with the state boards may increase the likelihood of improving the process for sanctioned supervisors.
The second major theme emerging from this study related to participant concerns about ethics-related issues. They were concerned about allowing licensees to select their own supervisees, negotiating and collecting payment from a supervisee, and accepting an assignment as a sanctioned supervisor without believing they had had proper training to serve in that role. Since each of their supervisees had personally selected them to serve as sanctioned supervisor, they believed they had been placed in dual roles. Licensing agencies appear to work on the assumption that sanctioned supervision serves as a form of discipline as well as a means of protecting consumers from potentially harmful practices (Walzer & Miltimore, 1993). Some participants may have experienced conflict between their responsibilities to help remediate the supervisee while also reporting to the board on the specifics of supervisee performance. Since there is typically a shortage of professional counselors to serve as sanctioned supervisors, particularly in rural and small communities, supervisors and supervisees often know or know of each other, which may make it more difficult for the supervisor to be objective or the supervisee to be honest. A dual-role relationship may create an opportunity for a supervisor to align with the supervisee. This may cause particular problems if a sanctioned supervisor minimizes the seriousness of the offense.
Sanctioned supervisors were also dissatisfied with having to negotiate and collect payment from supervisees. To avoid future difficulties, participants encouraged the regulatory board to serve as an intermediary for payment. One participant chose not to charge the supervisee, but he expressed his opinion that he should have received some type of remuneration. One solution is to have sanctioned supervisors paid out of a state-wide fund (Rapisarda & Britton, 2007), rather than directly by the supervisee. As state funds are often limited, one option may be to generate revenue from the fine the licensee pays for committing the violation.
All participants stated that they believed it would have been helpful to have completed specific training or at least an orientation for a new sanctioned supervisor that could have addressed some unanswered ethical questions, such as: Is the sanctioned supervisor providing supervision for all the licensee's clinical cases? If so, does the supervisor have access to files and clinical information related to these cases? Is the supervisor supposed to monitor records? Can or should the supervisor have direct knowledge of supervisee clinical work (e.g., recordings, live observations of sessions)? Who is responsible for client welfare when one independently licensed professional is serving as sanctioned supervisor of another? What is the liability of the state regulatory board and the sanctioned supervisor to the clients of licensees? What does the state regulatory board recommend in terms of supervisor remuneration? Should all sanctioned supervision relationships have the same parameters, and be defined similarly?
Due to the lack of clarity and the ethical issues, counselors may decline to participate as sanctioned supervisors because of the possible liability associated with participating in the disciplining of another professional. However, there may be some protection for sanctioned supervisors: Walzer and Miltimore (1993) believed that individuals who "serve the public interest in disciplinary cases might be assured immunity from civil suit in connection with these 'peer review' or state agency activities (p. 582)."
Limitations and Implications for Future Research
The results of the present study must be interpreted in light of certain methodological considerations: (a) Because the study was intentionally limited to the experiences of four supervisors of sanctioned counselors in a single Midwest state the results cannot necessarily be applied to other sanctioned supervision settings, (b) Participants were asked to recount their own experiences of supervision, which were undoubtedly influenced by the supervisors' own perspectives on the process. The current study did not account for the experiences of the supervisee. As the researchers are also the instruments in a qualitative study, interaction of the researchers with the participants may have influenced the findings. This is not necessarily a limitation but it is a consideration in terms of understanding how the research team interpreted the results. Additionally, the findings were generated through participant self-reports. Since the participants were initially contacted by an individual who was connected to the state counseling regulatory board and they are licensed by that board, they may have felt the need to answer as they would like to be perceived by individuals associated with the board. This study could have been broadened to include current or former supervised licensees to gather their perspective on the sanctioned supervision process and their experience with the state board.
Additional research is needed to examine how effective supervision is for remediating the problem that resulted in the process. Researchers could work with state boards to explore longitudinal outcomes of professional counselors who received sanctioned supervision as part of their consent agreement to see if they committed additional violations in the years following the process. Although there is a broad consensus between professions about the benefits of supervision, no published studies demonstrate whether it is effective in reducing problematic behaviors (Cobia & Pipes, 2002). It may well be that sanctioned supervision is very effective in preventing legal and ethical violations but, without research, that it does is mere speculation on the part of state regulator)' boards. Finally, it is important to consider whether the sanctioned supervision process should be the same for professional counselors as it is for psychologists, social workers, and other mental health professionals. While all these professions are often governed by a single board, each profession receives different training, particularly in the practice of clinical supervision. Each profession also has a different code of ethics, which may or may not discourage certain types of behavior, and the different professional identities may shape how sanctioned supervision is conducted.
Implications for Regulation of Counseling
This study elicited the perspectives of sanctioned supervisors on their counseling board's process. It is important for boards to take an intentional approach to managing sanctioned supervision and monitoring. Since the supervisors in this study voiced some frustration about the process and significant concerns about ethical issues related to their involvement, counselors who serve on state regulatory boards should work to formalize the process. This may include a training manual or handbook, a sanctioned supervision workshop, and specific answers to ethical questions (e.g., guidelines on how payment should be handled) and general process questions (e.g., when reports will be due). State counseling associations can contribute to the quality of the supervision provided by working in concert with the state board to create online and in-person workshops and collaborate with licensing boards to address impaired counselors (Hazler & Kottler, 1996).
Due to the inherent ethical issues and challenges of the process, there may often be only a small group of individuals willing to serve in this role (Walzer & Miltimore, 1993). It would be beneficial for boards to find ways to assemble larger groups of available and qualified supervisors who would be willing to serve regularly. Rather than placing the burden of remediation only on a few clinical mental health counselors, associations (e.g., associations for mental health counselors, counselor educators, and supervisors) could also identify a larger group of professional counselors who could serve as sanctioned supervisors.
A state regulatory board could consider creating a supervision registry to expand the pool of supervisors and to formalize and provide structure to the process. Applications and recommendations could be solicited from state professional counseling associations. In collaboration, those associations and the state boards could outline specific qualifications for serving as a sanctioned supervisor (e.g., clinical and supervisory experience, license in good standing, membership in state and national counseling associations, professional liability' insurance, clean ethics record, completion of training in sanctioned supervision, and agreement to a memorandum of understanding about expectations for serving as a sanctioned supervisor). These could then provide an efficient method to connect individuals in need of supervision with recommended and trained individuals interested in supervising. State boards and state counseling associations should consider amending their statutes to provide guidance and protection for sanctioned supervisors. Walzer and Miltimore (1993) provided an example of model regulations that could be updated and individualized for the profession of counseling in a particular state.
This research examined the perceptions of sanctioned supervisors about their involvement with the state licensure board during the sanctioned supervision process. The findings reinforce the need for greater structure, especially with regard to communication, and clearer guidelines for dealing with ethical issues for sanctioned supervisors who agree to participate. Individuals who serve as sanctioned supervisors should make specific requests related to the challenges to their own regulatory board and state counseling associations. Supervisors can identify opportunities to work together to provide suggestions and support for improving the process for themselves and colleagues who serve as sanctioned supervisors. Hopefully, with increased attention and practical resources, the sanctioned supervision process can be enhanced and produce successful remediation of licensees.
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Victoria E. Kress and Jake J. Protivnak are affiliated with Youngstown State University, Rachel O'Neill with Walden University, and Nicole A. Stargell with the University of North Carolina at Pembroke. Correspondence about this article should be addressed to Victoria E. Kress, Department of Counseling Special Education, and School Psychology. Beeghley Hall, Youngstown State University, Youngstown, OH 44555. Email: victoriaEkress@gmail.com.
Table 1. Participant Demographics Years of Supervision Number of Sanctioned Participant Experience Supervisees Degree Ron 24 1 Master's Tom 16 1 Master's Tammy 12 1 Master's Leslie 10 2 Master's
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|Author:||Kress, Victoria E.; O'Neill, Rachel M.; Protivnak, Jake J.; Stargell, Nicole A.|
|Publication:||Journal of Mental Health Counseling|
|Date:||Apr 1, 2015|
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